Sexually

Transmitted

Disease

Surveillance

2011

Division of STD Prevention

December 2012

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 2011

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 that provided surveillance data to CDC.

This report was prepared by the following CDC staff: 

Damarys Cordova, Elaine Flagg, Sarah Kidd, Robert Kirkcaldy, Eloisa Llata, Mark Stenger, John Su, Elizabeth 

Torrone, Hillard Weinstock, and Susan Bradley, Jim Braxton, Delicia Carey, Darlene Davis, LaZetta Grier, Alesia 

Harvey, Kathleen Hutchins, Rob Nelson, and Fred Rivers, the Epidemiology and Surveillance Branch and the 

Statistics and Data Management Branch, respectively, of the Division of STD Prevention, National Center for 

HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
STD Surveillance 2011 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 2011. Atlanta: U.S. 

Department of Health and Human Services; 2012.

Web Site

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

Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 1993–2011

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

STD Data in the NCHHSTP Atlas

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

STD Data on Wonder

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

STD Data Management & Information Technology

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

STD Fact Sheets

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

STD Treatment Guidelines

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

STD Program Evaluation Guidelines

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

STD Program Operation Guidelines

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

Recommendations for Public Health Surveillance of Syphilis in the United States

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

Behavioral Surveillance

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

National Survey of Family Growth

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

STD Surveillance 2011 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 communitybased interventions that are effective and can be 

implemented immediately. That is why a multifaceted 

approach is necessary at both the individual and 

community levels.

To successfully prevent STDs, many stakeholders 

need to redefine their mission, refocus their efforts, 

modify how they deliver services, and accept new 

responsibilities. In this process, strong leadership, 

innovative thinking, partnerships, and adequate 

resources will be required. The additional investment 

required to effectively prevent STDs may be 

considerable, but it is negligible when compared with 

the likely return on the investment. The process of 

preventing STDs must be a collaborative one. No one 

agency, organization, or sector can effectively do it 

alone; all members of the community must do their 

part. A successful national initiative to confront and 

prevent STDs requires widespread public awareness 

and participation and bold national leadership from 

the highest levels.”1

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

Washington (DC): National Academy Press; 1997. p. 43.
vi STD Surveillance 2011

Preface

Sexually Transmitted Disease Surveillance 2011 presents 

statistics and trends for sexually transmitted diseases 

(STDs) in the United States through 2011. 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 2011. 

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 positivity and 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 2011 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 2011 vii

Guide to Acronyms

CDC Centers for Disease Control and Prevention

CSF cerebrospinal fluid

DSTDP Division of STD Prevention

GISP Gonococcal Isolate Surveillance Project 

HEDIS Healthcare Effectiveness Data and Information Set

HHS U.S. Department of Health and Human Services

HMOs health maintenance organizations

HIV human immunodeficiency virus

HP2020 Healthy People 2020 

HPV human papillomavirus

HSV herpes simplex virus

MICs minimum inhibitory concentrations

MPC mucopurulent cervicitis 

MSA metropolitan statistical area

MSM men who have sex with men

MSW men who have sex with women only

NAATs nucleic acid amplification tests

NDTI National Disease and Therapeutic Index

NGU nongonococcal urethritis

NHANES National Health and Nutrition Examination Survey

NHDS National Hospital Discharge Survey

NJTP National Job Training Program

OMB Office of Management and Budget

P&S primary and secondary

PID pelvic inflammatory disease

QRNG quinolone-resistant Neisseria gonorrhoeae

RPR rapid plasma reagin

SSuN STD surveillance network 

STD sexually transmitted disease

VDRL Venereal Disease Research Laboratory

STD Surveillance 2011 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), 2011.................................................................1

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

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

Gonorrhea .............................................................................................................................................19

Syphilis..................................................................................................................................................35

Other Sexually Transmitted Diseases......................................................................................................47

Special Focus Profiles...........................................................................................................................55

STDs in Women and Infants.................................................................................................................57

STDs in Adolescents and Young Adults.................................................................................................65

STDs in Racial and Ethnic Minorities...................................................................................................71

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

STDs in Persons Entering Corrections Facilities ....................................................................................85

Tables

National Summary ................................................................................................................................89

Chlamydia.............................................................................................................................................91

Gonorrhea ...........................................................................................................................................103

Syphilis................................................................................................................................................114

Chancroid ...........................................................................................................................................135

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

Appendix

Interpreting STD Surveillance Data.....................................................................................................137

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

Selected Variables by State and by Nationally Notifiable STD, 2011 .............................. 144

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2011 .................. 145

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives....................... 146

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

Diseases Goals, Measures, and Target ............................................................................. 147

STD Surveillance Case Definitions......................................................................................................148

Contributors........................................................................................................................................156
x STD Surveillance 2011

Figures in the National Profile

Chlamydia

Figure 1. Chlamydia—Rates by Sex, United States, 1991–2011...................................................... 10

Figure 2. Chlamydia—Rates by Region, United States, 2002–2011................................................ 10

Figure 3. Chlamydia—Rates by State, United States and Outlying Areas, 2011 .............................. 11

Figure 4. Chlamydia—Rates by County, United States, 2011 ......................................................... 11

Figure 5. Chlamydia—Rates by Age and Sex, United States, 2011 .................................................. 12

Figure 6. Chlamydia—Rates by Race/Ethnicity, United States, 2002–2011 .................................... 12

Figure 7. Chlamydia—Cases by Reporting Source and Sex, United States, 2002–2011................... 13

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

Sources, United States, 2011 ............................................................................................ 13

Figure 9. Chlamydia—Proprotion of Sexually Transmitted Disease (STD) Clinic Patients Testing 

Positive by Age, Sex, and Sexual Behavior, STD Surveillance Network (SSuN), 2011 ...... 14

Figure 10. Chlamydia—Prevalence Among Persons Aged 14-39 Years by Sex and Survey Cycle, 

National Health and Nutrition Examination Survey, 1999-2008...................................... 14

Figure 11. Chlamydia—Prevalence Among Persons Aged 14-39 Years by Sex, Race/Ethnicity, 

or Age Group, National Health and Nutrition Examination Survey, 2005-2008.. ............ 15

Figure 12. Chlamydia—Median State-specific Positivity Rates Among Women 

Aged 15-24 Years Tested in Family Planning Clinics, Infertility Prevention 

Project, United States, 1997-2011.................................................................................... 15

Figure 13. Chlamydia—Positivity Among Women Aged 15-24 Years Tested In Family 

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

and Outlying Areas, 2011 ................................................................................................ 16

Figure 14. 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, 2007-2011...................... 16

Figure 15. 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, 2007-2011 ............... 17

Gonorrhea

Figure 16. Gonorrhea—Rates, United States, 1941–2011................................................................. 24

Figure 17. Gonorrhea—Rates by Sex, United States, 1991–2011...................................................... 24

Figure 18. Gonorrhea—Rates by Region, United States, 2002–2011 ................................................ 25

Figure 19. Gonorrhea—Rates by State, United States and Outlying Areas, 2011 .............................. 25

Figure 20. Gonorrhea—Rates by County, United States, 2011 ......................................................... 26

Figure 21. Gonorrhea—Rates by Age and Sex, United States, 2011 .................................................. 26

Figure 22. Gonorrhea—Rates by Age Among Women Aged 15–44 Years, 

United States, 2002–2011................................................................................................ 27

Figure 23. Gonorrhea—Rates by Age Among Men Aged 15–44 Years, 

United States, 2002–2011................................................................................................ 27

Figure 24. Gonorrhea—Rates by Race/Ethnicity, United States, 2002–2011 .................................... 28

Figure 25. Gonorrhea—Cases by Reporting Source and Sex, United States, 2002–2011................... 28

Figure 26. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting 

Sources, United States, 2011 ............................................................................................ 29

Figure 27. Proportion of MSM, MSW, and Women Among Interviewed Gonorrhea Cases by Site, 

STD Surveillance Network (SSuN), 2011 ........................................................................ 29
STD Surveillance 2011 xi

Figure 28. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family

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

Outlying Areas, 2011 ....................................................................................................... 30

Figure 29. Location of Participating Sentinel Sites and Regional Laboratories, 

Gonococcal Isolate Surveillance Project (GISP) United States, 2011 ................................ 30

Figure 30. Distribution of Minimum Inhibitory Concentrations (MICs) to Ceftriaxone 

Among Neisseria gonorrhoeae Isolates, Gonococcal Isolate Surveillance 

Project (GISP), 2007–2011.............................................................................................. 31

Figure 31. Distribution of Minimum Inhibitory Concentrations (MICs) to Cefixime

 Among Neisseria gonorrhoeae Isolates, Gonococcal Isolate 

Surveillance Project (GISP) 2009–2011 ........................................................................... 31

Figure 32. Distribution of Minimum Inhibitory Concentrations (MICs) of Azithromycin 

Among Neisseria gonorrhoeae Isolates, Gonococcal Isolate 

Surveillance Project (GISP) 2007–2011 ........................................................................... 32

Figure 33. Percentage of Neisseria gonorrhoeae Isolates that are Cirpofloxacin-Resistant by 

Sex of Sex Partner, Gonococcal Isolate Surveillance Project (GISP) 1995–2011 ............... 32

Figure 34. Penicillin, Tetracycline, and Ciprofloxacin Resistance Among Neisseria 

gonorrhoeae Isolates, Gonococcal Isolate Surveillance Project (GISP), 2011 ...................... 33

Figure 35. Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, Gonococcal 

Isolate Surveillance Project (GISP)—1988–2011 ............................................................. 33

Syphilis

Figure 36. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2011..................... 39

Figure 37. Primary and Secondary Syphilis—by Sex and Sexual Behavior, 33 Areas

2007–2011....................................................................................................................... 39

Figure 38. Primary and Secondary Syphilis —Rates by Sex and Male-to-Female 

Rate Ratios, United States, 1990-2011............................................................................. 40

Figure 39. Primary and Secondary Syphilis—Rates by Region, United States, 2002–2011................ 40

Figure 40. Primary and Secondary Syphilis—Rates by State, United States and 

Outlying Areas, 2011 ....................................................................................................... 41

Figure 41. Primary and Secondary Syphilis—Rates by County, United States, 2011 ......................... 41

Figure 42. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2011 ................. 42

Figure 43. Primary and Secondary Syphilis—Rates by Age Among Women Aged 15–44 Years, 

United States, 2002–2011................................................................................................ 42

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

United States, 2002–2011................................................................................................ 43

Figure 45. Primary and Secondary Syphilis—Rates by Race/Ethnicity, 

United States, 2002–2011................................................................................................ 43

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

Sexual Behavior, United States, 2011................................................................................ 44

Figure 47. Primary and Secondary Syphilis—Reported Cases by Sex, Sexual Behavior, 

and Race/Ethnicity, United States, 2011........................................................................... 44

Figure 48. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex, 

United States, 2002–2011................................................................................................ 45
xii STD Surveillance 2011

Figure 49. Primary and Secondary Syphilis—Percentage of Reported Cases by Sex, 

Sexual Behavior, and Selected Reporting Sources, 2011.................................................... 45

Figure 50. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates 

of Primary and Secondary Syphilis Among Women, United States, 2002–2011 .............. 46

Other Sexually Transmitted Diseases

Figure 51. Chancroid—Reported Cases, United States, 1981–2011.................................................. 49

Figure 52. Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among 

Females Aged 14–59 Years, National Health and Nutrition

Examination Survey, 2003–2006...................................................................................... 49

Figure 53. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2011................ 50

Figure 54. Genital Warts—Prevalence Among Sexually Transmitted Disease (STD) Clinic Patients by 

Sex, Sex of Partners, and Site, STD Surveillance Network (SSuN), 2011.......................... 50

Figure 55. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2011 ............. 51

Figure 56. 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.......................... 52

Figure 57. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to

Physicians’ Offices, United States, 1966–2011 ................................................................. 53
STD Surveillance 2011 xiii

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia—Women—Rates by State, United States and Outlying Areas, 2011 ............. 60

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

by State, Infertility Prevention Project, United States and Outlying Areas, 2011 ............ 60

Figure C. Gonorrhea—Women—Rates by State, United States and Outlying Areas, 2011 .............. 61

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

by State, Infertility Prevention Project, United States and Outlying Areas, 2011 ............ 61

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

Outlying Areas, 2011 ....................................................................................................... 62

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

United States and Outlying Areas, 2011........................................................................... 62

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

United States, 2001–2010................................................................................................ 63

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

Aged 15–44 Years, United States, 2002–2011 .................................................................. 63

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

United States, 2001–2010................................................................................................ 64

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, 2007–2011 .................................. 67

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, 2011........................................................................... 67

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, 2011........................................................................... 68

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, 2011........................................................................... 68

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, 2011........................................................................... 69

STDs in Racial and Ethnic Minorities

Figure O. Chlamydia—Rates by Race/Ethnicity and Sex, United States, 2011................................. 75

Figure P. Gonorrhea—Rate Ratios by Race/Ethnicity, United States, 2002–2011........................... 75

Figure Q. Gonorrhea—Rates by Race/Ethnicity and Sex, United States, 2011 ................................. 76

Figure R. Gonorrhea—Rate Ratios by Race/Ethnicity and Region, United States, 2011.................. 76

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

United States, 2011.......................................................................................................... 77

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

Ethnicity, United States, 2002–2011................................................................................ 77

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

by Race/Ethnicity, United States, 2002–2011................................................................... 78
xiv STD Surveillance 2011

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

Race/Ethnicity, United States, 2002–2011 ....................................................................... 78

STDs in Men Who Have Sex with Men

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

for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2011 ...................... 82

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

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

STD Surveillance Network (SSuN), 2011 ........................................................................ 82

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

Gonorrhea or Chlamydia by HIV Status, STD Surveillance Network (SSuN), 2011........ 83

Figure Z. Percentage of Urethral Neisseria gonorrhoeae Isolates Obtained From MSM Attending 

STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 1990–2011 ...................... 83

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

STD Clinics, by Site, Gonococcal Isolate Surveillance Project (GISP), 2008–2011.......... 84

STDs in Persons Entering Corrections Facilities

Figure BB. Chlamydia—Positivity by Age and Sex, Juvenile Corrections Facilities, 2011................... 87

Figure CC. Chlamydia—Positivity by Age and Sex, Adult Corrections Facilities, 2011....................... 87

Figure DD. Gonorrhea—Positivity by Age and Sex, Juvenile Corrections Facilities, 2011 ................... 88

Figure EE. Gonorrhea—Positivity by Age and Sex, Adult Corrections Facilities, 2011....................... 88
STD Surveillance 2011 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,1941–2011.......................................... 89

Chlamydia

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

United States, 2011.......................................................................................................... 91

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

Alphabetical Order, United States and Outlying Areas, 2007–2011 ................................. 92

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

Region in Alphabetical Order, United States and Outlying Areas, 2007–2011 ................. 93

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

in Alphabetical Order, United States and Outlying Areas, 2007–2011 ............................. 94

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

Areas (MSAs) in Alphabetical Order, United States, 2007–2011 ...................................... 95

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2007–2011 ...................... 96

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2007–2011 ...................... 97

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

Cities Ranked by Number of Reported Cases, United States, 2011 .................................. 98

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

Group and Sex, United States, 2007–2011....................................................................... 99

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

United States, 2007–2011.............................................................................................. 100

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

and Sex, United States, 2007–2011................................................................................ 101

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

United States, 2007–2011.............................................................................................. 102

Gonorrhea

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

United States, 2011........................................................................................................ 103

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

Alphabetical Order, United States and Outlying Areas, 2007–2011 ............................... 104

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

in Alphabetical Order, United States and Outlying Areas, 2007–2011 ........................... 105

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

in Alphabetical Order, United States and Outlying Areas, 2007–2011 ........................... 106

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

Areas (MSAs) in Alphabetical Order, United States, 2007–2011 .................................... 107

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2007–2011 .................... 108

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2007–2011 .................... 109
xvi STD Surveillance 2011

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

Ranked by Number of Reported Cases, United States, 2011 .......................................... 110

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

by Age Group and Sex, United States, 2007–2011 ......................................................... 111

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

United States, 2007–2011.............................................................................................. 112

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

and Sex, United States, 2007–2011................................................................................ 113

Syphilis

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

in Alphabetical Order, United States and Outlying Areas, 2007–2011 ........................... 114

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2007–2011 .................... 115

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

Ranked by Rates, United States, 2011 ............................................................................ 116

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

and Region in Alphabetical Order, United States and Outlying Areas, 2007–2011......... 117

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

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

Outlying Areas, 2007–2011 ........................................................................................... 118

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

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

Outlying Areas, 2007–2011 ........................................................................................... 119

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United 

States, 2007–2011.......................................................................................................... 120

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

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2007–2011.............................................................................................. 121

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

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2007–2011.............................................................................................. 122

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

Independent Cities Ranked by Number of Reported Cases, United States, 2011............ 123

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 2011, United States, 2010–2011 .................... 124

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

Population by Age Group and Sex, United States, 2007–2011 ....................................... 125

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

Age Group, and Sex, United States, 2007–2011............................................................. 126

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

Race/Ethnicity, Age Group, and Sex, United States, 2007–2011 .................................... 127

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

in Alphabetical Order, United States and Outlying Areas, 2007–2011 ........................... 128

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2007–2011 .................... 129
STD Surveillance 2011 xvii

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

Region in Alphabetical Order, United States and Outlying Areas, 2007–2011 .............. 130

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2007–2011 .................... 131

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

by State, Ranked by Rates, United States, 2011.............................................................. 132

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, 2007–2011 ........................................................................................... 133

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

Race/Ethnicity of Mother, United States, 2007–2011 .................................................... 134

Chancroid

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

United States and Outlying Areas, 2007–2011............................................................... 135

Selected STDs

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

National Disease and Therapeutic Index, United States, 1966–2011 .............................. 136

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, 2011 .............................. 144

Table A2. Reported Cases of STDs by Reporting Source and Sex: United States, 2011 ................. 145

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives....................... 146

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

Diseases Goals, Measures, and Target ............................................................................. 147

STD Surveillance 2011 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 2011 Overview 1

National Overview of Sexually 

Transmitted Diseases (STDs), 2011

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 2011 on the three notifiable diseases for which 

there are federally funded control programs: chlamydia, 

gonorrhea, and syphilis. Several observations for 2011 

are worthy of note.

Chlamydia

In 2011, a total of 1,412,791 cases of 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 457.6 cases per 100,000 population, an increase 

of 8.0% compared with the rate in 2010. 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 

2011 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 2011, the overall rate of chlamydial infection in 

the United States among women (648.9 cases per 

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

rate among men (256.9 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 2007–2011, 

the chlamydia rate in men increased 36.2%, compared 

with a 20.2% increase in women during this period. 

Rates also varied among different racial and ethnic 

minority populations. For example, in 2011, the 

chlamydia rate in blacks was over seven times the rate 

in whites.

Data from multiple sources on the positivity and 

prevalence of chlamydial infection in defined 

populations have been useful in monitoring disease 

burden and guiding chlamydia screening programs.

In 2011, the median state-specific chlamydia test 

positivity was 8.3% (range: 3.8% to 15.9%) 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 

13 and 14).

At selected prenatal clinics in 15 states, Puerto Rico, 

and the Virgin Islands, the median state-specific 

chlamydia positivity among women aged 15–24 years 

was 7.7% (range: 2.8% to 16.3%) (Figure B).
2 Overview STD Surveillance 2011

The prevalence of infection was greater among young 

economically disadvantaged women aged 16–24 

years who entered the National Job Training Program 

(NJTP) in 2011 in 46 states, the District of Columbia, 

and Puerto Rico. The median state-specific prevalence 

was 10.3% (range: 4.1% to 18.7%) (Figure K). Among 

men entering the program in 2011 in 48 states, the 

District of Columbia, and Puerto Rico, the median 

state-specific chlamydia prevalence was 8.0% (range: 

2.7% to 13.0%) (Figure L).

Among adolescent females aged 12–18 years entering 

selected juvenile corrections facilities, overall chlamydia 

positivity was 15.7%. Among adolescent males of the 

same age entering selected juvenile corrections facilities, 

overall chlamydia positivity was 7.4% (Figure BB).

Gonorrhea

Following a 74% decline in the rate of reported 

gonorrhea during 1975–1997, overall gonorrhea rates 

plateaued for 10 years; it decreased during 2006–2009 

to the lowest rate since national reporting began and 

then increased 2.1% between 2009 and 2010. In 

2011 there was another 4.0% increase with a total of 

321,849 cases of gonorrhea reported in the United 

States, corresponding to a rate of 104.2 cases per 

100,000 population (Figure 16, Table 1). 

In 2011, as in previous years, the South had the highest 

gonorrhea rate among the four regions of the country 

(Table 14). While rates in 2011 increased in all four 

regions, the rate in the South remained more than 

twice the rate in the West (Figure 18).

During 1997–2006, gonorrhea rates in men and women 

were similar. Recently, the rates in women have been 

somewhat higher than rates in men (Figure 17). In 

2011, the gonorrhea rate in women was 108.9 cases 

per 100,000 population compared with a rate of 98.7 

in men. 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 

21). In 2011, the gonorrhea rate in blacks was 17 times 

the rate in whites. As with chlamydia, data on gonorrhea 

prevalence in defined populations were available from 

several sources in 2011. These data showed a continuing 

high burden of disease in some adolescents and young 

adults in parts of the United States.

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea. With 

increased resistance to the fluoroquinolones and the 

declining susceptibility of cefixime, dual therapy with 

ceftriaxone and either azithromycin or doxycycline 

is now the only CDC recommended treatment for 

gonorrhea.2

 Continued monitoring of susceptibility 

patterns to these antibiotics is critical. No isolates 

with decreased susceptibility to ceftriaxone were seen 

in 2011 in CDC’s sentinel surveillance system, the 

Gonococcal Isolate Surveillance Project (GISP).

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 2006.3

 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; in 2011 this rate 

remained unchanged. Between 2010 and 2011, the 

rate decreased 9.1% in women but increased slightly, 

3.8%, in men. In 2011, a total of 13,970 cases of P&S 

syphilis were reported to CDC, approximately 200 

more than were reported in 2010. Approximately 72% 

of cases were in MSM. 

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 360 cases 

reported in 2011, a 19% 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 2011, 

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

rate among whites, which is substantially lower than 

the disparity observed in 1999, when the rate among 

blacks was 24 times the rate among whites. In some 

subgroups, however, these disparities remain much 

higher. The 2011 rate among black men aged 15–19 
STD Surveillance 2011 Overview 3

years was 16 times the rate for white men of that age. 

The 2011, rate for black women aged 15–19 years was 

30 times the rate for white women of the same age.

While efforts to eliminate syphilis have focused on 

racial and ethnic minority populations, the syphilis 

rates among all MSM have continued to increase since 

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. Update to CDC’s 

sexually transmitted diseases treatment guidelines, 2010. 

Oral cephalosporins no longer a recommended treatment for 

gonococcal infection. CDC’s MMWR Morb Mortal Wkly Rep. 

2012;61(31):590-594.

3 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. 

4 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.

5 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.

2001, especially among young MSM.4,5 Although some 

decreases were observed this year among blacks, 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.

NATIONAL PROFILE
NATIONAL PROFILE
STD Surveillance 2011 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 2011 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 annual chlamydia screening.4

The Healthcare Effectiveness Data and Information 

Set (HEDIS) contains a measure which assesses 

chlamydia screening coverage of sexually active young 

women who receive medical care through commercial 

or Medicaid managed care organizations.5 Among 

sexually-active women aged 16-24 years in commercial 

plans, chlamydia screening increased from 23.1% in 

2001 to 43.1% in 2010. During the same time period, 

the screening rate among sexually-active women aged 

16-24 years covered by Medicaid increased from 

40.4% to 57.5%.6 Although chlamydia screening is 

expanding, many women who are at risk are still not 

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

among some health care providers and the limited 

resources available to support these screenings.

The increase in reported chlamydial infections 

during the last 20 years reflects the expansion of 

chlamydia screening activities, the use of increasingly 

sensitive diagnostic tests, an increased emphasis on 

case reporting from providers and laboratories, and 

improvements in the information systems used for 

reporting. To supplement case report data, chlamydia 

positivity and prevalence among people screened in a 

variety of settings are monitored. 

Chlamydia—United States

In 2011, a total of 1,412,791 chlamydial infections 

were reported to CDC in 50 states and the District of 

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

rate of 457.6 cases per 100,000 population, which is 

an increase of 8.0% compared with the rate of 423.6 

in 2010. During 1991–2011, the rate of reported 

chlamydial infection increased from 179.7 to 457.6 

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

Chlamydia by Region

During 2002–2011, chlamydia rates increased in all 

regions (Figure 2). In 2011, rates were highest in the 

South (505.3 per 100,000 population), followed by the 

Midwest (445.7), the West (424.9), and the Northeast 

(415.8) (Table 3). 

Chlamydia by State

In 2011, chlamydia rates by state ranged from 228.6 

cases per 100,000 population in New Hampshire to 

808.0 cases in Alaska (Figure 3, Table 2). 

Chlamydia by Metropolitan 

Statistical Area 

In 2011, the chlamydia rate per 100,000 population 

in the 50 most populous metropolitan statistical 

areas (MSAs) increased (Table 6). In 2011, 57.2% 

of chlamydia cases were reported by these MSAs. 

Among women, the 2011 rate of 674.8 cases per 

100,000 females was a 6.2% increase over the 2010 

rate of 635.2 cases per 100,000 females (Table 7). 

Among men, the 2011 rate (287.6 per 100,000 males) 

increased 10.1% from the 2010 rate (261.3 cases per 

100,000 males) (Table 8). 
8 National Profile: Chlamydia STD Surveillance 2011

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 2011, 877 (27.9%) of 3,142 

counties had rates higher than 400.0 cases per 100,000 

population. Seventy counties and independent cities 

reported 44% of all chlamydia cases in 2011 (Table 9). 

Chlamydia by Sex

In 2011, the overall rate of reported chlamydial 

infection among women in all 50 states and the 

District of Columbia (648.9 cases per 100,000 

females) was over two and a half times the rate among 

men (256.9 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 2007–2011, the reported chlamydial infection 

rate among men increased 36.2% (from 188.6 to 

256.9 cases per 100,000 males) compared with a 

20.2% increase among women during the same period 

(from 539.8 to 648.9 cases per 100,000 females).

Chlamydia by Age

Among women, the highest age-specific rates of 

reported chlamydia in 2011 were among those aged 

15–19 years (3,416.5 cases per 100,000 females) and 

20–24 years (3,722.5 cases per 100,000 females) 

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

reported rates were highest among women aged 

18 years (4,760.0 cases per 100,000 females), aged 

19 years (5,012.4 cases per 100,000 females), and 

aged 20 years (4,883.2 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 (1,343.3 cases 

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

Chlamydia by Race/Ethnicity

In 2011, chlamydia rates were highest among black 

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

chlamydia among blacks was more than seven times 

the rate among whites (1,194.4 and 159.0 cases per 

100,000 population, respectively). The rate among 

American Indians/Alaska Natives (648.3 cases per 

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

rate among Hispanics (383.6 cases per 100,000) was 

2.4 times the rate among whites. 

During 2007–2011, rates among blacks increased 

17.6% (from 1,015.7 to 1,194.4 cases per 100,000). 

Among whites, rates increased 34.6% (from 118.1 to 

159.0 cases per 100,000). 

Chlamydia by Reporting Source

 Most chlamydia cases reported in 2011 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 2011, 

among women, only 7.7% of chlamydia cases were 

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

among women were reported from private physicians/

health maintenance organizations (HMOs) (37.7%). 

Among men, 23.6% of chlamydia cases were reported 

from an STD clinic in 2011 and 26.4% were reported 

from private physicians/HMOs.

Chlamydia Prevalence in the 

Population

The National Health and Nutrition Examination 

Survey (NHANES) is a nationally representative survey 

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

aged 14–39 years that provides an important measure 

of chlamydia disease burden. From 1999–2000 to 

2007–08, there was an estimated 40% reduction (95% 

Confidence Interval [CI]: 8%, 61%) in prevalence 

among persons aged 14–39 years (Figure 10).7 During 

2005–2008, the overall prevalence of chlamydia among 

persons aged 14–39 years was 1.5% (95% CI: 1.2%, 

1.9%). Prevalence was highest among non-Hispanic 

blacks (5.9%, 95% CI: 4.5%, 7.7%) (Figure 11). 

Chlamydia Positivity in Selected 

Populations

Chlamydia screening and monitoring activities have 

been conducted in all ten U.S. Department of Health 

and Human Services (HHS) regions since 1995. In 

some regions, federal funds may support local- and 

state-funded screening programs. Screening criteria and 
STD Surveillance 2011 National Profile: Chlamydia 9

practices vary by region and state. See Definitions of 

HHS Regions in the Appendix for details. 

In 2011, 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, Puerto Rico, and the Virgin Islands was 

8.3% (range: 3.8% to 15.9%) (Figures 12 and 13). 

Chlamydia test positivity among women aged 15–24 

years screened in family planning clinics increased in 

most HHS regions during 2007–2011 (Figure 14). 

The positivity trend data in Figure 12 and Figure 14 

are not adjusted for changes in laboratory test methods 

and associated increases in test sensitivity. Use of 

NAATs in family planning clinics to screen women 

aged 15–24 years for chlamydia has increased over 

time, with all ten HHS regions using NAATs nearly 

exclusively in 2011 (Figure 15). Additionally, positivity 

trends are influenced by changes in the population 

of women accessing care,8

 clinic screening criteria, 

and clinic participation in the screening program. In 

a regression analysis accounting for individual-level 

and clinic-level factors, chlamydia positivity among 

women aged 14–25 years who were screened in family 

planning clinics remained stable from 2004–2008.9

In 2005, the STD Surveillance Network (SSuN) was 

established to improve the capacity of national, state, and 

local STD programs to detect, monitor, and respond to 

trends in STDs. In 2011, a total of 42 STD clinics at 

12 sites collected enhanced behavioral information on 

patients who presented for care to these clinics. More 

detailed information about SSuN methodology can be 

found in the STD Surveillance Network section of the 

Appendix, Interpreting STD Surveillance Data.

In 2011, the proportion of STD clinic patients testing 

positive for chlamydia varied by age, sex, and sexual 

behavior. Adolescent men who have sex with women 

(MSW) had the highest prevalence (34.8%). Among 

MSW and women, prevalence among those tested 

decreased with age. The variation in prevalence by age 

was not as pronounced for men who have sex with 

men (MSM) (Figure 9). 

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; reported case rates and 

prevalence estimates among blacks continue to be 

substantially higher than 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 2013: technical 

specifications. Washington (DC): National Committee for Quality 

Assurance; 2012. p. 90-93. 

6 National Committee for Quality Assurance. The state of healthcare 

quality 2011. Washington (DC): National Committee for Quality 

Assurance; 2011. p. 77-78.

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

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

in the United States among persons 14 to 39 years of age, 1999-2008. 

Sex Transm Dis. 2012 Feb;39(2):92-6.

8 Miller WC. Epidemiology of chlamydial infection: are we losing 

ground? Sex Transm Infect. 2008 Apr;84(2):82-6.

9 Satterwhite CL, Grier L, Patzer R, Weinstock H, Howards PP, 

Kleinbaum D. Chlamydia positivity trends among women attending 

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

2011 Nov;38(11):989-94.
10 National Profile: Chlamydia STD Surveillance 2011

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

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

Year

 0

150

300

450

600

750

1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011

Rate (per 100,000 population)

Men

Women

Total

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

 0

120

240

360

480

600

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 2. Chlamydia—Rates by Region, United States, 2002–2011

Figure 1. Chlamydia—Rates by Sex, United States, 1991–2011

Note: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases
STD Surveillance 2011 National Profile: Chlamydia 11

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.

Rate per 100,000

population

Guam 592 

Puerto Rico 151 

<=300.0

300.1-400.0

>400.0

(n= 8)

(n= 15)

(n= 31)

VT 237

NH 229

MA 348

RI 394

CT 382

NJ 298

DE 502

MD 471

DC 1094

620

808

458 551

448 434

404

562

441

300

506 429

351

372 383

697

233

502

319

715

466

344

371 389

552

530

575

364

456

389

356

416

626

419

490

497

256

454

346

232

433

371

Virgin Islands 747 

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

Rate per 100,000

population

<=300.0 (n= 1,837)

300.1-400.0 (n= 428)

>400.0 (n= 877)

Figure 4. Chlamydia—Rates by County, United States, 2011 

Figure 3. Chlamydia—Rates by State, United States and Outlying Areas, 2011

Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 454.1 per 100,000 population. For

more information on chlamydia reporting, see Chlamydia Morbidity Reporting in the Appendix.
12 National Profile: Chlamydia STD Surveillance 2011

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

Men Rate (per 100,000 population) Women

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

16.5 10-14 134.6

803.0 15-19 3416.5

1343.3 20-24 3722.5

689.7 25-29 1343.6

349.8 30-34 567.6

168.4 35-39 233.9

100.6 40-44 105.9

44.8 45-54 35.8

13.1 55-64 10.1

3.3 65+ 2.1

256.9 Total 648.9

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

 0

 300

 600

 900

1200

1500

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

American Indians/Alaska Natives

Asians/Pacific Islanders

Blacks

Hispanics

Whites

Figure 6. Chlamydia—Rates by Race/Ethnicity, United States 2002–2011

Figure 5. Chlamydia—Rates by Age and Sex, United States, 2011
STD Surveillance 2011 National Profile: Chlamydia 13

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

 0

 200

 400

 600

 800

1,000

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

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.

Percentage

Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

 0

 10

 20

 30

 40

Men Women

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

United States, 2011 

Figure 7. Chlamydia—Cases by Reporting Source and Sex, United States, 2002–2011

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

Note: These categories represent 70.2% of cases with a known reporting source. Of all cases, 11.2% had a missing or unknown reporting source
14 National Profile: Chlamydia STD Surveillance 2011

Figure 10. Chlamydia—Prevalence Among Persons Aged 14–39 Years by Sex and Survey Cycle, 

National Health and Nutrition Examination Survey, 1999–2008

Figure 9. Chlamydia—Proportion of Sexually Transmitted Disease (STD) Clinic Patients Testing 

Positive by Age, Sex, and Sexual Behavior, STD Surveillance Network (SSuN), 2011

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

Source: Datta SD, Torrone E, Kruszon-Moran D, Berman S, Johnson R, Satterwhite CL, Papp J, Weinstock H. Chlamydia trachomatis trends in the United 

States among persons 14 to 39 years of age, 1999–2008. Sex Transm Dis. 2012 Feb;39(2):92–6.

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

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.

 0

 1

 2

 3

 4

 5

Year

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008

Prevalence, %

Men

Women

Total

Figure 9.

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.

Percentage

Age

MSM*

MSW*

Women

0

10

20

30

40

<=19 20-24 25-29 30-39 >=40
STD Surveillance 2011 National Profile: Chlamydia 15

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

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.

 0

 2

 4

 6

 8

 10

Year

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Median State-Specific Positivity Rate (%)

Figure 11.

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.

Prevalence, %

0

2

4

6

8

Overall Men

 Sex

Women NonHispanic

Whites

NonHispanic

Blacks

Race/Ethnicity

Mexican

Americans

14-25

 Age

26-39 Men

14-25

Age and Sex

Women

14-25

Figure 12. Chlamydia—Median State-specific Positivity Rates Among Women Aged 15–24 Years 

Tested in Family Planning Clinics, Infertility Prevention Project, United States, 1997–2011

Figure 11. Chlamydia—Prevalence Among Persons Aged 14–39 Years by Sex, Race/Ethnicity, or Age 

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

Note: Error bars indicate 95% confidence intervals

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 Definition of HHS Regions in the Appendix for definitions.
16 National Profile: Chlamydia STD Surveillance 2011

* 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 14.

Region I

Region II

Region III

Region IV

Region V

Region VII Region VI

Region VIII

Region IX

Region X

4.8

07

5.2

08

5.1

09

5.8

10

6.4

11

5.9

07

6.2

08

6.5

09

7.0

10

7.9

11

5.5

07

6.3

08

6.4

09

7.4

10

7.7

11

9.6

07

9.6

08

9.4

09

9.4

10

9.9

11

7.6

07

7.6

08

7.9

09

8.9

10

9.6

11

8.8

07

10.2

08

10.6

09

11.3

10

12.0

11

6.5

07

6.8

08

7.6

09

7.7

10

7.9

11

7.3

07

7.8

08

7.6

09

8.3

10

8.4

11

7.3

07

7.5

08

8.3

09

5.5

10

5.8

11

5.8

07

6.0

08

6.0

09

6.6

10

7.1

11

IV

VII IX

I II

X

III

VI

V

VIII

Figure 13.

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

Positivity, %

Puerto Rico 7.6 

Virgin Islands 15.9 

*

<5.0

5.0-9.9

>=10.0

(n= 1)

(n= 2)

(n= 39)

(n= 11)

VT 3.8

NH 5.7

MA 6.0

RI 9.7

CT 4.7

NJ 9.5

DE 9.8

MD 8.3

DC

10.3

7.2

8.6 11.3

5.2 8.9

8.9

11.1

8.5

6.6

9.5 9.7

7.5

7.4 6.1

13.4

6.0

8.2

7.6

14.3

8.8

6.6

8.0 8.6

10.2

6.9

9.3

7.3

10.1

8.4

6.6

7.8

12.2

8.6

6.6

14.1

9.4

8.1

8.0

5.0

11.2

7.7

Figure 14. 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, 2007–2011

Figure 13. Chlamydia—Positivity Among Women Aged 15–24 Years Tested in Family Planning 

Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2011

* States/areas reported chlamydia positivity data on fewer than 500 women aged 15–24 years in 2011.

Note: See Definition of HHS Regions in the Appendix for definitions
STD Surveillance 2011 National Profile: Chlamydia 17

Figure 15.

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

Region I

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region II

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region III

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region IV

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region V

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region VI

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region VII

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region VIII

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region IX

Percentage

0

20

40

60

80

100

07 08 09 10 11

Region X

Percentage

0

20

40

60

80

100

07 08 09 10 11

Figure 15. 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, 2007–2011

Note: Excludes tests where test type is not specified or otherwise unavailable. See Definition of HHS Regions in the Appendix for definitions

STD Surveillance 2011 National Profile: Gonorrhea 19

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 socioeconomic status, may contribute to 

the burden of gonorrhea in a community.2

During 1975–1997, the national gonorrhea rate 

declined 74% after implementation of the national 

gonorrhea control program in the mid-1970s 

(Figure 16). After the decline halted for several years, 

gonorrhea rates decreased further to 98.1 cases per 

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

since recording of gonorrhea rates began. The rate 

increased slightly in 2010 to 100.2 and increased again 

in 2011 to 104.2 per 100,000 population, with a total 

of 321,849 cases reported in the United States in 2011 

(Figure 16 and Table 1). 

The increase in gonorrhea rates during 2010–2011 was 

observed among both men and women (Figure 17), 

among all racial/ethnic groups (Figure 24), and in all 

regions of the United States (Figure 18). 

Although gonorrhea case reporting is useful for 

monitoring disease trends, the number of gonorrhea 

cases reported to CDC is affected by many factors 

in addition to the actual occurrence of the infection 

within the population. Changes in the burden of 

gonorrhea may be masked by changes in screening 

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

also detect N. gonorrhoeae infections and broader 

use of nucleic acid amplification tests [NAATs] at 

non-genital anatomic sites), the use of diagnostic 

tests with different test performance, and changes in 

reporting practices. As with other STDs, the reporting 

of gonorrhea cases to CDC is incomplete.3

 For these 

reasons, supplemental data on gonorrhea prevalence 

in persons screened in a variety of settings are useful in 

assessing the burden of disease in selected populations. 

Neisseria gonorrhoeae has progressively developed 

resistance to each of the antibiotics used for treatment 

of gonorrhea. In the last decade, the development 

of fluoroquinolone resistance has resulted in the 

availability of only a single class of antibiotics that meet 

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

recently, declining susceptibility to cefixime resulted 

in a change in the CDC treatment guidelines, so that 

dual therapy with ceftriaxone and either azithromycin 

or doxycycline is now the only CDC-recommended 

treatment regimen for gonorrhea.6 The emerging 

threat of cephalosporin resistance highlights the need 

for continued surveillance of N. gonorrhoeae antibiotic 

susceptibility. 

The combination of persistently high gonorrhea 

morbidity in some populations and threat of 

cephalosporin-resistant gonorrhea reinforces the need 

to better understand the epidemiology of gonorrhea. 

Gonorrhea—United States

In 2011, a total of 321,849 cases of gonorrhea were 

reported in the United States, yielding a rate of 104.2 

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

increased 4.0% since 2010; however, the rate decreased 

11.7% overall during 2007–2011.

Gonorrhea by Region

In 2011, as in previous years, the South had the highest 

gonorrhea rate (135.5 cases per 100,000 population) 

among the four regions of the United States, followed 

by the Midwest (111.2), Northeast (85.8), and West 

(62.2) (Table 14). During 2010–2011, rates increased 

10.9% in the Northeast, 6.5% in the West, 2.7% in the 

Midwest, and 2.1% in the South (Figure 18, Table 14). 

Gonorrhea by State

In 2011, gonorrhea rates per 100,000 population 

ranged by state from 7.7 in Vermont to 202.3 in 

Louisiana (Figure 19, Table 13). During 2010–2011, 

61% (31/51) of states, plus the District of Columbia, 

reported an increase in gonorrhea rates (Table 14).
20 National Profile: Gonorrhea STD Surveillance 2011

Gonorrhea by Metropolitan 

Statistical Area (MSA)

The overall gonorrhea rate in the 50 most populous 

MSAs was 117.9 cases per 100,000 population in 

2011 (Table 17), representing a 3.3% rate increase 

from 2010 (114.1). In 2011, 60.8% of gonorrhea 

cases were reported by these MSAs (Table 17). The 

total gonorrhea rate among women in these MSAs in 

2011 (115.6) was similar to rates among men (119.9) 

(Tables 18 and 19).

Gonorrhea by County

In 2011, 53% of reported gonorrhea cases occurred 

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

In 2011, 1,299 counties (41.3%) in the United States 

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

population (Figure 20). Rates ranged from 19.1 to 100 

per 100,000 population in 1,198 counties (38.1%) 

and more than 100 cases per 100,000 population in 

645 counties (20.5%). Most counties with more than 

100 cases per 100,000 population were located in the 

South. 

Gonorrhea by Sex

Gonorrhea rates among women have been higher 

than those among men since 2002 (Figure 17). 

During 2010–2011, the gonorrhea rate among 

women increased 3.1%, to 108.9 cases per 100,000 

population, and the rate among men increased 5.1%, 

to 98.7 per 100,000 population, (Tables 15 and 16).

Gonorrhea by Age

In 2011, gonorrhea rates were highest among 

adolescents and young adults. In 2011, the highest 

rates were observed among women aged 20–24 years 

(584.2) and 15–19 years (556.5). Among men, the 

rate was highest among those aged 20–24 years (450.6) 

(Figure 21, Table 21). 

In 2011, persons aged 15–44 years accounted for 

94.6% of reported gonorrhea cases with known age. 

During 2010–2011, gonorrhea rates increased among 

most age groups within this age range: the gonorrhea 

rate increased 5.8% among those aged 20–24 years, 

4.6% among those aged 25–29 years, 6.9% among 

those aged 30–34 years, 2.5% among those aged 

35–39 years, and 4.7% among those aged 40–44 years 

(Table 21). The gonorrhea rate decreased 0.1% among 

those aged 15–19 years.

Among women aged 15–44, the largest increase was 

among those aged 40–44 years (8.4%) (Figure 22). 

Among men aged 15–44, the largest increase was 

among those aged 30–34 years (8.4%) (Figure 23). 

Gonorrhea by Race/Ethnicity 

In 2011, gonorrhea rates remained highest among 

blacks (427.3 cases per 100,000 population) (Figure 

24). The rate among blacks was 17.0 times the rate 

among whites (25.2 per 100,000 population). The 

gonorrhea rate among American Indians/Alaska 

Natives (115.7) was 4.6 times that of whites, and the 

rate among Hispanics (53.8) was 2.1 times that of 

whites (Figure 24, Figure P).

During 2010–2011, gonorrhea rates increased among 

Hispanics (12.3%), whites (7.7%), American Indians/

Alaska Natives (7.7%), Asian/Pacific Islanders (4.9%), 

and blacks (0.3%) (Figure 24).

More information on gonorrhea rates among racial/

ethnicity groups can be found in the Special Focus 

Profiles.

Gonorrhea by Region and Sex

During 2010–2011, gonorrhea rates among women 

and among men increased in all four regions of the 

United States: the Northeast, Midwest, South, and West 

(Tables 15 and 16). In 2011, women (145.4) and men 

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

Gonorrhea by Race/Ethnicity and Sex

Gonorrhea rates were higher in women than men 

among whites and American Indians/Alaska Natives in 

2011 (Figure Q). Gonorrhea rates were highest among 

black men (428.3) and black women (425.4) and 

American Indian/Alaska Native women (145.3) and 

American Indian/Alaska Native men (84.4). 

Among blacks, Hispanics, and Asians/Pacific Islanders, 

rates were higher in women than men among persons 

aged 15–24, but were higher in men than women 

among those aged 25 years and older (Table 22B). 

Among whites, women had higher rates than men 

among persons aged 15–29 years; men had higher rates 

than women among those aged 30 years and older. 

Among American Indians/Alaska Natives, women 

had higher rates than men among persons aged 15–44 

years, but men had higher rates than women among 

those aged 45 years and older.
STD Surveillance 2011 National Profile: Gonorrhea 21

Gonorrhea by Reporting Source

The number of gonorrhea cases reported by STD 

clinics declined during 2002–2011 (Figure 25). In 

2011, 18.6% of gonorrhea cases with known reporting 

source were reported by STD clinics (Table A2). This is 

a decrease from 2010, when 21.5% of gonorrhea cases 

were reported by STD clinics. In 2011, among women, 

private physicians or HMOs (29.7%) were the most 

common reporting source, followed by STD clinics 

(11.7%), family planning clinics (10.4%), other health 

department clinics (8.0%), and emergency rooms 

(5.4%) (Figure 26). Among men, STD clinics were 

the most common reporting source (26.4%) (Figure 

26). Other common reporting sources for males were 

private physicians/HMOs (21.5%), other health 

department clinics (9.3%), emergency rooms (5.4%), 

and family planning clinics (5.2%) (Figure 26). 

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 2011, 

SSuN collaborators interviewed 4,540 gonorrhea 

cases representing 6.7% 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 

27). San Francisco County had the highest proportion 

of estimated MSM cases (83.0%), while the lowest 

proportion of morbidity estimated to be attributed to 

MSM was found in Jefferson County (Birmingham), 

Alabama at 4.8%. Across all SSuN jurisdictions in 2011, 

21.6% of gonorrhea cases were estimated to be among 

MSM, 31.0% among MSW, and 47.4% among women. 

Positivity in Selected Populations

Positivity data from gonorrhea tests are primarily 

available from family planning clinics. Screening 

criteria and practices vary by state and over time.

In 2011, the median state-specific gonorrhea test 

positivity among women aged 15–24 years screened 

in selected family planning clinics in 48 states, Puerto 

Rico, and the Virgin Islands was 0.7% (range: 0.0% to 

3.5%) (Figure 28). 

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 

N. gonorrhoeae strains in the United States.10 Data are 

collected from selected STD clinic sentinel sites and 

from regional laboratories (Figure 29).

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 2011 GISP data can be found at http://www.

cdc.gov/std/GISP.

Susceptibility to Ceftriaxone

Susceptibility testing for ceftriaxone began in 1987. 

Figure 30 displays the distribution of ceftriaxone 

minimum inhibitory concentrations (MICs) among 

GISP isolates during 2007–2011. During 2010–2011, 

the proportion of isolates with MICs of 0.125 μg/ml 

increased slightly from 0.3% in 2010 to 0.4% in 2011. 

The proportion of isolates with MICs of 0.25 μg/ml 

decreased slightly from 0.05% in 2010 to 0.02% (n = 

1) in 2011.

No isolates with decreased susceptibility to ceftriaxone 

(MIC ≥ 0.5 μg/ml) were seen in 2011. 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. 
22 National Profile: Gonorrhea STD Surveillance 2011

Susceptibility to Cefixime

Susceptibility testing for cefixime began in 1992, was 

discontinued in 2007, and was restarted in 2009. The 

percentage of isolates with cefixime MICs of 0.125 μg/

ml increased each year, from 1.4% in 2009 to 1.7% 

in 2011 (Figure 31). The percentage of isolates with 

cefixime MICs of 0.25 μg/ml increased from 0.7% in 

2009 to 1.3% in 2011.The proportion with decreased 

susceptibility to cefixime (MIC=0.5 μg/ml) decreased 

from 0.2% in 2010 to 0.05% in 2011.

Since 2000, GISP has reported 23 isolates with 

decreased susceptibility to cefixime (MICs of 0.5 μg/

ml). Three isolates with decreased susceptibility to 

cefixime were reported in 2011 and were collected 

in the South (Baltimore, Maryland), Midwest 

(Minneapolis, Minnesota) and West (Phoenix, 

Arizona). Unlike 2010, during which 89% of isolates 

with decreased susceptibility to cefixime were collected 

from MSM, two of the three isolates with decreased 

susceptibility to cefixime collected in 2011 were from 

men who have sex exclusively with women (MSW).

Susceptibility to Cefpodoxime

GISP began monitoring cefpodoxime susceptibility in 

2009. Of 5,467 GISP isolates tested for cefpodoxime 

susceptibility in 2011, 1.1% had MICs of 0.5 μg/ml, 

1.3% had MICs of 1 μg/ml, and 0.2% had MICs of 2 

μg/ml. 

Susceptibility to Azithromycin

Susceptibility testing for azithromycin began in 1992. 

Figure 32 displays the distribution of azithromycin 

MICs among GISP isolates during 2007–2011. The 

proportion of GISP isolates with azithromycin MICs 

of ≥ 2.0 μg/ml decreased from 0.5% in 2010 to 0.3% 

in 2011. In 2011, 5 (0.1%) isolates had azithromycin 

MICs of 8.0 μg/ml, and 1 (0.02%) isolate had an MIC 

of 16.0 μg/ml. Of these 6 isolates with MICs 8–16 μg/

ml, 5 (83.3%) were from the West and 5 were from 

MSM.

Susceptibility to Spectinomycin

All isolates were susceptible to spectinomycin in 2011. 

GISP has identified 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%. The overall proportion 

decreased to 9.6% by 2009, and increased to 13.3% in 

2011.

The prevalence of QRNG in isolates from MSM 

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

by 2009 (Figure 33). In 2011, 26.0% of isolates from 

MSM were identified as QRNG. The prevalence of 

QRNG in isolates from MSW peaked at 8.7% in 

2007, decreased to 6.0% in 2009, and increased to 

8.0% in 2011.

Other Antimicrobial Susceptibility Testing

In 2011, 30.4% of isolates collected from GISP sites 

were resistant to penicillin, tetracycline, ciprofloxacin, 

or some combination of those antimicrobials (Figure 

34). Although these antimicrobials are no longer 

recommended for treatment of gonorrhea, the 

resistance phenotypes remain common. 
STD Surveillance 2011 National Profile: Gonorrhea 23

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to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

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

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

M, et al. Are neighborhood sociocultural factors influencing the 

spatial pattern of gonorrhea in North Carolina? Ann Epidemiol 

2011; 21:245-252.

3 American Social Health Association. Sexually transmitted diseases 

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

Kaiser Family Foundation; 1998.

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

sexually transmitted diseases treatment guidelines, 2006: 

fluoroquinolones no longer recommended for treatment of 

gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2007;56:332-6.

5 Centers for Disease Control and Prevention. Sexually transmitted 

diseases treatment guidelines, 2010. MMWR Recomm Rep. 

2010;59(No.RR-12).

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

sexually transmitted diseases treatment guidelines, 2010: 

Oral cephalosporins no longer a recommended treatment 

for gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2012;61(31):590-594.

7 Centers for Disease Control and Prevention. Neisseria 

gonorrhoeae with reduced susceptibility to azithromycin — San 

Diego County, California, 2009. MMWR Morb Mortal Wkly 

Rep. 2011;60:579-81.

8 Centers for Disease Control and Prevention. Cephalosporin 

susceptibility among Neisseria gonorrhoeae isolates — United 

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

2011;60:873-7.

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

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

196-204.

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

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

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

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 35. The 

proportion of GISP patients treated with ceftriaxone 

250 mg increased from 37.4% in 2010 to 84.0% in 

2011. The proportion treated with ceftriaxone 125 mg 

decreased from 46.9% in 2010 to 4.8% in 2011, and 

the proportion treated with cefixime decreased from 

7.8% in 2010 to 5.3% in 2011. 

In 2011, 0.3% of GISP patients were treated with 

fluoroquinolones (ciprofloxacin, ofloxacin, or 

levofloxacin) and 2.3% were treated with azithromycin 

2 gram monotherapy. 

Among patients treated with ceftriaxone 250 

mg or cefixime 400 mg, 84.6% were also treated 

with azithromycin, 14.9% were also treated with 

doxycycline, 0.04% were treated with another 

antimicrobial, and 0.5% did not receive a second 

antimicrobial.

Gonorrhea Among Special Populations

More information about gonorrhea in racial/ethnic 

groups, women of reproductive age, adolescents, 

MSM, and other populations at higher risk can be 

found in the Special Focus Profiles.

Gonorrhea Summary

The national gonorrhea rate fluctuated at about 

115–120 cases per 100,000 population for 10 years 

during 1996–2006, decreased during 2006–2009, and 

increased during 2009–2011. High rates persist in 

some geographic areas, among adolescents and young 

adults, and in some racial/ethnic groups.

The GISP continues to monitor for the emergence 

of decreased susceptibility and resistance to 

cephalosporins and azithromycin.
24 National Profile: Gonorrhea STD Surveillance 2011

Figure 16.

 0

100

200

300

400

500

Year

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

Rate (per 100,000 population)

Figure 17.

 0

 70

140

210

280

350

Year

1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011

Rate (per 100,000 population)

Men

Women

Total

Figure 17. Gonorrhea—Rates by Sex, United States, 1991–2011

Figure 16. Gonorrhea—Rates, United States, 1941–2011
STD Surveillance 2011 National Profile: Gonorrhea 25

Figure 19.

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.

Rate per 100,000

population

Guam 53.1 

Puerto Rico 9.2 

Virgin Islands 126.7 

<=19.0

19.1-100.0

>100.0

(n= 7)

(n= 24)

(n= 23)

VT 7.7

NH 9.9

MA 35.9

RI 34.2

CT 68.5

NJ 83.6

DE 92.1

MD 111.9

DC 426.9

191.1

138.5

71.4 160.7

73.9 47.0

104.7

169.6

50.4

10.3

132.8 101.3

63.0

77.4 104.2

202.3

20.5

130.5

43.1

195.9

130.3

8.6

74.0 74.1

89.3

106.9

183.0

37.3

145.0

112.4

38.9

108.4

180.5

73.9

120.8

123.0

10.0

81.5

40.7

43.0

84.2

8.2

Figure 18.

 0

 60

120

180

240

300

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 19. Gonorrhea—Rates by State, United States and Outlying areas, 2011

Figure 18. Gonorrhea—Rates by Region, United States, 2002–2011

Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 103.1 per 100,000 population
26 National Profile: Gonorrhea STD Surveillance 2011

Figure 21.

Men Rate (per 100,000 population) Women

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

5.2 26.2 10-14

248.6 556.5 15-19

450.6 584.2 20-24

266.0 237.2 25-29

160.5 110.8 30-34

89.3 50.3 35-39

66.9 25.8 40-44

37.1 9.7 45-54

12.9 2.5 55-64

2.8 0.4 65+

98.7 108.9 Total

Figure 20.

Rate per 100,000

population

<=19.0 (n= 1,299)

19.1-100.0 (n= 1,198)

>100.0 (n= 645)

Figure 21. Gonorrhea—Rates by Age and Sex, United States, 2011

Figure 20. Gonorrhea—Rates by County, United States, 2011
STD Surveillance 2011 National Profile: Gonorrhea 27

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

2001–2010

 0

 150

 300

 450

 600

 750

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population) Age Group

15-19 30-34

20-24 35-39

25-29 40-44

Figure 22.

 0

 200

 400

 600

 800

1,000

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population) Age Group

15-19 30-34

20-24 35-39

25-29 40-44

Figure 23. Gonorrhea—Rates by Age Among Men Aged 15–44 Years, United States, 2002–2011

Figure 22. Gonorrhea—Rates by Age Among Women Aged 15–44 Years, United States, 2002–2011
28 National Profile: Gonorrhea STD Surveillance 2011

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

 0

 120

 240

 360

 480

 600

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

American Indians/Alaska Natives

Asians/Pacific Islanders

Blacks

Hispanics

Whites

Figure 25.

 0

 40

 80

120

160

200

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 25. Gonorrhea—Cases by Reporting Source and Sex, United States, 2002–2011

Figure 24. Gonorrhea—Rates by Race/Ethnicity, United States, 2002–2011
STD Surveillance 2011 National Profile: Gonorrhea 29

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.

Percentage

Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

 0

 10

 20

 30

 40

Men Women

Figure 27.

* 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.

Percentage

MSM*

MSW*

Women

 0

 20

 40

 60

 80

100

San Francisco California‡

Washington

Colorado ChicagoLouisiana AlabamaVirginia BaltimorePhiladelphia New

York City Connecticut

Figure 27. Proportion MSM*, MSW*, and Women Among Interviewed† Gonorrhea Cases by Site, 

STD Surveillance Network (SSuN), 2011

Figure 26. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting Sources, 

United States, 2011

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

Note: These categories represent 66.5% of cases with known reporting source. Of all cases, 11.7% had a missing or unknown reporting source

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

† SSuN interviews conducted in a randomly selected sample of the patient population with gonorrhea (n= 4,540).

‡ California data excludes San Francisco.

Note: See Appendix for included jurisdictions within each state
30 National Profile: Gonorrhea STD Surveillance 2011

Figure 29.

Sentinel Sites

Sites and 

Regional Labs

 Birmingham Phoenix

 Los Angeles

 Orange Co.

 San Diego

 San Francisco Denver

 Miami

 Atlanta

 Honolulu

 Tripler AMC

 Chicago

 New Orleans

 Baltimore

 Detroit Minneapolis

 Kansas City

 Las Vegas

 Albuquerque

 New York City

 Greensboro

 Cincinnati

 Cleveland

 Oklahoma City

 Portland

 Philadelphia

 Austin

 Dallas

 Richmond

 Seattle

Figure 28.

* 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.

Positivity, %

Puerto Rico 0.1 

Virgin Islands 2.0 

*

<1.0

1.0-1.9

>=2.0

(n= 3)

(n= 29)

(n= 12)

(n= 9)

VT 0.1

NH 0.3

MA 0.3

RI 0.5

CT 0.3

NJ 2.2

DE 1.1

MD 1.0

DC

1.7

0.2

0.6 1.9

0.5 0.4

1.2

2.0

0.2

1.6 1.5

0.7

0.5 0.6

2.3

0.2

1.1

0.3

2.4

0.9

0.5 0.8

0.5

1.2

1.6

0.4

2.3

1.0

0.1

1.2

2.1

0.5

0.7

2.4

0.7

0.9

0.3

0.3

3.5

0.0

Figure 29. Location of Participating Sentinel Sites and Regional Laboratories, Gonococcal Isolate 

Surveillance Project (GISP), United States, 2011

Figure 28. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family Planning 

Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2011

* States/areas had incomplete data or reported gonorrhea positivity data on fewer than 500 women aged 15–24 years in 2011.

NOTE: The Austin site is a regional laboratory only.
STD Surveillance 2011 National Profile: Gonorrhea 31

Figure 31.

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

Percentage

MICs (μg/ml)

2009

2010

2011

 0

 20

 40

 60

 80

 100

<=0.015 0.03 0.06 0.125 0.25 0.5

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

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

Percentage

MICs (μg/ml)

2007

2008

2009

2010

2011

 0

 20

 40

 60

 80

 100

<=0.008 0.015 0.03 0.06 0.125 0.25

Figure 31. Distribution of Minimum Inhibitory Concentrations (MICs) of Cefixime Among Neisseria 

gonorrhoeae Isolates, Gonococcal Isolate Surveillance Project (GISP), 2009–2011

Figure 30. Distribution of Minimum Inhibitory Concentrations (MICs) of Ceftriaxone Among Neisseria 

gonorrhoeae Isolates, Gonococcal Isolate Surveillance Project (GISP), 2007–2011

Note: Isolates were not tested for cefixime susceptibility in 2007 and 2008
32 National Profile: Gonorrhea STD Surveillance 2011

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

gonorrhoeae Isolates with Resistance or Intermediate Resistance to

Ciprofloxacin, 1990–2010

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.

Percentage

MSM*

MSW*

 0

 10

 20

 30

 40

 50

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Figure 32.

Percentage

MICs (μg/ml)

2007

2008

2009

2010

2011

 0

 12

 24

 36

 48

 60

<=0.03 0.06 0.125 0.25 0.5 1 248 16

Figure 33. Percentage of Neisseria gonorrhoeae Isolates that are Ciprofloxacin-Resistant by Sex of 

Sex Partner, Gonococcal Isolate Surveillance Project (GISP), 1995–2011

Figure 32. Distribution of Minimum Inhibitory Concentrations (MICs) of Azithromycin Among 

Neisseria gonorrhoeae Isolates, Gonococcal Isolate Surveillance Project (GISP), 2007–2011

* MSM = men who have sex with men; MSW = men who have sex exclusively with women.
STD Surveillance 2011 National Profile: Gonorrhea 33

Figure 35.

0

20

40

60

80

100

Year

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Other Cephalosporins

Ceftriaxone 125 mg Spectinomycin

Ceftriaxone 250 mg Cefixime

Penicillins

Ciprofloxacin

Tetracyclines

Ofloxacin

Other

Percentage

PenR/QRNG

PenR

TetR/QRNG

PenR/TetR

QRNG

PenR/TetR/QRNG

TetR

Susceptible

Figure 34.

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. 

69.6%

11.4%

5.8%

3.5%

1.9%

3.6%

3.8%

0.3%

Figure 35. Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, Gonococcal Isolate 

Surveillance Project (GISP), 1988–2011

Figure 34. Penicillin, Tetracycline, and Ciprofloxacin Resistance Among Neisseria gonorrhoeae

isolates, Gonococcal Isolate Surveillance Project (GISP), 2011

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. 

Note: For 2011, “Other” includes no therapy (1.2%), azithromycin 2g (2.3%), and other less frequently used drugs.

STD Surveillance 2011 National Profile: Syphilis 35

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 36). 

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. The 2011 rate remained unchanged. Overall 

increases in rates were observed primarily among men 

(increasing from 3.0 cases per 100,000 population in 

2001 to 8.2 cases in 2011). 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 and 1.0 cases per 100,000 

population in 2011.

Syphilis remains a major health problem with increases 

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

Cases among MSM have been characterized by 

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

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

cases attributable to MSM increased from 7% in 2000 

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

state health departments report the sex of sex partners 

for persons with syphilis. Of reported male cases with 

P&S syphilis, sex of sex partner information in 2011 

was available for 83%. In 2011, 72% of P&S syphilis 

cases in 46 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 2010–2011, the number of cases of early 

latent syphilis reported to CDC decreased 3.4% (from 

13,604 cases to 13,136), and the number of cases 

of late and late latent syphilis increased 2.7% (from 

18,079 cases to 18,576) (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 0.4% (from 45,844 cases to 46,042) during 

2010–2011 (Table 1).

P&S Syphilis—United States

P&S syphilis cases reported to CDC increased from 

13,774 in 2010 to 13,970 in 2011, an increase of 

1.4%. The rate of P&S syphilis in the United States 

in 2011 (4.5 cases per 100,000 population) remained 

unchanged from the rate in 2010 (Figure 36, Table 1). 

P&S Syphilis by Region

The South accounted for 44.1% of P&S syphilis cases 

in 2011 and 45.5% in 2010. During 2010–2011, rates 

decreased 1.8% in the South (from 5.5 to 5.4 cases per 

100,000 population), 5.0% in the Northeast (from 4.0 

to 3.8 cases), and 5.9% in the Midwest (from 3.4 to 

3.2 cases), and increased 14.0% in the West (from 4.3 

to 4.9 cases) (Figure 40, Table 26).

P&S Syphilis by State

In 2011, the 15 states and areas (including the District 

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

accounted for 71% of all U.S. cases of P&S syphilis. 

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

areas (including the District of Columbia) exceeded the 

national rate of 4.5 cases per 100,000 population; 10 

of these 15 states and areas (including the District of 

Columbia) were in the South (Figure 40, Table 25). 
36 National Profile: Syphilis STD Surveillance 2011

P&S Syphilis by Metropolitan 

Statistical Area 

The rate of P&S syphilis in 2011 for the 50 most 

populous MSAs (6.4 cases per 100,000 population) 

(Table 29) exceeded the overall rate for the United 

States (4.5 cases) (Table 26). The rate increased in 27 of 

these 50 MSAs (54%) during 2010–2011. 

P&S Syphilis by County

In 2011, 2,154 of 3,142 counties (68.5%) in the 

United States reported no cases of P&S syphilis, 

compared with 2,167 counties (69.0%) in 2010 

(Figure 41). In 2011, half of the total number of P&S 

syphilis cases was reported from 26 counties and two 

cities (Table 32).

P&S Syphilis by Sex

The rate of P&S syphilis increased 3.8% among men 

(from 7.9 to 8.2 cases per 100,000 men) during 2010–

2011 (Figure 38, Table 28). During this same period, 

the rate decreased 9.1% among women (from 1.1 to 

1.0 cases per 100,000 women) (Figure 38, Table 27).

P&S Syphilis by Age

In 2011, the rate of P&S syphilis was highest among 

persons aged 20–24 years and 25–29 years (13.8 and 

12.1 cases per 100,000 population, respectively) 

(Table 34).

Rates were highest among men 20–29 years, increasing 

5.9% (from 22.1 to 23.4 cases) among men 20–24 

years and 7.0% (from 20.0 to 21.4 cases) among men 

25–29 years during 2011 (Figures 42 and 44, Table 

34). This marks the fourth consecutive year that rates 

of P&S syphilis among men have been highest among 

men aged 20–29 years (Table 34).These data indicate 

a shift since 2006, when the highest rates were in men 

aged 35–39 years. 

Rates among women decreased in all age groups during 

2010–2011 (except for women aged 10–14 and 55 

years and older), with the largest decrease in women 

aged 45–54 years. Rates remained highest among 

women aged 20–24 years (Figures 42 and 43, Table 34).

P&S Syphilis by Race/Ethnicity

During 2010–2011, the rate of P&S syphilis increased 

4.5% among Hispanics (from 4.4 to 4.6 cases per 

100,000 population), 8.0% among American Indians/

Alaska Natives (from 2.5 to 2.7 cases per 100,000 

population), 9.5% among non-Hispanic whites 

(from 2.1 to 2.3 cases per 100,000 population), and 

33.3% among Asian/Pacific Islanders (from 1.2 to 1.6 

cases per 100,000 population) (Figure 45). The rate 

decreased 6.6% among non-Hispanic blacks (from 

16.6 to 15.5 cases per 100,000 population). 

P&S Syphilis by Sex and Sex Behavior

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

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

reflecting higher rates in men than women (Figure 38). 

This ratio has since increased more gradually to 8.2 in 

2011.

In 2005, CDC began collecting information on the 

sex partners of patients with P&S syphilis. In 2011, 

this information was available for 83% of male cases. 

During 2007–2011, 33 areas reported sex of partner 

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

period. In these areas, cases among women and men 

having sex with women only (MSW) have declined 

since 2008, while cases among MSM have increased 

each consecutive year (Figure 37). 

In 2011, among MSW with P&S syphilis, 40.1% had 

primary syphilis, and 59.9% had secondary syphilis. 

Among women with P&S syphilis, 18.9% had primary 

syphilis, and 81.1% had secondary syphilis. Among 

MSM, 26.3% had primary syphilis, and 73.7% had 

secondary syphilis (Figure 46).

Among women with P&S syphilis, 17.4% were 

white, 69.4% were black, 9.5% were Hispanic, and 

2.0% were of other races/ethnicities. Among MSW, 

18.9% were white, 61.8% were black, 14.6% were 

Hispanic, and 2.5% were of other races/ethnicities. 

Among MSM, 38.7% were white, 35.7% were black, 

18.8% were Hispanic, and 4.4% were of other races/

ethnicities (Figure 47).
STD Surveillance 2011 National Profile: Syphilis 37

P&S Syphilis by Race/Ethnicity and Sex

In 2011, rates of P&S syphilis among men were 

highest among non-Hispanic black men (27.0 cases per 

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

per 100,000 population), American Indians/Alaska 

Natives (5.0 cases per 100,000 population), nonHispanic white (4.4 cases per 100,000 population), 

and Asian/Pacific Islander (3.1 cases per 100,000 

population) men (Figure S, Table 35B).

In 2011, rates of P&S syphilis among women were 

highest among non-Hispanic black women (5.0 cases 

per 100,000 population), followed by Hispanic (0.6 

cases per 100,000 population), American Indian/

Alaska Native (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, Table 35B).

P&S Syphilis by Race/Ethnicity, Age, 

and Sex 

In 2011 the rate of P&S syphilis among non-Hispanic 

blacks was highest among women aged 20–24 years 

(18.9 cases per 100,000 women) and among men 

aged 20–24 years (96.2 cases per 100,000 men) and 

25–29 years (82.5 cases). For non-Hispanic whites, the 

rate was highest among women aged 20–24 years and 

25–29 years (0.9 cases for both) and among men aged 

25–29 years (9.5 cases) and 40–44 years (9.6 cases) 

(Table 35B).

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 and 25–29 years (18.8 

cases per 100,000 men for both). For Asians/Pacific 

Islanders, the rate was highest among women aged 

20–24 years (0.5 cases) and among men aged 30–34 

years (7.3 cases). For American Indians/Alaska Natives, 

the rate was highest among women aged 25–29 years 

(2.1 cases) and among men aged 20–24 years (13.5 

cases) and 30–34 years (13.3 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 1998–2011, the 

proportion of cases reported from sources other than 

STD clinics increased from 39.2% to 72.0% (Figure 

48, Table A2). During 2002–2011, 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 48).

During 2011, patients with P&S syphilis usually 

sought care from private physicians or STD clinics. 

Similar proportions of cases among women and 

MSM were reported from private physicians and STD 

clinics, while substantially more cases among MSW 

were reported from STD clinics than from private 

physicians (Figure 49). 

Congenital Syphilis—United States

After an 18% increase in the rate of congenital syphilis 

during 2006–2008, the rate of congenital syphilis 

decreased during 2008–2011 (from 10.5 to 8.5 cases 

per 100,000 live births) (Table 41). In 2011, a total 

of 360 cases were reported, a decrease from 387 cases 

in 2010 and 429 cases in 2009. This recent decrease 

in the rate of congenital syphilis is associated with the 

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

has occurred since 2008 (Figure 50).

In 2011, a total of 23 states, the District of Columbia, 

and 1 outlying area had 1 or more cases of congenital 

syphilis (Table 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.
38 National Profile: Syphilis STD Surveillance 2011

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.

Syphilis Summary

In recent years, young MSM have accounted for an 

increasing number of syphilis cases in the United 

States.9, 10 According to information reported from 

46 states and the District of Columbia, 72% of P&S 

syphilis cases are among MSM. Although the majority 

of U.S. syphilis cases have occurred among MSM, 

syphilis among MSW and women continues to be a 

problem. 11
STD Surveillance 2011 National Profile: Syphilis 39

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

 0

120

240

360

480

600

Year

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

Cases (in thousands)

Primary and Secondary

Early Latent

Total Syphilis

Figure 37.

 0

1600

3200

4800

6400

8000

Year

2007 2008 2009 2010 2011

Cases

MSM†

MSW†

Women

Figure 37. Primary and Secondary Syphilis—by Sex and Sexual Behavior, 33 Areas*, 2007–2011

Figure 36. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2011

* 32 states and Washington, DC reported sex of partner data for ≥70% of cases of P&S syphilis for each year during 2007–2011.

† MSM = men who have sex with men, MSW = men who have sex with women only.
40 National Profile: Syphilis STD Surveillance 2011

Figure 39.

0

2

4

6

8

10

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 39. Primary and Secondary Syphilis—Rates by Region, United States, 2002–2011

Figure 38.

 0

 5

 10

 15

 20

 25

Year

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

1:1

2:1

4:1

8:1

16:1

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

Male Rate

Female Rate

Total Rate

Male-to-Female Rate Ratio

Figure 38. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate Ratios, United 

States, 1990–2011
STD Surveillance 2011 National Profile: Syphilis 41

Figure 40.

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.

Rate per 100,000

population

Guam 2.8 

Puerto Rico 6.8 

Virgin Islands 0.0 

<=0.2

0.21-2.2

>2.2

(n= 5)

(n= 14)

(n= 35)

VT 1.4

NH 1.4

MA 4.1

RI 4.4

CT 1.8

NJ 2.6

DE 3.0

MD 7.8

DC 27.4

4.8

0.7

4.3 6.2

6.6 2.6

6.7

7.0

1.0

0.8

6.9 2.7

0.7

0.8 3.0

9.9

0.9

2.9

2.6

6.4

2.3

0.7

0.5 5.0

3.4

5.6

4.5

0.1

3.8

2.2

2.5

2.9

4.8

0.0

4.4

4.6

0.5

2.7

4.9

0.2

1.1

0.0

Figure 40. Primary and Secondary Syphilis—Rates by State, United States and Outlying Areas, 2011

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. 

Figure 41.

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

Rate per 100,000

population

<=0.2 (n= 2,152)

0.21-2.2 (n= 385)

>2.2 (n= 605)

Figure 41. Primary and Secondary Syphilis—Rates by County, United States, 2011

Note: In 2011, 2,154 (68.5%) of 3,142 counties in the United States reported no cases of primary and secondary syphilis
42 National Profile: Syphilis STD Surveillance 2011

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

United States, 2001–2010

 0

 2

 4

 6

 8

 10

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population) Age Group

15-19 20-24

25-29 30-34

35-39 40-44

Figure 43. Primary and Secondary Syphilis—Rates by Age Among Women Aged 15–44 Years, United 

States, 2002–2011

Figure 42.

Men Rate (per 100,000 population) Women

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

0.1 0.1 10-14

5.4 2.4 15-19

23.4 3.8 20-24

21.4 2.6 25-29

16.6 1.9 30-34

12.6 1.1 35-39

13.5 0.9 40-44

9.0 0.5 45-54

2.9 0.2 55-64

0.8 0.0 65+

8.2 1.0 Total

Figure 42. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2011
STD Surveillance 2011 National Profile: Syphilis 43

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

United States, 2001–2010

 0

 5

 10

 15

 20

 25

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

Age Group

15-19 20-24

25-29 30-34

35-39 40-44

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

States, 2002–2011

Figure 45.

 0

 4

 8

 12

 16

 20

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

American Indians/Alaska Natives

Asians/Pacific Islanders

Blacks

Hispanics

Whites

Figure 45. Primary and Secondary Syphilis—Rates by Race/Ethnicity, United States, 2002–2011
44 National Profile: Syphilis STD Surveillance 2011

Figure 47.

* 

Cases

Whites

Blacks

Hispanics

Other

 0

 700

 1400

 2100

 2800

 3500

MSW† Women MSM†

Figure 47. Primary and Secondary Syphilis—Reported Cases* by Sex, Sexual Behavior, and Race/

Ethnicity, United States, 2011

* Of the reported male cases of primary and secondary syphilis, 17.0% were missing sex of sex partner information; 2.4% of reported male cases with sex 

of sex partner data were missing race/ethnicity data.

†

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

Figure 46.

* 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.

Cases

Primary

Secondary

 0

 1500

 3000

 4500

 6000

MSW† Women MSM†

Figure 46. Primary and Secondary Syphilis—Reported Cases* by Stage, Sex, and Sexual Behavior, 

United States, 2011

* Of the reported male cases of primary and secondary syphilis, 17.0% were missing sex of sex partner information.

† MSW = men who have sex with women only; MSM = men who have sex with men.
STD Surveillance 2011 National Profile: Syphilis 45

Figure 48.

 0

 2

 4

 6

 8

 10

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 48. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex, United 

States, 2002–2011

Figure 49.

* 

Percentage

Correctional Facility HIV Counseling and Testing Site

Private Physician/HMO† STD Clinic

 0

 15

 30

 45

 60

MSW† Women MSM†

Figure 49. Primary and Secondary Syphilis—Percentage of Reported Cases* by Sex, Sexual Behavior, 

and Selected Reporting Sources, 2011

* Of the reported male cases of primary and secondary syphilis, 17.0% were missing sex of sex partner information, and 3.9% of reported male cases with 

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

† HMO = health maintenance organization; MSM = men who have sex with men; MSW = men who have sex with women only.
46 National Profile: Syphilis STD Surveillance 2011

Figure 50.

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

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

P&S Rate

CS Cases

0.0

0.2

0.4

0.6

0.8

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

0

1

2

3

4

Figure 50. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates of Primary 

and Secondary Syphilis Among Women, United States, 2002–2011

* CS = congenital syphilis; P&S = primary and secondary syphilis.
STD Surveillance 2011 National Profile: Other Sexually Transmitted Diseases 47

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 51, Table 1). In 2011, 

a total of 8 cases of chancroid were reported in the 

United States. Only six states reported one or more 

cases of chancroid in 2011 (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 highrisk 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 using a commercially available test for highrisk HPV DNA (Hybrid Capture 2, Qiagen). 

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% 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 52). 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 

females aged 14–59 years.4

 HPV vaccine-preventable 

low-risk types 6 or 11 or high-risk types 16 or 18 were 

detected in 8.8% of female participants: HPV-6 in 

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

0.2–0.7), HPV-16 in 4.7% (95% CI: 4.0–5.5), and 

HPV-18 in 1.9% (95% CI: 1.4–2.5).5

Data from the National Disease and Therapeutic 

Index (NDTI) suggest that incidence of genital warts 

(Figure 53, 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 54, enhanced behavioral 

and demographic information on patients who 

presented for care in 2011 at the 42 clinics 

participating in the STD Surveillance Network (SSuN) 

was used. Genital warts were identified by provider 

diagnosis or by documentation from the physical 

examination. Men who have sex with men (MSM) 

and men who have sex with women only (MSW) were 

defined by self-report or by sex of reported sex partners. 

More detailed information about SSuN methodology 

can be found in the STD Surveillance Network section 

of the Appendix, Interpreting STD Surveillance Data. 

The prevalence of genital warts in 2011 is presented 

separately for MSM, MSW, and women by SSuN site. 

Prevalence was lowest in women for all sites. Among 

women the median prevalence of genital warts was 

1.7% (range 1.0% to 2.7%) across all sites compared 

to 5.5% (range 2.3% to 8.1%) for MSM and 5.8% 

(range 2.0% to 11.0%) for MSW.
48 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2011

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 55, 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 21.0% (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 56). 

Although HSV-2 seroprevalence is decreasing, most 

persons with HSV-2 have not received a diagnosis. 

During 2005–2008, the percentage of NHANES 

survey participants aged 20–49 years infected with 

HSV-2 who reported a diagnosis of genital herpes was 

18.9%. An overall increase in the number of visits for 

genital herpes over time, as suggested by NDTI data, 

may indicate increased recognition of infection.

Trichomoniasis

Trend data for this infection are limited to estimates of 

initial physician office visits from the NDTI (Figure 

57, 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 D, 

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

prevalence among females in the United States-National Health 

and Nutrition Examination Survey, 2003–2006: opportunity to 

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

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 2011 National Profile: Other Sexually Transmitted Diseases 49

Figure 52.

* 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

Prevalence, %

Age

Low-risk HPV*

High-risk HPV*

0

10

20

30

40

50

60

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

Figure 51.

0

1

2

3

4

5

Year

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011

Cases (in thousands)

Figure 52. Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among Females 

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

Figure 51. Chancroid—Reported Cases, United States, 1981–2011

* HPV = human papillomavirus.

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

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

Health and Nutrition Examination Survey, 2003–2006. J Infect Dis. 2011;204(4):566–73
50 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2011

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

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. 

 0

100

200

300

400

500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Figure 54.

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

Prevalence, %

MSM*

MSW*

Women

 0

 3

 6

 9

 12

 15

San

Francisco

Los

Angeles

Seattle

Denver

Chicago New

Orleans

Birmingham

Richmond

Baltimore

Philadelphia

New York

City

Hartford/

New Haven

Figure 54. Genital Warts—Prevalence Among Sexually Transmitted Disease (STD) Clinic Patients by 

Sex, Sex of Partners, and Site, STD Surveillance Network (SSuN), 2011

Figure 53. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2011

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, 1966–2011.

* MSM = men who have sex with men; MSW = men who have sex with women only.
STD Surveillance 2011 National Profile: Other Sexually Transmitted Diseases 51

Figure 55.

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. 

 0

 80

160

240

320

400

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Figure 55. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2011

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, 1966–2011.
52 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2011

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

* 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.

Non-Hispanic Whites

Percentage

Age

0

20

40

60

80

100

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

Non-Hispanic Blacks

Percentage

Age

0

20

40

60

80

100

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

1976 - 1980 1988 - 1994

1999 - 2004 2005 - 2008

Figure 56. 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

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

Note: Error bars indicate 95% confidence interval
STD Surveillance 2011 National Profile: Other Sexually Transmitted Diseases 53

Figure 57.

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.

 0

 900

1,800

2,700

3,600

4,500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Trichomoniasis

Other Vaginitis

Figure 57. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to Physicians’ 

Offices, United States, 1966–2011

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, 1966–2011.

SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
STD Surveillance 2011 Special Focus Profiles 55

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 disease-specific sections of the National Profile, as well as throughout this section.
56 Special Focus Profiles STD Surveillance 2011
STD Surveillance 2011 Special Focus Profiles: STDs in Women and Infants 57

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 sociodemographic characteristics, including age, income, 

education, and acculturation.5 Because it may be the 

behavior of her male partner, rather than the woman’s 

own behavior, that increases a woman’s risk for STDs, 

even a woman who has only one partner may be 

obliged to practice safer sex such as using condoms.6

Women infected with C. trachomatis or N. 

gonorrhoeae can develop PID, which, in turn, can 

lead to reproductive system morbidity such as ectopic 

pregnancy and tubal factor infertility. An estimated 

10%–20% of women with chlamydia or gonorrhea 

may develop PID if they do not receive adequate 

treatment.7,8 Among women with PID, tubal scarring 

can cause infertility in 20% of women, ectopic 

pregnancy in 9%, and chronic pelvic pain in 18%.9

About 80%–90% of chlamydial infections10 and 

up to 80% of gonococcal infections11 in women are 

asymptomatic.These infections are detected primarily 

through screening. The symptoms associated with PID 

are vague so 85% of women with PID delay seeking 

medical care, thereby increasing the risk for infertility 

and ectopic pregnancy.12 Data from 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 2010-2011, the rate of reported chlamydial 

infections in women increased from 605.1 to 648.9 

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).

Positivity in Selected Populations

Prenatal Clinics—In 2011, the median state-specific 

chlamydia test positivity among women aged 15–24 

years who were screened in selected prenatal clinics in 

15 states, Puerto Rico, and the Virgin Islands was 7.7% 

(range: 2.8% to 16.3%) (Figure B). In a multivariateregression analysis accounting for individual-level and 

clinic-level factors, chlamydia positivity among women 

aged 14-25 years who were screened in prenatal care 

clinics decreased from 2004-2009.17
58 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2011

Family Planning Clinics—In 2011, the median 

state-specific chlamydia test positivity among women 

aged 15–24 years who were screened during visits to 

selected family planning clinics in all 50 states, Puerto 

Rico, and the Virgin Islands was 8.3% (range: 3.8% 

to 15.9%) (Figure 13). In a multivariate-regression 

analysis accounting for individual-level and clinic-level 

factors, chlamydia positivity among women aged 14-

25 years who were screened in family planning clinics 

remained stable from 2004-2008.18

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 16). After reaching an all-time low in 2009 

(104.5 cases per 100,000 females), the gonorrhea rate 

for women increased slightly in 2010 and 2011 to 

108.9 cases per 100,000 females (Figure 17, 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 10 consecutive years (Figure 17, Tables 

15 and 16).

Positivity in Selected Populations

Prenatal Clinics—In 2011, the median state-specific 

gonorrhea test positivity among women aged 15–24 

years who were screened in selected prenatal clinics in 

15 states, Puerto Rico, and the Virgin Islands was 0.8% 

(range: 0.0% to 3.8%) (Figure D).

Family Planning Clinics—In 2011, the median statespecific gonorrhea test positivity among women aged 

15–24 years who were screened during visits to selected 

family planning clinics in 48 states, Puerto Rico, and 

the Virgin Islands was 0.7% (range 0.0% to 3.5%) 

(Figure 28).

Congenital Syphilis

Trends in congenital syphilis usually follow trends in 

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

(Figure 50). 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 38). 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 1.0 cases 

per 100,000 women in 2011 (Table 27), and the rate 

of congenital syphilis was 8.5 cases per 100,000 live 

births in 2011 (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.19

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 1990s.20,21 During 2001-2010, hospitalizations 

for acute PID overall have shown modest declines, 

although hospitalizations for acute PID increased by 

44.3% (from 36.3 to 52.4 per 100,000) between 2009 

and 2010 (Figure G). While this does not represent 

a trend in this data, and the explanations may not be 

immediately clear, continued monitoring of these data 

is warranted. Hospitalizations for chronic PID have 

also shown modest declines, remaining relatively stable 

between 2007 and 2010 (Figure G).

The estimated number of initial visits to physicians’ 

offices for PID from NDTI declined during 2002–

2011 (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.21
STD Surveillance 2011 Special Focus Profiles: STDs in Women and Infants 59

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

Relationship power, condom use and HIV risk among women in 

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

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

associated with STDs/HIV in women: implications for behavioral 

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

Behavioral Interventions for Prevention and Control of Sexually 

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

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

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

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

1998;13(4):377-393.

4 Hogben M, Leichliter JS. Social determinants and sexually 

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

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

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

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

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

Academic Publishers.

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

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

7 Paavonen J, Westrom L, Eschenbach. Pelvic Inflammatory 

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

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

Transm Dis. 4th ed. New York: McGraw-Hill; 2008:1017-1050. 

8 Hook EW III, Handsfield HH. Gonococcal infections in the 

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

JN, Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:627-45.

9

 Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. 

Pelvic inflammatory disease and fertility: a cohort study of 1,844 

women with laparoscopically verified disease and 657 control 

women with normal laparoscopy. Sex Transm Dis. 1992;9:185-92.

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

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

Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:575-93.

11 Marrazzo JM, Handsfield HH, Sparling PF. Neisseria gonorrhoeae 

In: Mandell GL, Bennett JE, Dolin R (editors). Principles and 

practice of Infectious Diseases, 7th ed. Philadelphia, PA: Churchill 

Livingstone; 2010: 2753-2770.

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

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

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

1993;168:1503-9.

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

KK, Stamm WE. Prevention of pelvic inflammatory disease 

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

1996;34(21):1362-6.

14 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).

17Satterwhite CL, Gray AM, Berman S, Weinstock H, Kleinbaum 

D, Howards PP. Chlamydia trachomatis infections among women 

attending prenatal clinics: United States, 2004-2009.Sex Transm 

Dis. 2012 Jun;39(6):416-20.

18Satterwhite CL, Grier L, Patzer R, Weinstock H, Howards PP, 

Kleinbaum D. Chlamydia positivity trends among women attending 

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

2011 Nov;38(11):989-94.

19 Centers for Disease Control and Prevention. Congenital syphilis 

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

2010;59:413-17.

20 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.

21 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.

22 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.

Ectopic Pregnancy

The incidence of ectopic pregnancy in the United 

States during the 1970’s and 1980’s was marked by 

significant increases. This surveillance relied on the 

National Hospital Discharge Survey (NHDS), which 

collects information on discharged hospital inpatients 

in the United States. Since the late 1980s, the ability to 

ascertain the number of ectopic pregnancies occurring 

in the United States has been affected by changing 

health care practices, including technological advances 

that permit early, accurate diagnosis of pregnancy and 

ectopic pregnancy, and pharmacological and technical 

advances in treatment of ectopic pregnancy. Data from 

the NHDS suggest that hospitalizations for ectopic 

pregnancy have decreased from 33.0 per 100,000 in 

2001 to 21.6 per 100,000 in 2010 (Figure I). However, 

this likely does not reflect a decrease in the actual 

public health burden of ectopic pregnancy given that 

administrative data from the middle of the decade 

shows that the proportion of cases being treated with 

nonsurgical intervention is increasing.22
60 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2011

Figure A.

Rate per 100,000

population

Guam 880 

Puerto Rico 233 

Virgin Islands 1021 

<=400.0

400.1-600.0

>600.0

(n= 6)

(n= 19)

(n= 29)

VT 348

NH 327

MA 466

RI 548

CT 536

NJ 441

DE 689

MD 671

DC 1372

863

1116

659 803

612 628

565

803

635

428

715 609

497

567 544

1011

317

722

443

1029

658

485

520 540

798

705

879

482

659

546

490

560

938

612

683

752

351

645

493

329

608

491

Figure B. 

Positivity, %

Puerto Rico 16.3 

Virgin Islands 9.7 

*

<5.0

5.0-9.9

>=10.0

(n= 36)

(n= 2)

(n= 8)

(n= 7)

VT

NH

MA

RI

CT

NJ

DE

MD 5.3

DC

10.6

6.0

6.5

6.9 5.5

11.1

14.4

11.8

7.7

10.3

2.8

12.2

3.8 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, 2011

Figure A. Chlamydia—Women—Rates by State, United States and Outlying Areas, 2011

Note: The total chlamydial infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 644.1 per

100,000 female population.

* States/areas reported chlamydia positivity data on fewer than 100 women aged 15–24 years in 2011. 
STD Surveillance 2011 Special Focus Profiles: STDs in Women and Infants 61

Figure C. 

Rate per 100,000

population

Guam 49.5 

Puerto Rico 7.2 

Virgin Islands 162.5 

<=19.0

19.1-100.0

>100.0

(n= 8)

(n= 22)

(n= 24)

VT 7.6

NH 8.8

MA 32.0

RI 30.7

CT 75.1

NJ 86.8

DE 101.7

MD 116.1

DC 380.8

207.5

151.2

68.8 181.0

57.7 51.2

104.0

173.2

40.2

10.1

145.3 112.0

79.1

94.6 117.8

227.4

18.0

150.9

48.4

219.1

137.3

10.4

89.5 65.7

88.8

97.2

206.1

44.8

169.5

126.4

31.1

118.0

209.7

98.1

126.4

130.0

4.8

90.6

31.6

49.7

101.5

9.1

Figure D.

Positivity, %

Puerto Rico 0.6 

Virgin Islands 0.7 

*

<1.0

1.0-1.9

>=2.0

(n= 36)

(n= 9)

(n= 3)

(n= 5)

VT

NH

MA

RI

CT

NJ

DE

MD 0.0

DC

1.6

0.8

1.4

0.7 0.4

2.6

2.0

3.8

1.1

3.1

0.0

2.2

0.2 0.4

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

State, Infertility Prevention Project, United States and Outlying Areas, 2011

Figure C. Gonorrhea—Women—Rates by State, United States and Outlying Areas, 2011

Note: The total gonorrhea infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 107.7 per

100,000 female population.

* States/areas reported gonorrhea positivity data on fewer than 100 women aged 15–24 years in 2011. 
62 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2011

Figure F.

Rate per 100,000

live births

Guam 0.0 

Puerto Rico 4.4 

Virgin Islands 0.0 

<=1.0

1.1-10.0

>10.0

(n= 29)

(n= 15)

(n= 10)

VT 0.0

NH 0.0

MA 0.0

RI 0.0

CT 0.0

NJ 4.4

DE 0.0

MD 31.1

DC 11.0

15.5

0.0

14.1 36.9

7.2 0.0

13.8

6.8

0.0

0.0

10.2 0.0

0.0

0.0 3.4

27.6

0.0

5.0

0.0

13.3

1.2

0.0

0.0 7.6

0.0

5.2

3.8

0.0

8.7

3.7

0.0

3.3

0.0

0.0

9.4

26.4

0.0

0.0

2.2

0.0

0.0

0.0

Figure E. 

Rate per 100,000

population

Guam 2.2 

Puerto Rico 0.9 

Virgin Islands 0.0 

<=0.2

0.21-4.0

>4.0

(n= 22)

(n= 30)

(n= 2)

VT 0.0

NH 0.1

MA 0.7

RI 0.6

CT 0.3

NJ 0.3

DE 0.2

MD 1.6

DC 2.2

2.2

0.3

0.5 5.1

0.5 0.2

1.4

1.2

0.0

0.1

1.2 0.4

0.3

0.0 0.9

7.7

0.0

0.5

0.2

2.9

0.2

0.2

0.1 0.5

0.2

0.4

0.6

0.0

1.8

0.6

0.0

0.5

1.0

0.0

1.0

2.0

0.0

0.4

0.2

0.0

0.2

0.0

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

Outlying Areas, 2011

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

Areas, 2011

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

1.0 per 100,000 females.

Note: The total rate of congenital syphilis for infants by year of birth for the United States and outlying areas Guam, Puerto Rico, and Virgin Islands) was

8.5 per 100,000 live births.
STD Surveillance 2011 Special Focus Profiles: STDs in Women and Infants 63

Figure H.

 0

 40

 80

120

160

200

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Visits (in thousands)

Figure G.

 0

 15

 30

 45

 60

 75

Year

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Hospitalizations (in thousands)

Acute, Unspecified

Chronic

Figure H. Pelvic Inflammatory Disease—Initial Visits to Physicians’ Offices by Women Aged 15–44 

Years, United States, 2002–2011

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

States, 2001–2010

Note: The relative standard errors for acute and unspecified pelvic inflammatory disease (PID) cases ranges from 8%–18%. The relative standard error for

chronic PID cases ranges from 12%–28%. Data only available through 2010.

Source: 2010 National Hospital Discharge Survey [Internet]. Atlanta: Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/

nchs/nhds.htm.

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

Source: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2011. 
64 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2011

Figure I. 

 0

 10

 20

 30

 40

 50

Year

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Hospitalizations (in thousands)

Figure I. Ectopic Pregnancy—Hospitalizations of Women Aged 15–44 Years, United States, 2001–

2010

Note: The relative standard errors for these estimates are 10%–23%. Data only available through 2010

Source: 2010 National Hospital Discharge Survey [Internet]. Atlanta: Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/

nchs/nhds.htm
STD Surveillance 2011 Special Focus Profiles: STDs in Adolescents and Young Adults 65

STDs in Adolescents and Young Adults

Public Health Impact

Estimates suggest that young people aged 15–24 

years 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 2010–2011, rates increased 4.0% 

for those aged 15–19 years and 11.0% for those aged 

20–24 years (Table 10).

15- to 19-Year-Old Women—In 2011, the rate 

among women aged 15–19 years was 3,416.5 cases per 

100,000 females, a 3.5% increase from the 2010 rate 

of 3,299.5 cases per 100,000 (Figure 5, Table 10). 

20- to 24-Year-Old Women—In 2011, women aged 

20–24 years had the highest rate of chlamydia (3,722.5 

cases per 100,000 females) compared with any other 

age and sex group. Chlamydia rates for women in this 

age group increased 10.5% during 2010–2011.

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

aged 15–19 years increased 6.1% from 757.0 cases per 

100,000 males in 2010 to 803.0 cases per 100,000 in 

2011.

20- to 24-Year-Old Men—In 2011, as in previous 

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

of chlamydia (1,343.3 cases per 100,000 males). 

Chlamydia rates for men in this age group increased 

12.4% during 2010–2011.

Gonorrhea

During 2010–2011, gonorrhea rates remained 

essentially unchanged for persons aged 15–19 years 

(decreased 0.1%) and increased for persons aged 20–24 

years (5.8%). 

15- to 19-Year-Old Women—In 2011, women aged 

15–19 years had the second highest rate of gonorrhea 

(556.5 cases per 100,000 females) compared with any 

other age or sex group (Figure 21, Table 21). During 

2010–2011, the gonorrhea rate for women in this age 

group decreased 0.2%. 

20- to 24-Year-Old Women—In 2011, women aged 

20–24 years had the highest rate of gonorrhea (584.2 

cases per 100,000 females) compared with any other 

age or sex group (Figure 21, Table 21). During 2010–

2011, the gonorrhea rate for women in this age group 

increased 5.4%.

15- to 19-Year-Old Men—In 2011, the gonorrhea 

rate among men aged 15–19 years was 248.6 cases per 

100,000 males (Figure 21, Table 21). During 2010–

2011, the gonorrhea rate for men in this age group 

increased 0.4%.

20- to 24-Year-Old Men—In 2011, as in previous 

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

gonorrhea (450.6 cases per 100,000 males) compared 

with other males (Figure 21, Table 21). During 2010–

2011, the gonorrhea rate for men in this age group 

increased 6.2%.

Primary and Secondary Syphilis 

Syphilis rates among women aged 15–19 years 

increased annually during 2004–2009, from 1.5 

cases per 100,000 females to 3.3 cases in 2009, but 

decreased to 2.9 cases in 2010 and 2.4 cases in 2011. 
66 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2011

Rates in women have been highest each year among 

those aged 20–24 years with 3.8 cases per 100,000 

females in 2011 (Figures 42 and 43, Table 34). 

Rates among men aged 15–19 years are much lower 

than the rates among men in older age groups (Figures 

42 and 44, Table 34). Rates in this group increased 

during 2002–2009 (from 1.3 cases per 100,000 males 

to 6.0 cases in 2009), but decreased to 5.5 cases in 2010 

and 5.4 cases in 2011. However, rates among men aged 

20–24 years have increased each consecutive year since 

2002, from 5.2 cases per 100,000 males to 23.4 cases 

in 2011. Not only have men aged 20–24 years seen 

large increases in rates, they also have had the highest 

rate of P&S syphilis among men of any age group since 

2008 (Table 34). These changes reflect a shift in the age 

distribution of P&S syphilis; rates were highest among 

men aged 35–39 years during 2002–2006. 

Positivity in Selected Populations

In 2011, the median state-specific chlamydia test 

positivity among women aged 15–19 years who were 

tested during visits to selected family planning clinics 

in all 50 states, Puerto Rico, and the Virgin Islands 

was 9.8% (range: 3.4% to 19.1%). Chlamydia test 

positivity among women aged 15–19 years screened in 

selected family planning clinics increased in most HHS 

regions during 2007–2011 (Figure J). Test positivity 

data presented in Figure J are not adjusted for changes 

in laboratory test methods and associated increases in 

test sensitivity.

Among adolescent females entering selected juvenile 

corrections facilities, the median facility-specific 

chlamydia positivity was 13.5% (range: 3.7% to 

27.7%); the median gonorrhea positivity was 3.4% 

(range: 0.0% to 9.6%). Among adolescent males 

entering selected juvenile corrections facilities, the 

median facility-specific chlamydia positivity was 6.3% 

(range: 0.4 to 19.1%); the median gonorrhea positivity 

was 0.7% (range: 0.0% to 6.0%) (Figures BB and 

DD). See the STDs in Persons Entering Corrections 

Facilities section for more details.

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 2011.

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 46 states, the 

District of Columbia, and Puerto Rico, the median 

state-specific chlamydia prevalence was 10.3% (range: 

4.1% to 18.7%) (Figure K). Among men entering 

the program in 48 states, the District of Columbia, 

and Puerto Rico, the median state-specific chlamydia 

prevalence was 8.0% (range: 2.7% to 13.0%) (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 44 states 

and Puerto Rico, the median state-specific gonorrhea 

prevalence in 2011 was 1.0% (range: 0.0% to 4.9%) 

(Figure M). Among men entering the program in 

38 states and Puerto Rico, the median state-specific 

gonorrhea prevalence was 0.9% (range: 0.0% to 2.6%) 

(Figure N).

* Laboratory data are provided by the Center for Disease Detection, 

LLC 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 2011 Special Focus Profiles: STDs in Adolescents and Young Adults 67

Figure J.

Region I

Region II

Region III

Region IV

Region V

Region VII Region VI

Region VIII

Region IX

Region X

5.6

07

5.8

08

5.8

09

7.2

10

7.8

11

7.6

07

8.3

08

8.9

09

9.5

10

10.1

11

6.8

07

7.9

08

8.0

09

9.2

10

9.6

11

11.7

07

11.9

08

11.8

09

11.9

10

12.4

11

9.0

07

9.3

08

9.8

09

11.2

10

11.9

11

10.7

07

12.6

08

12.9

09

13.5

10

14.4

11

7.6

07

7.9

08

9.0

09

9.3

10

9.0

11

8.1

07

8.7

08

8.5

09

9.2

10

9.6

11

9.0

07

9.3

08

9.8

09

6.5

10

6.9

11

6.8

07

7.2

08

7.0

09

8.1

10

8.4

11

IV

VII IX

I II

X

III

VI

V

VIII

Figure K. 

Prevalence, %

Puerto Rico 10.1 

Virgin Islands 

*

<10.0

10.0-14.9

>=15.0

(n= 5)

(n= 21)

(n= 19)

(n= 8)

VT 5.1

NH

MA 8.9

RI 7.4

CT 9.0

NJ 16.0

DE 7.8

MD 11.1

DC 10.4

17.4

6.3

10.9 15.4

7.3 6.5

13.5

17.2

8.8

8.0

14.3 14.1

4.1

8.4 12.5

18.0

6.7

13.6

9.2

15.4

14.0

9.3

7.0 9.0

12.3

12.7

11.8

10.8

11.9

5.9

8.4

18.7

14.7

15.3

8.6

10.3

5.2

13.9

10.1

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, 2011

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, 2007–2011

Note: See Definition of HHS Regions in the Appendix for definitions

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2011.
68 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2011

Figure M. 

Prevalence, %

Puerto Rico 0.0 

Virgin Islands 

*

<2.0

>=2.0

(n= 8)

(n= 32)

(n= 13)

VT 0.7

NH

MA 0.5

RI 0.9

CT 0.7

NJ 1.4

DE 0.0

MD 1.1

DC

4.2

2.7

1.0 4.9

0.5 0.0

1.7

2.8

0.6

2.7 1.7

0.0

1.7 1.9

4.9

0.6

2.5

0.7

2.6

1.7

0.3

0.8 0.5

0.9

0.9

0.8

2.8

1.8

0.0

1.4

3.6

2.2

2.2

0.0

0.9

0.0

3.2

Figure L. 

Prevalence, %

Puerto Rico 4.1 

Virgin Islands 

*

<10.0

>=10.0

(n= 3)

(n= 37)

(n= 13)

VT 3.3

NH

MA 5.6

RI 5.9

CT 9.7

NJ 7.5

DE 8.3

MD 8.9

DC 11.7

13.0

5.3

8.2 12.2

5.3 4.7

9.9

11.3

7.7

4.0

12.0 9.1

5.5

6.0 8.6

11.5

4.1

10.9

4.5

12.9

8.2

4.5

3.5 2.7

4.7

9.2

9.4

3.2

11.1

7.0

3.4

6.9

11.3

6.1

11.0

9.3

3.0

10.7

2.8

9.4

11.0

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, 2011

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, 2011

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2011.

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2011.

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.
STD Surveillance 2011 Special Focus Profiles: STDs in Adolescents and Young Adults 69

Figure N.

Prevalence, %

Puerto Rico 0.3 

Virgin Islands

*

<2.0

>=2.0

(n= 14)

(n= 37)

(n= 2)

VT 0.3

NH

MA 0.3

RI

CT 0.9

NJ 1.2

DE

MD 1.6

DC

2.1

0.0

1.8

0.4 0.0

0.9

1.9

0.9

1.9 1.0

0.3

1.4

0.3

0.9

1.0

0.9

1.0

0.0

0.0 0.5

0.6

0.6

2.6

1.0

0.0

0.6

1.6

0.5

1.5

0.5

0.7

0.1

0.9

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, 2011

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2011.

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.

STD Surveillance 2011 Special Focus Profiles: STDs in Racial and Ethnic Minorities 71

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 2010, the poverty rates, 

unemployment rates, and high school drop-out rates 

for blacks, American Indians/Alaska Natives, and 

Hispanics were considerably higher than for whites, 

differences commensurate with observed disparities 

in STD burden.6–9 Recent data show that one-fifth of 

blacks (20.8%) 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.10,11 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.12

In communities where STD prevalence is higher, 

individuals may have a more difficult time reducing 

their risk for infection. With each sexual encounter, 

they face a greater chance of encountering an infected 

partner than those in lower prevalence settings.13 

Acknowledging the inequity in STD rates by race or 

ethnicity is one of the first steps in empowering affected 

communities to organize and focus on this problem. 

STD Reporting Practices

Surveillance data are based on cases of STDs reported 

to state and local health departments (see Interpreting 

STD Surveillance Data in the Appendix). In many 

state and local health jurisdictions, reporting from 

public sources (e.g., STD clinics) is thought to be more 

complete than reporting from private sources. Because 

minority populations may use public clinics more 

than whites, differences in rates between minorities 

and whites may be increased by this reporting 

bias.14 However, prevalence data from populationbased surveys, such as NHANES and the National 

Longitudinal Study of Adolescent Health, confirm the 

existence of marked STD disparities in some minority 

populations.15,16

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 2011, 26.1% of chlamydia case 

reports were missing race or ethnicity data, ranging by 

state from 0.2% to 55.5% (Table A1).

Gonorrhea—In 2011, 20.4% of gonorrhea case 

reports were missing information on race or ethnicity, 

ranging by state from 0.0% to 42.3% (Table A1).

Syphilis—In 2011, 2.9% of P&S syphilis case reports 

were missing information on race or ethnicity, ranging 

from 0.0% to 30.0% among states with 10 or more 

cases of P&S syphilis (Table A1).

Observations

Chlamydia

Chlamydia rates based on reported cases increased 

during 2011–2012 among all racial and ethnic groups 

(Figure 6). During 2007–2011, chlamydia rates 

increased by 17.6% among blacks, 23.6% among 

American Indians/Alaska Natives, 14.4% among 

Hispanics, 17.1% among Asians/Pacific Islanders, and 

34.6% among whites. 

Blacks—In 2011, the overall rate among blacks in 

the United States was 1,194.4 cases per 100,000, a 

3.8% increase from the 2010 rate of 1,150.4 cases per 

100,000. The rate of chlamydia among black women 

was over six times the rate among white women 

(1,563.0 and 232.7 per 100,000 women, respectively) 

(Figure O). The chlamydia rate among black men was 

over nine times the rate among white men (787.7 and 

82.3 cases per 100,000 men, respectively).
72 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2011

Chlamydia rates were highest for blacks aged 15–19 

and 20–24 years in 2011 (Table 11B). The chlamydia 

rate among black females aged 15–19 years was 

7,507.1 cases per 100,000 women, which was almost 

six times the rate among white females in the same 

age group (1,301.5). The rate among black women 

aged 20–24 years was 4.8 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 11.1 times the rate among 

whites (Table 11B). The chlamydia rate among black 

men aged 20–24 years was seven times the rate among 

white men of the same age group (3,662.0 and 516.4 

cases per 100,000 men, respectively).

American Indians/Alaska Natives—In 2011, the 

chlamydia rate among American Indians/Alaska 

Natives was 648.3 cases per 100,000 population, an 

increase of 7.7% from the 2010 rate of 602.0 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 2011, the chlamydia 

rate among Asians/Pacific Islanders was 115.3 cases 

per 100,000 population, an increase of 7.9% from the 

2010 rate of 106.9 cases per 100,000. The overall rate 

among Asians/Pacific Islanders was lower than the rate 

among whites.

Hispanics—In 2011, the chlamydia rate among 

Hispanics was 383.6 cases per 100,000 population, 

which is a 8.2% increase from the 2010 rate of 354.6 

cases per 100,000 and over two times the rate among 

whites.

Gonorrhea

During 2010–2011, gonorrhea rates increased 12.3% 

among Hispanics (47.9 to 53.8), 7.7% among 

American Indians/Alaska Natives (107.4 to 115.7), 

7.7% among whites (23.4 to 25.2), 4.9% among 

Asians/Pacific Islanders (14.4 to 15.1), and 0.3% 

among blacks (426.2 to 427.3) (Figure 24).

Blacks—In 2011, 67% of reported gonorrhea cases 

with known race/ethnicity occurred among blacks 

(excluding cases with missing information on race or 

ethnicity, and cases whose reported race or ethnicity 

was other). The rate of gonorrhea among blacks in 

2011 was 427.3 cases per 100,000 population (Figure 

24), which was 17.0 times the rate among whites (25.2 

per 100,000). This disparity has changed little in recent 

years (Figure P). This disparity was larger for black 

men (19.4 times) than for black women (15.2 times) 

(Figure Q). 

As in previous years, the disparity in gonorrhea rates 

for blacks in 2011 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 2011 (Table 22B). Black women 

aged 15–19 years had a gonorrhea rate of 1,929.6 cases 

per 100,000 women. This rate was 15.9 times the rate 

among white women in the same age group (121.2). 

Black women aged 20–24 had a gonorrhea rate of 

2050.4 cases per 100,000 women, which was 12.1 

times the rate among white women in the same age 

group (169.2 per 100,000) (Table 22B). 

Black men aged 15–19 years had a gonorrhea rate of 

959.9 cases per 100,000 men, which was 30.3 times 

the rate among white men in the same age group 

(31.7 per 100,000). Black men aged 20–24 years had 

a gonorrhea rate of 1875.1 cases per 100,000 men, 

which was 20.4 times the rate among white men in the 

same age group (91.8 per 100,000) (Table 22B).

American Indians/Alaska Natives—In 2011, the 

gonorrhea rate among American Indians/Alaska 

Natives was 115.7 cases per 100,000 population, 

which was 4.6 times the rate among whites (Figure 24, 

Figure P). The disparity between gonorrhea rates for 

American Indians/Alaska Natives and whites was larger 

for American Indian/Alaska Native women (5.2 times) 

than for American Indian/Alaska Native men (3.8 

times) (Figure Q). As in previous years, the disparity in 

gonorrhea rates for American Indians/Alaska Natives in 

2011 was larger in the West and Midwest than in the 

Northeast or South (Figure R).

Asians/Pacific Islanders—In 2011, the gonorrhea 

rate among Asians/Pacific Islanders was 15.1 cases per 

100,000 population, which was lower than the rate 

among whites (Figure 24, Figure P). This difference is 

larger for Asian/Pacific Islander women than for Asian/

Pacific Islander men (Figure Q). In 2011, rates among 

Asians/Pacific Islanders were again lower than rates 

among whites in all four regions of the United States 

(Figure R).
STD Surveillance 2011 Special Focus Profiles: STDs in Racial and Ethnic Minorities 73

Hispanics—In 2011, the gonorrhea rate among 

Hispanics was 53.8 cases per 100,000 population, 

which was 2.1 times the rate among whites (Figures 24 

and P). This disparity between Hispanics and whites 

was similar to that in recent years and was larger for 

Hispanic men than for Hispanic women (Figure Q). 

As In previous years, 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.17,18 During 

the 1990s, the rate of P&S syphilis declined among all 

racial and ethnic groups. During 2007–2011, the rate 

increased among all racial and ethnic groups except 

American Indians/Alaska Natives (Figure 45).

Blacks—During 2010–2011, the rate of P&S syphilis 

among blacks decreased 6.6% (from 16.6 to 15.5 cases 

per 100,000 population). In 2011, 43.8% of all cases 

reported to CDC were among blacks and 32.8% of all 

cases were among whites. 

The overall 2011 rate for blacks was 7.0 times the 

rate for whites, while the 2010 rate was 7.9 times 

the rate for whites (Figure 45). In 2011, the rate of 

P&S syphilis among black men was 6.1 times the rate 

among white men; the rate among black women was 

17 times the rate among white women (Figure S).

In some age groups, particularly black men (including 

men who have sex with men) aged 20–24 years and 

25–29 years, disparities have increased markedly in 

recent years as rates of disease have increased (Table 

35B). 19 During 2007–2011, rates among black men 

aged 20–24 years increased from 54.9 to 96.2 cases 

per 100,000 population (75%); the magnitude of 

this increase (41.3 cases per 100,000 population) 

was the greatest reported regardless of age, sex, or 

race/ethnicity. Among men and women aged 15–19 

years, disparities between blacks and other races/

ethnicities have decreased since 2009 (Figures T and 

U). Nonetheless, large disparities remain; the 2011 

rate among black men aged 15–19 years was 16 times 

the rate for whites and 5 times the rate for Hispanics 

(Table 35B). 

The largest rate increases among black women during 

2007–2011 occurred among women aged 20–24 years 

(from 15.7 to 18.9 cases per 100,000 population). In 

2011, rates for black women aged 15–19 years were 

30 times and 24 times the rate for white and Hispanic 

women of the same ages, respectively.

Recent trends in syphilis rates in young black men are 

of particular concern given data indicating high HIV 

incidence in this population.20,21

American Indians/Alaska Natives—During 2010–

2011, the rate of P&S syphilis among American 

Indians/Alaska Natives increased 8.0% (from 2.5 to 

2.7 cases per 100,000 population). In 2011, 0.5% 

of all cases reported to CDC were among American 

Indians/Alaska Natives. The 2011 rate of P&S syphilis 

for American Indians/Alaska Natives was 1.2 times the 

rate for whites (Figure 45).

Asians/Pacific Islanders—During 2010–2011, the 

rate of P&S syphilis among Asians/Pacific Islanders 

increased 33.3% (from 1.2 to 1.6 cases per 100,000 

population). In 2011, 1.8% of all cases reported to 

CDC were among Asians/Pacific Islanders. The 2011 

rate of P&S syphilis for Asians/Pacific Islanders was less 

than the rate for whites (Figure 45).

Hispanics—During 2010–2011, the rate of P&S 

syphilis among Hispanics increased 4.5% (from 4.4 to 

4.6 cases per 100,000 population). In 2011, 16.7% of 

all cases reported to CDC were among Hispanics. The 

2011 rate of P&S syphilis for Hispanics was 2.0 times 

the rate for whites (Figure 45).

Congenital Syphilis

In 2011, the rate of congenital syphilis was 33.0 cases 

per 100,000 live births among blacks and 7.6 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 15.0 and 3.5 times, 

respectively, the rate among whites (2.2 cases per 

100,000 live births) (Table 42, Figure V). 
74 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2011

1 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 2008;35(12 

Suppl):S13-8.

2 Cunningham PJ, Cornelius LJ. Access to ambulatory care for 

American Indians and Alaska Natives; the relative importance of 

personal and community resources. Soc Sci Med. 1995:40(3):

393-407. 

3 Gonzalez JS, Hendriksen ES, Collins EM, Duran RE, Safren SA. 

Latinos and HIV/AIDS: examining factors related to disparity and 

identifying opportunities for psychosocial intervention research. 

AIDS Behav. 2009:13:582-602.

4 Laumann EO, Youm Y. Racial/ethinic group differences in the 

prevalence of sexually transmitted diseases in the United States: a 

network explanation. Sex Transm Dis. 1999;26(5):250-61. 

5 Institute of Medicine. The Hidden Epidemic: Confronting 

Sexually Transmitted Diseases. Washington, DC: National 

Academy Press; 1997. 

6 DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. 

Smith, U.S. Census Bureau, Current Population Reports, P60-238, 

Income, Poverty, and Health Insurance Coverage in the United States: 

2010, U.S. Government Printing Office, Washington, DC, 2011.

7 U.S. Department of Labor U.S. Bureau of Labor Statistics. Labor 

Force Characteristics by Race and Ethnicity, 2010. August 2011.

Report 1032.

8 U.S. Department of Commerce, Census Bureau. Current 

Population Survey (CPS), October 1967-October 2010.

9 Austin, Algernon. Different Race, Different Recession: American 

Indian Unemployment in 2010. www.epi.org/publication/ib289.

10 Pérez-Escamilla R. Health care access among latinos: implications 

for social and health care reform. J Hispanic High Educ. 

2010:9(1):43-60.

11 Berk ML, Schur CL. The effect of fear on access to care 

among undocumented latino immigrants. J Immigr Health. 

2001;3(3):151-156. 

12 Wiehe SE, Rosenman MB, Wang J, Katz BP, Fortenberry D. 

Chlamydia screening among young women: individual- and 

provider-level differences in testing. Pediatrics. 2011;127(2):

e336-44.

13 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 2008;35(12 

Suppl):S13-8. 

14 Miller WC. Epidemiology of chlamydial infection: are we losing 

ground? Sex Transm Infect. 2008;84:82-6. 

15 Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, 

McQuillan G, et al. Gonorrhea and chlamydia in the United 

States among persons 14 to 39 years of age, 1999 to 2002. Ann 

Intern Med. 2007;147(2):89-96.

16 Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, 

Hobbs MM, et al. Prevalence of chlamydial and gonococcal 

infections among young adults in the United States. JAMA. 

2004;291(18):2229-36.

17 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.

18 Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. 

The changing epidemiology of syphilis. Sex Transm Dis. 

2005;32(Suppl 10):S4-10.

19 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.

20 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.

21 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 2011 Special Focus Profiles: STDs in Racial and Ethnic Minorities 75

Figure O.

Men Rate (per 100,000 population) Women

2250 1800 1350 900 450 0 0 Race/Ethnicity 450 900 1350 1800 2250

296.9 AI/AN* 983.8

61.2 A/PI* 164.3

787.7 Blacks 1563.0

193.8 Hispanics 578.2

82.3 Whites 232.7

256.9 Total 648.9

Figure P.

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate Ratio†

American Indians/Alaska Natives

Asians/Pacific Islanders

Blacks

Hispanics

Figure P. Gonorrhea—Rate Ratios* by Race/Ethnicity, United States, 2002–2011

Figure O. Chlamydia—Rates by Race/Ethnicity and Sex, United States, 2011

* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.

* 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.
76 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2011

Figure R.

Rate Ratio†

West

Midwest

Northeast

South

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Blacks Hispanics A/PI‡ AI/AN‡

Figure Q.

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 Race/Ethnicity 150 300 450 600 750

84.4 AI/AN* 145.3

17.0 A/PI* 13.2

428.3 Blacks 425.4

53.9 Hispanics 53.6

22.1 Whites 28.0

98.7 Total 108.9

Figure R. Gonorrhea—Rate Ratios* by Race/Ethnicity and Region, United States, 2011

Figure Q. Gonorrhea—Rates by Race/Ethnicity and Sex, United States, 2011

* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.

* Rate ratios are calculated as the gonorrhea rate per 100,000 population for a given racial or ethnic minority population divided by the gonorrhea rate 

per 100,000 population for non-Hispanic whites. Any population with a lower rate of gonorrhea than the non-Hispanic white population will have a rate 

ratio of less than 1:1.

† Y-axis is log scale.

‡ AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.
STD Surveillance 2011 Special Focus Profiles: STDs in Racial and Ethnic Minorities 77

Figure S. 

Men Rate (per 100,000 population) Women

30 24 18 12 6 0 Race/Ethnicity 0 6 12 18 24 30

5.0 AI/AN* 0.5

3.1 A/PI 0.1 *

27.0 Blacks 5.0

8.5 Hispanics 0.6

4.4 Whites 0.3

8.2 To 1.0 tal

Figure T.

 0

 4

 8

 12

 16

 20

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

American Indians/Alaska Natives

Asians/Pacific Islanders

Blacks

Hispanics

Whites

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

Ethnicity, United States, 2002–2011

Figure S. Primary and Secondary Syphilis—Rates by Race/Ethnicity and Sex, United States, 2011

* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.
78 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2011

Figure U.

 0

 10

 20

 30

 40

 50

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 population)

American Indians/Alaska Natives

Asians/Pacific Islanders

Blacks

Hispanics

Whites

Figure V.

 0

 10

 20

 30

 40

 50

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate (per 100,000 live births)

American Indians/Alaska Natives

Asians/Pacific Islanders

Blacks

Hispanics

Whites

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

States, 2002–2011

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

United States, 2002–2011

Note: Cases missing maternal race/ethnicity information were excluded (< 1% of cases).
STD Surveillance 2011 Special Focus Profiles: STDs in Men Who Have Sex with Men 79

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, 

trends in STDs among MSM in the United States are 

based on findings from sentinel surveillance systems. 

Furthermore, testing strategies are often suboptimal 

for detecting STDs in MSM. Testing for gonorrhea 

and chlamydia in MSM largely focuses on detecting 

urethral infections, which are more likely to be 

symptomatic than pharyngeal or rectal infections.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, 2011

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 2011, a total of 42 STD clinics at these 12 sites 

collected enhanced behavioral and demographic 

information on patients who presented for care to these 

clinics.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 2011, the proportion of MSM who tested positive 

for gonorrhea and chlamydia at STD clinics varied 

by SSuN site (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 Hartford/New Haven (where the 

proportion for chlamydia was higher). 

Across the participating sites, about the same number 

of MSM were tested for gonorrhea (20,333) and 

chlamydia (19,957). The median site-specific gonorrhea 

prevalence was 14.5% (range by site: 2.8%–21.0%). 

The median site-specific chlamydia prevalence was 

11.3% (range by site: 6.5%–23.1%). For this report, a 

person who tested positive for gonorrhea or chlamydia 

more than one time in a year was counted only once for 

each infection.
80 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2011

Co-infection of P&S Syphilis and HIV

In 2011, the proportion of MSM who presented to 

SSuN clinics with P&S syphilis infection who also 

were infected with HIV ranged from 14.3% in Los 

Angeles to 65% in Baltimore (Figure X). The median 

site-specific proportion co-infected with HIV was 

40.4%. P&S syphilis was identified by provider 

diagnosis and HIV was identified by laboratory report, 

self-report, or provider diagnosis.

HIV status and STDs

When comparing the prevalence of STDs by HIV 

status in MSM visiting SSuN STD clinics, the 

prevalence was lower among HIV-negative MSM 

status than among HIV-positive MSM (Figure Y). The 

prevalence of P&S syphilis was 2.6% among HIVnegative MSM and 10.1% among HIV-positive MSM. 

Urethral gonorrhea positivity was 9.0% in MSM who 

were HIV-negative and 12.5% in HIV-positive MSM. 

Pharyngeal gonorrhea positivity was 5.5% in MSM 

who were HIV-negative and 6.6% in HIV-positive 

MSM; rectal gonorrhea positivity was 7.2% in MSM 

who were HIV-negative and 12.9% in HIV-positive 

MSM. Urethral chlamydia was 7.4% in MSM who 

were HIV-negative and 8.3% in HIV-positive MSM; 

rectal chlamydia positivity was 10.8% in MSM who 

were HIV-negative and 20.6% in HIV-positive MSM. 

Nationally Notifiable Syphilis 

Surveillance Data

In 33 areas reporting sex of partner data, cases among 

women and among men having sex with women only 

(MSW) have declined since 2008, while cases among 

MSM have increased each consecutive year (Figure 

37). Increases in primary and secondary syphilis among 

MSM have been increasing since 2000. 14,15 In 2011, 

MSM accounted for 72% of all P&S syphilis cases in 

46 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 47). 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.4,16

GISP also reports the percentage of N. gonorrhoeae

isolates obtained from MSM. Overall, the proportion 

of isolates from MSM in selected STD clinics from 

GISP sentinel sites has increased steadily, from 4.6% 

in 1990 to 29.7% in 2011 (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 2011 Special Focus Profiles: STDs in Men Who Have Sex with Men 81

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

in primary and secondary syphilis among men who have sex 

with men in the United States. Am J Public Health. 2007 

Jun;97(6):1076-83.

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

III, Thompson S, et al. National surveillance of antimicrobial 

resistance in Neisseria gonorrhoeae. JAMA. 1990;264(11):1413‐7. 
82 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2011

Figure W.

Percentage

Gonorrhea

Chlamydia

 0

 7

 14

 21

 28

 35

San Francisco Los Angeles Seattle Denver Chicago New

Orleans Birmingham Richmond Baltimore Philadelphia New York City Hartford/ New Haven

100

Figure X. 

Percentage

 0

 20

 40

 60

 80

100

San

Francisco

Los

Angeles

Seattle Denver Chicago Baltimore Philadelphia New York

City

Figure X. Primary and Secondary Syphilis and HIV—Proportion of MSM* Attending STD Clinics with 

Primary and Secondary Syphilis Who are Co-infected with HIV, STD Surveillance Network 

(SSuN), 2011

Figure W. Gonorrhea and Chlamydia—Proportion of MSM* Attending STD Clinics Testing Positive 

for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2011

* MSM = men who have sex with men.

* MSM = men who have sex with men.

Note: Includes sites that reported data on at least 25 MSM with primary and secondary syphilis in 2011
STD Surveillance 2011 Special Focus Profiles: STDs in Men Who Have Sex with Men 83

Figure Z.

 0

 10

 20

 30

 40

 50

Year

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Percentage

Figure Y.

Percentage

HIVHIV+

 0

 4

 8

 12

 16

 20

P&S 

syphilis

GC‡

urethral

GC

pharyngeal

GC

rectal

CT‡

urethral

CT

rectal

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

STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 1990–2011

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

Gonorrhea or Chlamydia by HIV Status†

, STD Surveillance Network (SSuN), 2011

* MSM = men who have sex with men.

† Excludes all persons for whom there was no laboratory documentation or self-report of HIV status.

‡ GC urethral and CT urethral include results from both urethral and urine specimens.

* MSM = men who have sex with men.
84 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2011

Figure AA. 

Year

0%

50%

100%

'08'09'10 '11

% of Isolates

from MSM*

 BHM

 PHX

 LAX

 ORA

 SDG

 SFO DEN

 MIA

 ATL

 HON TRP

 CHI

 NOR

 BAL

 DTR

 MIN

 LVG KCY

 ALB

 NYC

 GRB

 CIN

 CLE

 OKC

 POR

 PHI

 DAL

 RIC

 SEA

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

STD*Clinics, by Site, Gonococcal Isolate Surveillance Project (GISP), 2008–2011

* MSM = men who have sex with men; STD = sexually transmitted disease.

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)
STD Surveillance 2011 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 85

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 2011, STD screening data from corrections 

facilities were reported in 33 states and Puerto 

Rico for chlamydia and in 32 states and Puerto 

Rico for gonorrhea. Line-listed (i.e., case-specific) 

data for chlamydia and gonorrhea are provided to 

CDC through the regional infertility prevention 

infrastructure. The figures and tables presented in this 

section represent 40,211 chlamydia tests of women 

(19,081 from juvenile corrections facilities and 21,130 

from adult facilities), 96,917 chlamydia tests of men 

(64,350 from juvenile facilities and 32,567 from 

adult facilities), 37,754 gonorrhea tests of women 

(16,991 from juvenile facilities and 20,763 from 

adult facilities), and 93,193 gonorrhea tests of men 

(61,080 from juvenile facilities and 32,113 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 118 juvenile 

corrections facilities, the overall chlamydia positivity 

was 7.4% (Figure BB). Chlamydia positivity ranged 

from 1.0% for adolescent males aged 12 years to 

10.2% for those aged 18 years. 

Females in Juvenile Corrections Facilities—Among 

females aged 12–18 years entering 63 juvenile 

corrections facilities, the overall chlamydia positivity 

was 15.7% (Figure BB). Positivity ranged from 5.4% 

for females aged 12 years to 17.3% for those aged 17 

years. 

Men in Adult Corrections Facilities—Among 

men entering 49 adult corrections facilities in 2011, 

positivity in men aged younger than 20 years (12.6%) 

was higher than the overall prevalence observed in 

adolescent males entering juvenile facilities (7.4%) 

(Figure CC). Chlamydia positivity decreased with 

age, from 12.6% for those aged younger than 20 years 

to 1.6% for those aged older than 34 years. Overall 

chlamydia positivity among adult men entering 

corrections facilities in 2011 was 7.1%. 

Women in Adult Corrections Facilities—Among 

women entering 34 adult corrections facilities in 2011, 

positivity was 7.4% (Figure CC). Chlamydia positivity 

decreased with age, from 16.8% for those aged younger 

than 20 years to 2.5% for those aged older than 34 

years. Overall chlamydia positivity in women entering 

adult corrections facilities (7.4%) was substantially 

lower than that in adolescent females entering juvenile 

corrections facilities (15.7%). However, chlamydia 

positivity among women aged younger than 20 years 

entering adult corrections facilities was similar to that 

among females entering juvenile corrections facilities.
86 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2011

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 115 

juvenile corrections facilities in 2011 was 1.2% (Figure 

DD). Positivity increased with age, from 0.1% for 

those aged 12 years to 2.3% for those aged 18 years.

Females in Juvenile Corrections Facilities—The 

overall gonorrhea positivity for adolescent females 

entering 57 juvenile corrections facilities in 2011 was 

4.4% (Figure DD). Positivity ranged from 2.5% for 

those aged 13 years to 4.9% for those aged 16 years. 

Men in Adult Corrections Facilities—The overall 

gonorrhea positivity for men entering 49 adult 

corrections facilities in 2011 was 1.0% (Figure EE). 

Positivity was highest in men aged younger than 20 

years (1.7%) and declined with age to 0.4% in men 

aged older than 34 years. Men aged younger than 

20 years entering adult facilities (1.7%) had a similar 

gonorrhea positivity compared with males entering 

juvenile corrections facilities (1.2%).

Women in Adult Corrections Facilities—Among 

women entering 32 adult corrections facilities in 2011, 

overall gonorrhea positivity was 1.8% (Figure EE). 

Positivity decreased with age, from 4.3% among those 

aged younger than 20 years to 0.8% among those 

aged older than 34 years. Women aged younger than 

20 years entering adult facilities (4.3%) had a similar 

gonorrhea positivity compared with females entering 

juvenile corrections facilities (4.4%).

Syphilis

In 2011, reports of P&S syphilis cases from corrections 

facilities accounted for 6% of P&S syphilis among 

MSW, 3% among women, and 1% among MSM 

(Figure 49).

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 2011 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 87

Figure BB. 

Men Positivity Women

20 16 12 8 4 0 0 Age 4 8 12 16 20

1.0 12 5.4

1.5 13 10.1

3.7 14 14.3

6.0 15 16.5

8.9 16 16.6

9.9 17 17.3

10.2 18 12.6

7.4 To 15.7 tal

Figure CC. 

Men Positivity Women

20 16 12 8 4 0 0 Age 4 8 12 16 20

12.6 <20 16.8

10.3 20-24 10.4

5.9 25-29 7.0

4.1 30-34 4.8

1.6 >=35 2.5

7.1 To 7.4 tal

Figure CC. Chlamydia—Positivity by Age and Sex, Adult Corrections Facilities, 2011

Figure BB. Chlamydia—Positivity by Age and Sex, Juvenile Corrections Facilities, 2011

Note: Includes chlamydia positivity data from facilities reporting more than 100 results.

Note: Includes chlamydia positivity data from facilities reporting more than 100 results
88 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2011

Figure DD. 

Men Positivity Women

20 16 12 8 4 0 0 Age 4 8 12 16 20

0.1 12 3.0

0.3 13 2.5

0.7 14 4.8

1.0 15 4.3

1.5 16 4.9

1.6 17 4.6

2.3 18 4.0

1.2 To 4.4 tal

Figure EE. 

Men Positivity Women

20 16 12 840 Age 0 4 8 12 16 20

1.7 <20 4.3

1.4 20-24 2.2

0.7 25-29 1.8

0.5 30-34 1.3

0.4 >=35 0.8

1.0 Total 1.8

Figure EE. Gonorrhea—Positivity by Age and Sex, Adult Corrections Facilities, 2011

Figure DD. Gonorrhea—Positivity by Age and Sex, Juvenile Corrections Facilities, 2011

Note: Includes gonorrhea positivity data from facilities reporting more than 100 results.

Note: Includes gonorrhea positivity data from facilities reporting more than 100 results.
TABLES
TABLES
STD Surveillance 2011 National Summary Tables 89

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

per 100,000 Population, United States, 1941–2011

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Laten

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancr

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
90 National Summary Tables STD Surveillance 2011

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

per 100,000 Population, United States, 1941–2011 (continued)

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Laten

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancr

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3

1995 69,359 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,863 47.8 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1

1997 46,716 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,082 27.9 537,904 205.5 327,665 120.2 246 0.1

1998 38,289 13.9 7,007 2.5 12,696 4.6 17,743 6.4 843 21.4 614,250 231.8 356,492 129.2 189 0.1

1999 35,386 12.7 6,617 2.4 11,534 4.1 16,655 6.0 580 14.6 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 580 14.3 709,452 251.4 363,136 128.7 78 0.0

2001 32,286 11.3 6,103 2.1 8,701 3.0 16,976 5.9 506 12.6 783,242 274.5 361,705 126.8 38 0.0

2002 32,919 11.4 6,862 2.4 8,429 2.9 17,168 6.0 460 11.4 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 432 10.6 877,478 301.7 335,104 115.2 54 0.0

2004 33,423 11.4 7,980 2.7 7,768 2.6 17,300 5.9 375 9.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,288 11.2 8,724 2.9 8,176 2.8 16,049 5.4 339 8.2 976,445 329.4 339,593 114.6 17 0.0

2006 36,958 12.3 9,756 3.3 9,186 3.1 17,644 5.9 372 8.7 1,030,911 344.3 358,366 119.7 19 0.0

2007 40,925 13.6 11,466 3.8 10,768 3.6 18,256 6.1 435 10.1 1,108,374 367.5 355,991 118.0 23 0.0

2008 46,292 15.2 13,500 4.4 12,401 4.1 19,945 6.6 446 10.5 1,210,523 398.1 336,742 110.7 25 0.0

2009 44,830 14.6 13,997 4.6 13,066 4.3 17,338 5.6 429 10.1 1,244,180 405.3 301,174 98.1 28 0.0

2010 45,844 14.8 13,774 4.5 13,604 4.4 18,079 5.9 387 9.1 1,307,893 423.6 309,341 100.2 24 0.0

2011 46,042 14.9 13,970 4.5 13,136 4.3 18,576 6.0 360 8.5 1,412,791 457.6 321,849 104.2 8 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 7, 2012 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. For more information regarding 

reporting, see Appendix, Interpreting STD Surveillance Data. Cases and rates shown in this table exclude the outlying areas of Guam, Puerto Rico, and Virgin Islands.
STD Surveillance 2011 Chlamydia Tables 91

Table 2. Chlamydia—Reported Cases and Rates by State, Ranked by Rates, United States, 2011

Rank* State Cases Rate per 100,000 Populat

1 Alaska 5,739 808.0

2 Mississippi 21,216 715.0

3 Louisiana 31,614 697.4

4 South Carolina 28,932 625.5

5 Alabama 29,626 619.8

6 North Carolina 54,819 574.9

7 Georgia 54,403 561.6

8 New Mexico 11,374 552.4

9 Arkansas 16,052 550.5

10 New York 102,763 530.3

11 Illinois 64,939 506.1

12 Delaware 4,508 502.0

13 Michigan 49,568 501.5

14 Texas 124,882 496.6

15 Tennessee 31,105 490.1

16 Maryland 27,212 471.3

17 Missouri 27,887 465.6

18 Arizona 29,251 457.6

U.S. TOTAL† 1,412,791 457

19 Ohio 52,653 456.4

20 Virginia 36,314 453.9

21 California 166,773 447.7

22 Hawaii 6,001 441.2

23 Colorado 21,811 433.7

24 Wisconsin 24,619 432.9

25 Indiana 27,801 428.8

26 South Dakota 3,409 418.7

27 Pennsylvania 52,884 416.3

28 Florida 76,033 404.4

29 Rhode Island 4,146 393.9

30 Oklahoma 14,596 389.1

31 Nevada 10,507 389.1

32 Kentucky 16,629 383.2

33 Connecticut 13,649 381.9

34 Kansas 10,598 371.5

35 Nebraska 6,780 371.2

36 Wyoming 2,092 371.2

37 North Dakota 2,445 363.5

38 Oregon 13,643 356.1

39 Iowa 10,705 351.4

40 Massachusetts 22,764 347.7

41 Washington 23,280 346.2

42 Montana 3,406 344.2

43 Minnesota 16,902 318.7

44 Idaho 4,699 299.8

45 New Jersey 26,209 298.1

46 Utah 7,086 256.4

47 Vermont 1,483 237.0

48 Maine 3,094 232.9

49 West Virginia 4,295 231.8

50 New Hampshire 3,010 228.6

* States were ranked by rate, then case count, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 6,585 cases and a rate of 1,094.4, but excludes outlying areas (Guam with 1,071 cases and rate of 

592.2, Puerto Rico with 5,634 cases and rate of 151.2, and Virgin Islands with 820 cases and rate of 747.2).
92 Chlamydia Tables STD Surveillance 2011

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

United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 25,153 24,760 25,929 27,041 29,626 543.5 531.1 550.7 565.7 619.8

Alaska 4,911 4,861 5,166 6,019 5,739 718.5 708.3 739.6 847.5 808.0

Arizona 24,866 24,769 26,002 26,861 29,251 392.3 381.1 394.2 420.2 457.6

Arkansas 9,954 14,136 14,354 15,424 16,052 351.1 495.1 496.8 529.0 550.5

California 141,928 148,798 146,796 150,443 166,773 388.3 404.8 397.2 403.8 447.7

Colorado 17,186 19,180 19,998 19,447 21,811 353.5 388.3 398.0 386.7 433.7

Connecticut 11,454 12,519 12,127 12,649 13,649 327.0 357.6 344.7 353.9 381.9

Delaware 3,479 3,868 4,718 4,464 4,508 402.3 443.0 533.0 497.1 502.0

District of Columbia 6,029 6,924 6,549 5,589 6,585 1,024.8 1,169.9 1,092.1 928.8 1,094.4

Florida 57,575 71,017 72,931 74,744 76,033 315.5 387.5 393.4 397.5 404.4

Georgia 42,913 42,629 39,828 45,147 54,403 449.6 440.1 405.2 466.0 561.6

Hawaii 5,659 5,982 6,026 6,015 6,001 440.9 464.4 465.3 442.2 441.2

Idaho 3,722 4,194 3,842 4,208 4,699 248.2 275.2 248.5 268.4 299.8

Illinois 55,470 59,169 60,542 60,672 64,939 431.6 458.6 468.9 472.9 506.1

Indiana 20,712 22,154 21,732 22,825 27,801 326.4 347.4 338.3 352.0 428.8

Iowa 8,643 9,372 9,406 10,542 10,705 289.3 312.1 312.7 346.1 351.4

Kansas 8,180 9,208 10,510 9,601 10,598 294.7 328.6 372.9 336.5 371.5

Kentucky 8,798 12,163 13,293 16,376 16,629 207.4 284.9 308.1 377.4 383.2

Louisiana 19,362 22,659 27,628 29,151 31,614 451.0 513.7 615.0 643.0 697.4

Maine 2,541 2,608 2,431 2,586 3,094 192.9 198.1 184.4 194.7 232.9

Maryland 23,150 24,669 23,747 26,192 27,212 412.0 437.9 416.7 453.7 471.3

Massachusetts 16,145 17,503 19,315 21,080 22,764 250.3 269.4 292.9 321.9 347.7

Michigan 37,353 44,923 45,714 49,478 49,568 370.9 449.1 458.5 500.6 501.5

Minnesota 13,413 14,351 14,197 15,294 16,902 258.1 274.9 269.6 288.4 318.7

Mississippi 21,686 21,253 23,589 21,417 21,216 743.0 723.2 799.1 721.8 715.0

Missouri 23,308 24,817 25,868 26,049 27,887 396.5 419.8 432.0 435.0 465.6

Montana 2,748 3,101 2,988 3,082 3,406 286.9 320.5 306.5 311.5 344.2

Nebraska 5,132 5,573 5,443 5,114 6,780 289.2 312.5 303.0 280.0 371.2

Nevada 9,514 9,670 10,045 9,666 10,507 370.9 371.9 380.0 357.9 389.1

New Hampshire 2,055 2,109 2,102 2,462 3,010 156.2 160.3 158.7 187.0 228.6

New Jersey 21,536 22,405 23,974 26,142 26,209 247.9 258.0 275.3 297.3 298.1

New Mexico 9,460 9,262 9,493 11,706 11,374 480.2 466.8 472.4 568.5 552.4

New York 80,717 88,359 92,069 99,920 102,763 418.3 453.3 471.1 515.6 530.3

North Carolina 30,611 37,516 41,045 42,048 54,819 337.8 406.8 437.5 441.0 574.9

North Dakota 1,789 1,921 1,957 2,404 2,445 279.7 299.5 302.5 357.4 363.5

Ohio 47,434 47,117 48,239 51,150 52,653 413.7 410.2 417.9 443.4 456.4

Oklahoma 12,529 14,803 15,023 14,302 14,596 346.4 406.4 407.5 381.2 389.1

Oregon 9,849 10,744 11,497 12,352 13,643 262.8 283.5 300.5 322.4 356.1

Pennsylvania 42,469 42,233 43,068 47,518 52,884 341.6 339.3 341.7 374.1 416.3

Rhode Island 3,177 3,317 3,615 3,480 4,146 300.3 315.7 343.2 330.6 393.9

South Carolina 26,431 26,323 26,654 26,525 28,932 599.7 587.6 584.4 573.5 625.5

South Dakota 2,620 2,956 3,015 3,192 3,409 329.1 367.6 371.1 392.1 418.7

Tennessee 26,866 28,038 29,711 28,327 31,105 436.4 451.1 471.9 446.4 490.1

Texas 85,786 100,870 105,910 119,872 124,882 358.9 414.6 427.4 476.7 496.6

Utah 5,721 6,021 6,145 6,690 7,086 216.3 220.0 220.7 242.1 256.4

Vermont 1,057 1,190 1,186 1,257 1,483 170.1 191.5 190.7 200.9 237.0

Virginia 24,579 31,218 30,903 30,797 36,314 318.7 401.8 392.0 384.9 453.9

Washington 18,784 21,402 21,387 21,348 23,280 290.4 326.8 320.9 317.5 346.2

West Virginia 3,168 3,316 3,604 3,876 4,295 174.8 182.8 198.0 209.2 231.8

Wisconsin 19,555 20,996 20,906 23,236 24,619 349.1 373.1 369.7 408.6 432.9

Wyoming 1,197 1,577 1,963 2,113 2,092 228.9 296.1 360.7 374.9 371.2

U.S. TOTAL 1,108,374 1,210,523 1,244,180 1,307,893 1,412,791 367.5 398.1 405.3 423.6 457

Northeast 181,151 192,243 199,887 217,094 230,002 331.3 350.0 361.6 392.5 415.8

Midwest 243,609 262,557 267,529 279,557 298,306 366.9 394.5 400.3 417.7 445.7

South 428,069 486,162 505,416 531,292 578,821 387.6 435.2 446.0 463.8 505.3

West 255,545 269,561 271,348 279,950 305,662 364.6 380.4 379.1 389.1 424.9

Guam 822 687 620 899 1,071 473.7 390.4 347.5 497.1 592.2

Puerto Rico 7,909 6,874 7,302 5,960 5,634 200.6 173.8 184.1 160.0 151.2

Virgin Islands 348 587 488 609 820 316.9 534.4 444.4 554.9 747.2

OUTLYING AREAS 9,079 8,148 8,410 7,468 7,525 214.8 192.2 197.6 185.9 1

TOTAL 1,117,453 1,218,671 1,252,590 1,315,361 1,420,316 365.4 395.3 402.4 420.6 454.
STD Surveillance 2011 Chlamydia Tables 93

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

Alphabetical Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 19,186 18,744 19,413 20,030 21,217 804.2 779.8 799.8 814.4 862.6

Alaska 3,295 3,253 3,364 3,960 3,801 1,002.6 989.7 1,000.5 1,162.6 1,116.0

Arizona 18,794 18,358 19,097 19,529 21,196 593.7 566.0 580.6 607.2 659.0

Arkansas 7,893 10,643 10,689 11,303 11,921 546.0 730.6 725.2 761.5 803.1

California 101,175 104,201 101,716 102,645 114,657 553.6 567.3 551.1 547.8 612.0

Colorado 12,707 13,825 14,765 14,188 15,751 527.1 564.7 592.1 565.6 627.9

Connecticut 8,577 9,239 8,937 9,223 9,824 477.7 515.0 496.3 502.8 535.5

Delaware 2,554 2,789 3,573 3,296 3,191 573.3 620.1 784.5 711.9 689.2

District of Columbia 3,970 4,438 4,153 3,782 4,357 1,279.9 1,422.7 1,311.8 1,191.2 1,372.3

Florida 42,173 52,206 52,747 53,318 54,262 454.3 560.0 560.3 554.7 564.5

Georgia 31,827 31,515 29,074 32,863 39,829 656.1 640.4 582.2 662.8 803.2

Hawaii 4,228 4,422 4,399 4,340 4,314 663.1 692.4 686.5 639.1 635.3

Idaho 2,660 3,048 2,768 3,014 3,345 357.1 402.5 359.5 385.3 427.6

Illinois 41,733 43,112 44,560 44,598 46,728 640.2 659.0 680.2 682.1 714.7

Indiana 15,576 16,513 16,150 16,344 20,065 483.9 510.6 495.6 496.2 609.1

Iowa 6,310 6,882 6,785 7,612 7,647 416.9 452.9 445.7 494.9 497.2

Kansas 6,629 7,401 8,209 7,449 8,158 473.6 524.8 578.5 518.1 567.4

Kentucky 6,184 8,622 9,621 11,859 11,990 285.9 395.3 438.0 538.0 543.9

Louisiana 15,334 17,260 20,719 20,564 23,390 694.6 760.4 898.1 888.6 1,010.8

Maine 1,831 1,847 1,705 1,814 2,149 271.5 274.0 252.7 267.4 316.8

Maryland 18,230 19,337 18,782 19,827 20,004 628.7 665.4 639.8 664.9 670.9

Massachusetts 11,671 12,646 13,786 14,753 15,744 351.2 378.1 406.8 436.4 465.7

Michigan 28,341 33,719 33,860 36,431 36,367 554.4 663.8 668.3 723.5 722.2

Minnesota 9,681 10,266 10,204 10,965 11,827 371.0 391.8 385.7 410.4 442.7

Mississippi 16,718 16,323 17,829 15,958 15,697 1,110.8 1,077.6 1,172.2 1,045.7 1,028.6

Missouri 17,080 18,116 18,825 18,867 20,097 567.9 599.1 614.9 617.5 657.7

Montana 2,024 2,227 2,134 2,194 2,390 423.2 461.1 438.2 445.3 485.0

Nebraska 3,755 4,123 3,884 3,561 4,783 419.5 458.5 429.2 387.0 519.9

Nevada 7,044 7,131 7,112 6,897 7,215 559.7 559.0 548.3 515.9 539.7

New Hampshire 1,533 1,548 1,542 1,808 2,184 230.0 232.2 229.6 271.0 327.4

New Jersey 17,355 18,001 18,757 20,128 19,886 391.1 406.3 422.5 446.1 440.7

New Mexico 7,044 6,986 6,987 8,718 8,309 705.7 694.4 688.3 836.9 797.6

New York 56,590 61,280 63,882 68,693 70,466 569.5 611.1 636.1 686.9 704.6

North Carolina 25,110 30,693 33,002 33,836 42,992 541.9 652.3 688.9 691.9 879.2

North Dakota 1,194 1,291 1,297 1,577 1,603 374.7 404.0 403.0 474.0 481.8

Ohio 36,143 35,021 36,724 38,636 38,914 615.1 595.4 621.5 654.4 659.1

Oklahoma 9,130 11,117 11,101 10,297 10,349 499.0 603.0 595.2 543.6 546.3

Oregon 6,890 7,433 8,136 8,565 9,489 365.5 389.7 421.9 442.6 490.4

Pennsylvania 30,511 30,509 30,335 33,175 36,463 477.9 477.6 469.1 509.4 559.9

Rhode Island 2,282 2,400 2,603 2,478 2,984 418.0 442.7 480.5 455.4 548.4

South Carolina 20,793 20,492 21,124 20,842 22,278 919.8 891.5 902.7 877.5 937.9

South Dakota 1,894 2,185 2,214 2,300 2,491 474.2 541.7 544.7 565.4 612.3

Tennessee 19,604 20,479 21,655 20,559 22,200 622.2 642.8 671.1 632.1 682.5

Texas 67,966 79,002 82,551 92,847 95,326 567.4 648.4 665.5 732.6 752.2

Utah 3,926 3,982 4,019 4,473 4,821 299.8 293.8 290.5 325.2 350.5

Vermont 812 896 889 910 1,106 257.4 284.0 281.6 286.6 348.3

Virginia 18,136 23,172 22,390 22,348 26,283 461.8 586.3 558.7 548.4 645.0

Washington 13,793 15,581 15,741 15,634 16,641 425.0 475.1 472.0 463.3 493.1

West Virginia 2,423 2,490 2,684 2,832 3,092 262.0 269.0 289.3 301.5 329.1

Wisconsin 14,438 15,229 15,038 16,657 17,402 512.4 538.1 528.4 581.5 607.5

Wyoming 913 1,011 1,187 1,305 1,357 354.2 385.2 444.2 472.5 491.3

U.S. TOTAL 825,660 893,004 912,718 949,802 1,018,552 539.8 579.4 586.7 605.1 648

Northeast 131,162 138,366 142,436 152,982 160,806 467.1 490.9 502.6 537.8 565.3

Midwest 182,774 193,858 197,750 204,997 216,082 542.6 574.2 583.1 602.9 635.5

South 327,231 369,322 381,107 396,361 428,378 582.3 649.8 661.6 678.5 733.3

West 184,493 191,458 191,425 195,462 213,286 527.2 541.5 536.2 541.5 590.9

Guam 669 574 512 664 783 785.4 664.1 583.9 746.6 880.4

Puerto Rico 6,781 5,834 6,336 4,878 4,528 330.8 283.7 307.0 251.4 233.3

Virgin Islands 267 448 435 427 591 462.5 775.2 752.2 738.0 1,021.4

OUTLYING AREAS 7,717 6,856 7,283 5,969 5,902 351.9 311.5 329.6 286.0 2

TOTAL 833,377 899,860 920,001 955,771 1,024,454 537.1 575.6 583.1 600.9 644.

NOTE: Cases reported with unknown sex are not included in this table
94 Chlamydia Tables STD Surveillance 2011

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

Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 5,955 6,007 6,508 6,877 7,648 265.6 266.0 285.2 296.4 329.6

Alaska 1,616 1,608 1,802 2,058 1,938 455.4 449.7 497.5 556.8 524.3

Arizona 6,055 6,401 6,904 7,331 8,052 190.8 196.5 208.8 230.8 253.5

Arkansas 2,060 3,491 3,664 4,112 4,125 148.3 249.6 258.8 287.2 288.1

California 40,213 44,060 44,592 47,239 51,554 220.0 239.6 241.0 255.1 278.4

Colorado 4,479 5,319 5,228 5,259 6,057 182.8 213.5 206.6 208.6 240.3

Connecticut 2,877 3,264 3,190 3,426 3,825 168.5 191.2 185.7 196.9 219.9

Delaware 925 1,079 1,145 1,168 1,317 220.6 254.9 266.5 268.5 302.8

District of Columbia 2,034 2,438 2,390 1,789 2,225 731.4 871.1 844.3 629.4 782.8

Florida 15,376 18,593 20,069 21,362 21,685 171.4 206.5 220.0 232.5 236.0

Georgia 10,808 10,690 10,513 11,965 13,978 230.3 224.3 217.4 253.0 295.6

Hawaii 1,431 1,560 1,626 1,675 1,687 221.6 240.2 248.5 245.9 247.6

Idaho 1,030 1,133 1,051 1,183 1,347 136.5 147.8 135.5 150.6 171.5

Illinois 13,736 16,052 15,964 15,957 18,083 216.9 252.4 251.0 253.6 287.4

Indiana 5,032 5,572 5,502 6,451 7,681 160.9 177.3 173.9 202.2 240.8

Iowa 2,333 2,490 2,621 2,930 3,058 158.2 167.9 176.4 194.3 202.7

Kansas 1,551 1,807 2,301 2,152 2,440 112.7 129.8 164.4 152.0 172.4

Kentucky 2,605 3,508 3,647 4,488 4,577 125.3 168.0 172.2 210.2 214.4

Louisiana 3,758 5,226 6,841 6,658 7,568 180.2 244.1 313.1 300.0 341.0

Maine 708 761 726 768 944 110.1 118.5 112.8 118.1 145.2

Maryland 4,907 5,307 4,885 6,336 7,197 180.5 194.6 176.7 227.0 257.8

Massachusetts 4,457 4,839 5,490 6,302 7,000 142.6 153.5 171.3 199.0 221.1

Michigan 8,845 11,007 11,675 12,926 13,095 178.3 223.5 238.1 266.6 270.1

Minnesota 3,732 4,085 3,993 4,329 5,075 144.2 157.1 152.4 164.5 192.8

Mississippi 4,968 4,930 5,760 5,459 5,519 351.4 346.2 402.5 378.8 382.9

Missouri 6,228 6,701 7,043 7,182 7,790 216.9 232.0 240.7 244.8 265.6

Montana 716 865 851 888 1,016 149.3 178.5 174.4 178.8 204.6

Nebraska 1,363 1,441 1,549 1,548 1,987 155.0 163.0 173.7 170.8 219.2

Nevada 2,460 2,539 2,931 2,768 3,290 188.3 191.7 217.7 203.0 241.3

New Hampshire 522 561 560 654 826 80.4 86.4 85.8 100.7 127.2

New Jersey 4,169 4,390 5,200 5,874 6,231 98.1 103.3 121.8 137.3 145.6

New Mexico 2,415 2,272 2,500 2,986 3,054 248.5 232.2 251.3 293.5 300.2

New York 24,045 27,056 28,171 31,224 32,126 256.9 285.9 296.6 333.0 342.6

North Carolina 5,493 6,656 7,798 8,030 11,585 124.1 147.4 169.9 172.9 249.4

North Dakota 594 629 654 822 841 185.0 195.4 201.2 241.9 247.5

Ohio 10,852 10,847 10,978 12,320 13,731 194.1 193.6 194.9 218.7 243.8

Oklahoma 3,399 3,606 3,879 3,997 3,851 190.2 200.5 212.9 215.2 207.4

Oregon 2,959 3,311 3,361 3,786 4,154 158.9 175.9 177.2 199.7 219.1

Pennsylvania 11,934 11,722 12,700 14,297 16,364 197.3 193.4 206.9 231.0 264.3

Rhode Island 892 915 1,012 1,002 1,162 174.3 179.9 197.9 197.1 228.6

South Carolina 5,549 5,723 5,418 5,653 6,585 258.4 262.4 243.9 251.2 292.7

South Dakota 725 767 788 883 914 182.7 191.3 194.1 216.8 224.4

Tennessee 7,262 7,559 8,055 7,748 8,905 241.6 249.5 262.4 250.5 287.9

Texas 17,687 21,812 23,302 26,966 29,533 148.3 179.6 188.3 216.2 236.8

Utah 1,795 2,039 2,126 2,215 2,265 134.4 147.6 151.8 159.5 163.1

Vermont 245 294 297 347 377 80.1 96.2 97.1 112.6 122.3

Virginia 6,433 7,985 8,442 8,397 9,929 170.0 209.2 217.9 213.9 252.9

Washington 4,991 5,767 5,645 5,711 6,639 154.9 176.4 169.6 170.5 198.2

West Virginia 744 825 920 1,044 1,203 83.9 92.8 103.1 114.3 131.7

Wisconsin 5,090 5,707 5,740 6,573 7,203 182.8 204 204.3 232.9 255.2

Wyoming 284 563 776 808 734 107.2 208.4 280.1 281.1 255.4

U.S. TOTAL 280,337 313,779 328,783 353,923 389,970 188.6 209.3 217.1 233.2 256

Northeast 49,849 53,802 57,346 63,894 68,855 187.4 201.2 212.8 237.8 256.3

Midwest 60,081 67,105 68,808 74,073 81,898 183.7 204.6 209 225 248.7

South 99,963 115,435 123,236 132,049 147,430 184.3 210.3 221.2 235.2 262.6

West 70,444 77,437 79,393 83,907 91,787 200.7 218.1 221.3 234.1 256.0

Guam 153 113 108 235 288 173.1 126.2 119.0 255.6 313.3

Puerto Rico 1,125 1,034 957 1,076 1,106 59.4 54.5 50.3 60.3 62.0

Virgin Islands 81 139 53 182 229 155.5 267.1 102.0 350.7 441.3

OUTLYING AREAS 1,359 1,286 1,118 1,493 1,623 66.8 63.1 54.6 77.4 

TOTAL 281,696 315,065 329,901 355,416 391,593 186.9 207.3 214.9 231.2 254.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2011 Chlamydia Tables 95

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

(MSAs)* in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 21,609 20,722 20,292 22,144 27,308 409.3 385.4 370.6 420.3 518.3

Austin-Round Rock, TX 6,814 8,413 8,456 8,511 9,360 426.4 509.1 495.9 495.9 545.4

Baltimore-Towson, MD 13,053 13,537 12,883 13,988 14,399 489.2 507.6 478.8 516.1 531.2

Birmingham-Hoover, AL 6,913 6,690 6,120 6,126 6,834 623.8 598.6 541.1 543.1 605.8

Boston-Cambridge-Quincy, MA-NH 10,697 11,854 13,285 14,291 15,703 238.6 262.1 289.5 313.9 344.9

Buffalo-Cheektowaga-Tonawanda, NY 5,078 5,561 5,769 5,938 5,965 450.1 494.6 513.3 522.9 525.3

Charlotte-Gastonia-Concord, NC-SC 4,216 7,046 8,869 7,458 11,452 255.3 414.0 508.1 424.2 651.4

Chicago-Naperville-Joliet, IL-IN-WI 41,403 45,803 46,505 45,726 49,590 434.7 478.6 485.4 483.3 524.1

Cincinnati-Middletown, OH-KY-IN 10,080 10,016 8,872 9,805 10,059 472.4 464.8 408.5 460.3 472.2

Cleveland-Elyria-Mentor, OH 9,351 8,731 10,439 11,608 12,348 446.0 418.1 499.2 558.8 594.4

Columbus, OH 7,157 8,314 9,015 9,545 8,953 408.0 468.9 500.3 519.7 487.5

Dallas-Fort Worth-Arlington, TX 22,292 26,090 27,142 29,314 31,871 362.8 414.1 421.0 460.1 500.2

Denver-Aurora, CO 9,539 10,996 11,803 14,320 12,710 387.0 438.7 462.5 563.0 499.7

Detroit-Warren-Livonia, MI 17,934 24,987 25,347 27,751 26,237 401.4 564.7 575.6 645.9 610.7

Hartford-West Hartford-East Hartford, CT 4,300 4,781 4,467 4,616 4,837 361.6 401.6 373.5 380.7 399.0

Houston-Baytown-Sugar Land, TX 17,196 21,100 21,032 27,522 26,543 305.5 368.4 358.4 462.8 446.3

Indianapolis, IN 8,173 8,814 7,716 8,274 10,559 482.2 513.8 442.5 471.1 601.2

Jacksonville, FL 6,501 7,318 6,745 7,093 7,264 499.8 557.3 507.9 527.1 539.8

Kansas City, MO-KS 8,358 9,559 9,892 9,443 10,133 421.0 477.5 478.4 464.0 497.9

Las Vegas-Paradise, NV 7,333 7,753 8,177 7,614 8,337 399.3 415.5 429.7 390.2 427.3

Los Angeles-Long Beach-Santa Ana, CA 52,352 55,276 54,892 56,033 58,552 406.6 429.4 426.4 436.8 456.4

Louisville, KY-IN 3,493 4,953 5,294 6,344 6,691 283.1 397.9 420.6 494.2 521.3

Memphis, TN-MS-AR 11,349 11,896 13,368 12,463 11,685 886.3 925.2 1,024.4 947.0 887.9

Miami-Fort Lauderdale-Miami Beach, FL 13,761 18,128 19,101 19,095 19,561 254.2 334.8 344.3 343.1 351.5

Milwaukee-Waukesha-West Allis, WI 10,150 1,441 10,588 11,512 11,712 657.2 93.0 678.9 739.9 752.7

Minneapolis-St. Paul-Bloomington, MN-WI 9,514 10,093 9,925 10,870 12,027 296.6 312.5 303.5 331.4 366.7

Nashville-Davidson-Murfreesboro, TN 4,972 5,574 5,816 5,705 6,713 326.8 359.4 367.6 358.8 422.2

New Orleans-Metairie-Kenner, LA 4,573 5,109 6,701 6,947 7,998 443.8 450.5 563.1 594.9 684.9

New York-Newark-Edison, NY-NJ-PA 74,071 80,306 83,904 90,704 93,295 393.7 422.5 440.0 480.0 493.7

Oklahoma City, OK 4,646 5,650 5,475 4,704 5,087 389.4 468.4 446.1 375.4 406.0

Orlando, FL 6,825 8,287 9,199 9,491 9,545 335.8 403.3 441.7 444.7 447.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 28,116 28,749 30,449 33,050 34,799 482.4 492.4 510.2 554.0 583.4

Phoenix-Mesa-Scottsdale, AZ 15,245 14,314 15,615 16,519 17,746 364.8 334.3 357.8 394.0 423.2

Pittsburgh, PA 6,616 6,920 6,597 7,096 8,436 280.8 294.3 280.1 301.2 358.0

Portland-Vancouver-Beaverton, OR-WA 5,970 6,499 7,215 7,415 8,509 274.5 294.4 321.8 333.1 382.3

Providence-New Bedford-Fall River, RI-MA 4,297 4,551 4,865 4,759 5,559 268.4 285.0 303.9 297.3 347.3

Richmond, VA 5,294 6,783 6,681 7,065 7,845 436.4 553.4 539.6 561.5 623.5

Riverside-San Bernardino-Ontario, CA 14,316 13,557 16,934 12,263 20,749 350.8 329.4 408.7 290.3 491.1

Rochester, NY 4,833 5,294 5,767 6,575 5,842 469.0 511.9 556.9 623.6 554.1

Sacramento-Arden-Arcade-Roseville, CA 8,770 8,395 6,320 8,084 10,866 419.4 397.9 297.1 376.2 505.6

Salt Lake City, UT 3,395 3,562 3,424 3,717 3,821 308.6 319.3 302.9 330.6 339.9

San Antonio, TX 8,727 9,734 11,555 12,430 13,066 438.4 479.2 557.6 580.2 609.8

San Diego-Carlsbad-San Marcos, CA 12,693 14,373 14,169 15,341 15,346 426.7 478.9 464.0 495.6 495.8

San Francisco-Oakland-Fremont, CA 16,710 17,555 16,642 17,686 18,745 397.5 410.7 385.4 407.9 432.4

San Jose-Sunnyvale-Santa Clara, CA 5,892 5,796 5,537 5,691 5,965 326.7 318.6 301.0 309.8 324.7

Seattle-Tacoma-Bellevue, WA 10,397 11,532 11,533 11,510 12,329 314.2 344.8 338.4 334.6 358.4

St. Louis, MO-IL 13,710 14,092 14,546 14,691 15,556 489.0 500.3 514.2 522.3 553.0

Tampa-St. Petersburg-Clearwater, FL 9,501 11,230 11,835 12,158 12,595 348.8 410.8 430.8 436.8 452.5

Virginia Beach-Norfolk-Newport News, VA-NC 9,383 11,867 11,954 11,388 13,669 565.7 715.6 713.9 681.2 817.7

Washington-Arlington-Alexandria, DC-VA-MD-WV 18,069 20,943 20,116 19,870 22,660 340.5 390.9 367.3 356.0 405.9

U.S. MSAs TOTAL 635,637 690,544 718,843 752,263 807,431 390.6 420.4 432.5 453.3 486

* 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.
96 Chlamydia Tables STD Surveillance 2011

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

Areas (MSAs)* in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 15,553 14,898 14,208 15,508 19,457 582.4 547.7 512.7 573.3 719.3

Austin-Round Rock, TX 4,753 5,933 6,020 6,212 6,644 609.2 735.3 721.0 725.5 776.0

Baltimore-Towson, MD 10,416 10,774 10,187 10,744 10,668 753.5 779.9 730.8 764.4 759.0

Birmingham-Hoover, AL 5,165 4,948 4,530 4,525 4,834 900.4 855.2 774.5 775.0 828.0

Boston-Cambridge-Quincy, MA-NH 7,721 8,458 9,369 9,937 10,747 335.2 364.3 398.0 422.9 457.4

Buffalo-Cheektowaga-Tonawanda, NY 3,818 4,076 4,254 4,386 4,370 653.5 700.2 731.7 746.5 743.8

Charlotte-Gastonia-Concord, NC-SC 3,430 5,469 6,747 5,764 8,535 407.4 631.5 758.0 637.6 944.1

Chicago-Naperville-Joliet, IL-IN-WI 31,134 33,220 34,202 33,360 35,360 644.2 684.4 702.6 689.5 730.8

Cincinnati-Middletown, OH-KY-IN 8,082 8,031 7,243 7,749 7,774 740.4 728.5 652.1 711.8 714.1

Cleveland-Elyria-Mentor, OH 7,023 6,487 7,755 8,556 9,065 645.2 598.6 714.7 793.1 840.3

Columbus, OH 5,428 6,027 6,619 6,886 6,203 611.1 671.6 725.2 736.5 663.4

Dallas-Fort Worth-Arlington, TX 17,251 20,125 21,235 22,876 24,111 564.5 642.8 662.9 708.2 746.4

Denver-Aurora, CO 7,020 7,824 8,617 10,458 9,143 572.1 627.4 677.3 817.7 714.9

Detroit-Warren-Livonia, MI 13,580 18,826 18,870 20,530 19,161 594.5 831.9 836.7 927.2 865.4

Hartford-West Hartford-East Hartford, CT 3,122 3,474 3,250 3,324 3,470 511.7 569.4 530.6 534.2 557.6

Houston-Baytown-Sugar Land, TX 14,170 17,287 16,737 21,925 20,985 504.4 605.0 572.0 733.4 702.0

Indianapolis, IN 5,808 6,352 5,430 5,632 7,190 673.8 727.9 611.8 626.2 799.5

Jacksonville, FL 4,627 5,392 4,874 5,191 5,213 695.7 803.3 716.5 752.4 755.6

Kansas City, MO-KS 6,231 7,115 7,278 6,852 7,351 616.2 698.4 691.8 659.5 707.5

Las Vegas-Paradise, NV 5,620 5,842 5,874 5,537 5,777 623.0 637.5 628.5 571.4 596.1

Los Angeles-Long Beach-Santa Ana, CA 36,520 38,100 36,965 37,486 38,802 563.3 588.0 571.1 576.7 596.9

Louisville, KY-IN 2,482 3,504 3,821 4,646 4,867 392.6 548.5 593.3 707.4 741.1

Memphis, TN-MS-AR 8,846 9,199 10,170 9,529 8,743 1,332.7 1,377.8 1,501.5 1,392.6 1,277.8

Miami-Fort Lauderdale-Miami Beach, FL 9,985 13,144 13,788 13,566 13,815 359.0 472.2 485.5 472.5 481.2

Milwaukee-Waukesha-West Allis, WI 7,653 1,116 7,747 8,376 8,397 968.8 140.9 970.2 1,048.2 1,050.8

Minneapolis-St. Paul-Bloomington, MN-WI 6,727 7,037 7,028 7,710 8,275 417.2 433.7 427.0 464.2 498.2

Nashville-Davidson-Murfreesboro, TN 3,445 3,916 4,136 4,027 4,741 446.5 497.1 514.1 495.7 583.5

New Orleans-Metairie-Kenner, LA 3,503 3,722 4,875 5,065 5,956 653.5 630.1 789.5 845.0 993.7

New York-Newark-Edison, NY-NJ-PA 52,815 56,829 59,274 63,280 64,705 543.6 579.7 603.3 645.9 660.4

Oklahoma City, OK 3,262 4,119 3,912 3,292 3,518 539.5 673.4 627.6 517.9 553.5

Orlando, FL 5,203 6,160 6,740 6,777 6,993 507.6 594.1 640.8 621.9 641.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 20,132 20,708 21,297 22,863 23,928 668.7 686.9 690.9 740.7 775.3

Phoenix-Mesa-Scottsdale, AZ 11,675 10,725 11,405 11,892 12,696 564.2 506.4 529.1 564.3 602.5

Pittsburgh, PA 4,870 5,092 4,884 5,146 5,963 398.4 417.7 400.3 422.5 489.5

Portland-Vancouver-Beaverton, OR-WA 4,109 4,468 5,069 5,091 5,824 376.7 403.7 450.0 451.8 516.8

Providence-New Bedford-Fall River, RI-MA 3,116 3,327 3,503 3,433 4,022 376.8 403.6 425.1 415.1 486.4

Richmond, VA 3,778 4,981 4,843 5,282 5,710 605.1 790.6 760.1 812.9 878.8

Riverside-San Bernardino-Ontario, CA 10,773 10,009 12,305 8,810 15,241 528.4 486.8 595.5 414.8 717.6

Rochester, NY 3,337 3,594 3,859 4,448 3,935 632.2 679.0 728.8 820.8 726.1

Sacramento-Arden-Arcade-Roseville, CA 6,310 5,997 4,589 5,754 7,874 594.0 559.6 425.7 525.2 718.6

Salt Lake City, UT 2,299 2,254 2,173 2,434 2,558 425.3 411.0 389.2 436.0 458.2

San Antonio, TX 6,567 7,206 8,566 8,972 9,286 646.8 695.8 811.6 823.1 851.9

San Diego-Carlsbad-San Marcos, CA 9,187 10,257 10,050 10,538 10,395 620.4 688.0 660.5 683.6 674.3

San Francisco-Oakland-Fremont, CA 11,118 11,514 10,618 10,940 11,733 525.7 536.0 489.6 497.8 533.9

San Jose-Sunnyvale-Santa Clara, CA 4,232 4,218 3,989 3,951 4,187 480.4 475.3 443.2 431.6 457.4

Seattle-Tacoma-Bellevue, WA 7,412 7,975 8,062 8,000 8,259 447.2 477.1 473.1 463.0 478.0

St. Louis, MO-IL 10,012 10,166 10,481 10,489 11,108 691.6 699.4 718.4 723.2 765.8

Tampa-St. Petersburg-Clearwater, FL 6,841 8,099 8,323 8,527 8,913 489.4 577.2 590.9 593.9 620.8

Virginia Beach-Norfolk-Newport News, VA-NC 6,884 8,789 8,503 8,098 9,786 811.7 1,037.4 992.8 950.5 1,148.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 13,194 14,967 14,429 14,146 15,811 485.5 545.7 516.1 493.6 551.7

U.S. MSAs TOTAL 466,239 501,750 518,703 538,520 572,099 564.1 601.7 614.9 635.2 674

* 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 2011 Chlamydia Tables 97

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

(MSAs )* in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 5,896 5,585 5,923 6,471 7,549 226.0 210.3 219.0 252.4 294.4

Austin-Round Rock, TX 2,053 2,472 2,430 2,290 2,710 251.0 292.3 279.3 266.2 315.1

Baltimore-Towson, MD 2,624 2,754 2,665 3,231 3,723 204.1 214.2 205.5 247.6 285.3

Birmingham-Hoover, AL 1,745 1,740 1,588 1,545 1,852 326.4 322.8 290.7 283.9 340.3

Boston-Cambridge-Quincy, MA-NH 2,966 3,383 3,891 4,334 4,946 136.1 153.7 174.1 196.7 224.5

Buffalo-Cheektowaga-Tonawanda, NY 1,260 1,485 1,515 1,552 1,595 231.7 273.9 279.3 283.2 291.1

Charlotte-Gastonia-Concord, NC-SC 786 1,549 2,102 1,684 2,877 97.1 185.3 245.7 197.2 336.9

Chicago-Naperville-Joliet, IL-IN-WI 10,259 12,578 12,273 12,250 14,110 218.7 266.7 260.4 265.0 305.2

Cincinnati-Middletown, OH-KY-IN 1,935 1,963 1,565 2,022 2,283 185.7 186.5 147.5 194.1 219.2

Cleveland-Elyria-Mentor, OH 2,285 2,216 2,579 3,016 3,283 226.7 220.6 256.3 302.1 328.8

Columbus, OH 1,706 2,275 2,319 2,627 2,747 197.0 259.8 260.8 291.4 304.7

Dallas-Fort Worth-Arlington, TX 4,987 5,962 5,903 6,432 7,757 161.5 188.1 182.0 204.7 246.9

Denver-Aurora, CO 2,519 3,161 3,184 3,862 3,564 203.5 250.9 248.8 305.4 281.8

Detroit-Warren-Livonia, MI 4,220 5,996 6,329 7,134 7,011 193.3 277.3 294.6 342.6 336.7

Hartford-West Hartford-East Hartford, CT 1,178 1,303 1,217 1,292 1,367 203.5 224.5 208.6 219.0 231.7

Houston-Baytown-Sugar Land, TX 2,963 3,776 4,259 5,560 5,556 105.1 131.5 144.8 188.0 187.9

Indianapolis, IN 2,340 2,451 2,275 2,636 3,345 280.9 290.8 265.7 307.6 390.4

Jacksonville, FL 1,873 1,912 1,868 1,893 2,047 294.6 297.8 288.3 288.7 312.2

Kansas City, MO-KS 2,127 2,444 2,614 2,591 2,782 218.3 248.5 257.4 260.1 279.2

Las Vegas-Paradise, NV 1,704 1,911 2,301 2,076 2,558 182.4 201.3 237.7 211.4 260.4

Los Angeles-Long Beach-Santa Ana, CA 15,639 16,886 17,728 18,343 19,577 244.7 264.1 276.9 289.9 309.3

Louisville, KY-IN 1,011 1,436 1,460 1,686 1,794 168.1 237.0 237.6 269.0 286.2

Memphis, TN-MS-AR 2,503 2,697 3,197 2,928 2,942 405.8 436.4 509.4 463.4 465.6

Miami-Fort Lauderdale-Miami Beach, FL 3,771 4,934 5,304 5,523 5,721 143.3 187.5 195.9 205.0 212.4

Milwaukee-Waukesha-West Allis, WI 2,473 321 2,767 3,134 3,312 327.8 42.4 363.5 414.1 437.6

Minneapolis-St. Paul-Bloomington, MN-WI 2,787 3,056 2,897 3,160 3,752 174.6 190.1 178.4 195.2 231.8

Nashville-Davidson-Murfreesboro, TN 1,527 1,658 1,680 1,670 1,972 203.7 217.3 216.0 214.8 253.6

New Orleans-Metairie-Kenner, LA 985 1,349 1,804 1,687 2,017 199.3 248.3 315.1 296.8 354.9

New York-Newark-Edison, NY-NJ-PA 21,165 23,441 24,602 27,324 28,367 232.6 254.7 266.1 300.3 311.8

Oklahoma City, OK 1,384 1,473 1,536 1,410 1,457 235.2 247.8 254.3 228.4 236.0

Orlando, FL 1,620 2,117 2,452 2,705 2,539 160.8 208.0 237.9 258.9 243.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 7,972 8,040 9,129 10,146 10,817 283.0 284.7 316.4 352.4 375.7

Phoenix-Mesa-Scottsdale, AZ 3,569 3,586 4,210 4,626 5,047 169.1 165.7 190.6 221.8 242.0

Pittsburgh, PA 1,745 1,828 1,712 1,947 2,471 154.0 161.4 150.8 171.1 217.1

Portland-Vancouver-Beaverton, OR-WA 1,861 2,029 2,146 2,323 2,685 171.6 184.3 192.4 211.4 244.3

Providence-New Bedford-Fall River, RI-MA 1,178 1,222 1,360 1,325 1,536 152.2 158.2 175.1 171.2 198.5

Richmond, VA 1,514 1,793 1,817 1,759 2,089 257.2 301.0 302.3 289.1 343.3

Riverside-San Bernardino-Ontario, CA 3,532 3,548 4,622 3,437 5,412 172.9 172.2 222.5 163.6 257.6

Rochester, NY 1,496 1,700 1,908 2,127 1,907 297.6 336.8 377.0 415.1 372.2

Sacramento-Arden-Arcade-Roseville, CA 2,387 2,346 1,682 2,287 2,960 232.0 226.0 160.3 217.1 281.0

Salt Lake City, UT 1,096 1,308 1,251 1,283 1,263 195.9 230.6 218.7 226.7 223.2

San Antonio, TX 2,160 2,527 2,986 3,458 3,780 221.5 253.8 293.7 328.6 359.2

San Diego-Carlsbad-San Marcos, CA 3,457 4,078 4,097 4,785 4,925 231.4 270.0 267.4 308.0 317.0

San Francisco-Oakland-Fremont, CA 5,465 5,968 5,909 6,645 6,948 261.6 280.7 274.9 310.8 325.0

San Jose-Sunnyvale-Santa Clara, CA 1,633 1,558 1,513 1,649 1,667 177.0 167.2 161.0 179.0 180.9

Seattle-Tacoma-Bellevue, WA 2,985 3,538 3,471 3,509 4,070 180.7 211.4 203.7 205.0 237.7

St. Louis, MO-IL 3,698 3,925 4,065 4,200 4,444 272.7 287.9 296.7 308.3 326.2

Tampa-St. Petersburg-Clearwater, FL 2,652 3,050 3,441 3,601 3,657 200.0 229.2 257.0 267.2 271.4

Virginia Beach-Norfolk-Newport News, VA-NC 2,494 3,064 3,422 3,284 3,864 307.7 377.8 418.3 400.6 471.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 4,849 5,897 5,623 5,680 6,823 187.3 225.5 209.8 209.1 251.2

U.S. MSAs TOTAL 168,034 187,289 198,591 212,139 233,477 209.9 231.6 242.6 261.3 287

* 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.
98 Chlamydia Tables STD Surveillance 2011

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

Number of Reported Cases, United States, 2011

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Perc

1 Los Angeles County, CA 50,542 514.8 3

2 Cook County, IL 36,769 707.8 6

3 Harris County, TX 21,631 528.6 7

4 Philadelphia County, PA 20,471 1,341.5 9

5 Kings County, NY 20,123 803.4 10

6 Wayne County, MI 19,800 1,087.6 11

7 Bronx County, NY 18,037 1,302.2 13

8 Dallas County, TX 17,265 729.1 14

9 Maricopa County, AZ 16,667 436.6 15

10 San Diego County, CA 15,346 495.8 16

11 Queens County, NY 12,930 579.6 17

12 New York County, NY 12,562 792.1 18

13 Bexar County, TX 11,904 694.2 19

14 San Bernardino County, CA 10,947 537.9 20

15 Milwaukee County, WI 10,864 1,146.3 20

16 Cuyahoga County, OH 10,301 804.7 21

17 Shelby County, TN 9,802 1,056.7 22

18 Riverside County, CA 9,802 447.7 23

19 Sacramento County, CA 9,331 657.7 23

20 Marion County, IN 9,118 1,009.3 24

21 Miami-Dade County, FL 8,827 353.6 24

22 Clark County, NV 8,337 427.3 25

23 Tarrant County, TX 8,053 445.2 26

24 Orange County, CA 8,010 266.1 26

25 Baltimore (City), MD 7,837 1,262.1 27

26 Mecklenburg County, NC 7,518 817.5 27

27 Fulton County, GA 7,456 809.9 28

28 Franklin County, OH 7,412 637.1 28

29 Hillsborough County, FL 7,290 593.1 29

30 Broward County, FL 7,091 405.6 29

31 Alameda County, CA 7,040 466.1 30

32 Washington, D.C. 6,585 1,094.4 30

33 Hamilton County, OH 6,449 803.7 31

34 King County, WA 6,386 330.7 31

35 Travis County, TX 6,309 616.0 32

36 Suffolk County, MA 6,212 860.4 32

37 Prince George's County, MD 6,086 704.9 33

38 Orange County, FL 6,076 530.2 33

39 Allegheny County, PA 6,000 490.5 33

40 Orleans County, LA 5,970 1,736.3 34

41 Fresno County, CA 5,960 640.6 34

42 Duval County, FL 5,939 687.2 35

43 Santa Clara County, CA 5,764 323.5 35

44 Hennepin County, MN 5,719 496.3 35

45 Jackson County, MO 5,676 841.9 36

46 Jefferson County, AL 5,636 855.9 36

47 Kern County, CA 5,590 665.8 37

48 St. Louis County, MO 5,548 555.4 37

49 Denver County, CO 5,533 921.9 37

50 Essex County, NJ 5,263 671.3 38

51 Jefferson County, KY 5,125 691.5 38

52 Guilford County, NC 5,093 1,042.8 39

53 Erie County, NY 5,065 551.1 39

54 DeKalb County, GA 5,053 730.3 39

55 Monroe County, NY 5,009 672.9 40

56 Wake County, NC 4,961 550.6 40

57 Honolulu County, HI 4,794 502.9 40

58 San Francisco County, CA 4,778 593.4 41

59 St. Louis (City), MO 4,642 1,453.8 41

60 El Paso County, TX 4,528 565.5 41

61 Contra Costa County, CA 4,404 419.8 42

62 Hartford County, CT 4,223 472.4 42

63 Pierce County, WA 4,184 526.1 42

64 New Haven County, CT 4,123 478.0 43

65 Pima County, AZ 4,078 416.0 43

66 Davidson County, TN 4,062 648.2 43

67 Multnomah County, OR 3,957 538.1 43

68 Bell County, TX 3,951 1,273.6 44

69 Bernalillo County, NM 3,870 584.1 44

70 Pinellas County, FL 3,868 422.0 44

* Accounting for 44% of reported chlamydia cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2011.
STD Surveillance 2011 Chlamydia Tables 99

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

Sex, United States, 2007–2011

Age

Group

Cases Rates per 100,00

Total Male Female Unknown Sex Total Male Female Unknown S

0–4 1,152 422 725 5 5.6 4.0 7.2

2007

5–9 265 45 218 2 1.3 0.4 2.2

10–14 13,583 1,242 12,303 38 66.9 11.9 124.1

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

TOTAL 1,108,374 280,337 825,660 2,377 367.5 188.6 539.

0–4 1,109 409 696 4 5.3 3.8 6.8

2008

5–9 240 52 185 3 1.2 0.5 1.9

10–14 14,297 1,441 12,816 40 71.3 14.0 130.9

15–19 419,026 76,741 340,975 1,310 1,947.7 695.9 3,251.4

20–24 437,163 113,948 322,054 1,161 2,075.9 1,050.7 3,153.2

25–29 188,033 60,629 126,901 503 881.4 554.1 1,221.0

30–34 74,737 26,740 47,757 240 381.4 268.5 495.5

35–39 36,537 14,908 21,510 119 174.0 141.1 206.3

40–44 17,991 8,525 9,398 68 83.7 79.3 87.3

45–54 14,271 7,386 6,832 53 32.2 33.8 30.3

55–64 3,064 1,634 1,424 6 9.1 10.1 8.2

65+ 887 427 453 7 2.3 2.6 2.0

Unknown Age 3,168 939 2,003 226

TOTAL 1,210,523 313,779 893,004 3,740 398.1 209.3 579.

0–4 1,022 339 676 7 4.8 3.1 6.5

2009

5–9 187 33 154 0 0.9 0.3 1.5

10–14 13,899 1,405 12,447 47 69.6 13.7 127.6

15–19 429,173 80,725 347,597 851 1,992.6 730.5 3,314.7

20–24 454,760 120,975 332,946 839 2,111.3 1,090.5 3,187.3

25–29 190,481 62,437 127,708 336 878.7 561.7 1,209.1

30–34 77,606 28,344 49,103 159 390.2 280.4 502.0

35–39 36,286 14,859 21,354 73 176.7 143.5 209.7

40–44 18,263 8,750 9,467 46 87.0 83.3 90.3

45–54 15,033 7,818 7,183 32 33.7 35.6 31.8

55–64 3,365 1,787 1,573 5 9.7 10.6 8.7

65+ 946 472 471 3 2.4 2.8 2.1

Unknown Age 3,159 839 2,039 281

TOTAL 1,244,180 328,783 912,718 2,679 405.3 217.1 586.

0–4 964 327 619 18 4.8 3.2 6.3

2010

5–9 188 26 158 4 0.9 0.3 1.6

10–14 14,531 1,590 12,860 81 70.3 15.0 127.4

15–19 441,342 85,570 354,252 1,520 2,002.4 757.0 3,299.5

20–24 488,996 131,686 355,994 1,316 2,265.3 1,195.6 3,367.4

25–29 197,525 66,470 130,561 494 936.1 625.0 1,247.4

30–34 83,408 31,230 51,925 253 417.8 312.4 521.0

35–39 38,384 15,861 22,421 102 190.2 157.9 221.2

40–44 19,614 9,594 9,931 89 93.9 92.3 94.6

45–54 16,106 8,635 7,423 48 35.8 39.0 32.5

55–64 3,523 1,834 1,674 15 9.7 10.4 8.9

65+ 954 464 481 9 2.4 2.7 2.1

Unknown Age 2,358 636 1,503 219

TOTAL 1,307,893 353,923 949,802 4,168 423.6 233.2 605.

0–4 747 284 458 5 3.7 2.8 4.6

2011

5–9 143 24 118 1 0.7 0.2 1.2

10–14 15,405 1,743 13,588 74 74.5 16.5 134.6

15–19 459,029 90,764 366,818 1,447 2,082.7 803.0 3,416.5

20–24 542,947 147,948 393,534 1,465 2,515.3 1,343.3 3,722.5

25–29 214,534 73,357 140,628 549 1,016.7 689.7 1,343.6

30–34 91,787 34,971 56,562 254 459.8 349.8 567.6

35–39 40,734 16,911 23,711 112 201.9 168.4 233.9

40–44 21,654 10,460 11,120 74 103.7 100.6 105.9

45–54 18,136 9,910 8,182 44 40.3 44.8 35.8

55–64 4,210 2,300 1,903 7 11.5 13.1 10.1

65+ 1,064 569 486 9 2.6 3.3 2.1

Unknown Age 2,401 729 1,444 228

TOTAL 1,412,791 389,970 1,018,552 4,269 457.6 256.9 648.

* No population data are available for unknown sex and age; therefore, rates are not calculated.

NOTE: This table should be used only for age comparisons. Cases in the 0–4 age group may include cases due to perinatal transmission.
100 Chlamydia Tables STD Surveillance 2011

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

2007–2011

Age

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/ 

Alaska Natives

Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Femal

2007 0–4 210 70 140 0 347 139 207 1 119 45 74 0 7 2 5 0 7 1 6 0

5–9 36 8 28 0 89 16 73 0 29 4 24 1 2 0 2 0 5 1 4 0

10–14 1,860 75 1,785 0 5,941 682 5,253 6 1,560 167 1,387 6 93 6 87 0 184 13 171 0

15–19 76,281 9,047 67,183 51 147,795 32,378 115,282 135 45,851 7,979 37,820 52 3,050 430 2,615 5 4,317 700 3,613 4

20–24 96,207 22,184 73,977 46 136,713 40,976 95,635 102 55,656 13,591 42,013 52 4,838 1,015 3,815 8 4,673 1,014 3,657 2

25–29 37,206 11,492 25,698 16 55,183 20,271 34,884 28 27,812 7,991 19,795 26 2,826 746 2,072 8 2,162 493 1,667 2

30–34 12,589 4,441 8,144 4 21,194 9,228 11,953 13 11,912 3,576 8,321 15 1,450 440 1,006 4 917 241 676 0

35–39 6,284 2,563 3,715 6 9,746 5,030 4,707 9 5,281 1,763 3,512 6 823 272 551 0 431 110 321 0

40–44 3,150 1,597 1,551 2 4,849 2,793 2,052 4 2,251 858 1,390 3 452 189 263 0 245 75 170 0

45–54 2,622 1,578 1,043 1 3,948 2,415 1,527 6 1,416 564 850 2 352 141 208 3 159 51 108 0

55–64 568 381 185 2 716 449 267 0 244 90 154 0 109 51 58 0 17 5 11 1

65+ 149 99 50 0 166 88 75 3 75 33 42 0 16 8 8 0 6 3 3 0

UNK Age 542 140 393 9 765 235 519 11 322 102 217 3 43 8 33 2 38 11 26 1

TOTAL 237,704 53,675 183,892 137 387,452 114,700 272,434 318 152,528 36,763 115,599 166 14,061 3,308 10,723 30 13,161 2,718 10,433 1

2008 0–4 182 66 115 1 364 144 220 0 120 48 72 0 16 5 11 0 7 0 7 0

5–9 43 11 31 1 65 12 53 0 26 4 22 0 1 0 1 0 8 4 4 0

10–14 1,902 102 1,800 0 6,147 721 5,421 5 1,701 171 1,527 3 79 9 70 0 152 10 142 0

15–19 80,850 10,062 70,730 58 163,079 36,861 126,084 134 50,890 9,166 41,683 41 3,517 460 3,053 4 4,688 758 3,924 6

20–24 101,534 24,144 77,325 65 149,056 45,631 103,283 142 60,909 15,577 45,273 59 5,782 1,276 4,492 14 5,161 1,127 4,022 12

25–29 39,615 12,593 26,982 40 59,300 22,118 37,145 37 29,862 8,969 20,850 43 3,253 890 2,356 7 2,476 597 1,877 2

30–34 13,852 4,954 8,885 13 22,451 9,749 12,687 15 12,914 3,995 8,902 17 1,680 517 1,154 9 1,009 253 756 0

35–39 6,659 2,752 3,900 7 10,267 5,279 4,973 15 6,041 1,987 4,050 4 938 316 617 5 473 121 352 0

40–44 3,418 1,774 1,634 10 5,153 2,921 2,223 9 2,623 1,010 1,609 4 455 177 276 2 264 89 174 1

45–54 2,808 1,653 1,146 9 4,180 2,525 1,648 7 1,556 630 923 3 422 181 239 2 208 60 148 0

55–64 645 411 234 0 804 495 305 4 278 117 161 0 132 48 84 0 30 7 23 0

65+ 163 107 56 0 174 92 81 1 83 32 50 1 28 14 14 0 10 5 5 0

UNK Age 408 116 281 11 626 225 383 18 303 93 205 5 45 8 36 1 18 3 15 0

TOTAL 252,079 58,745 193,119 215 421,666 126,773 294,506 387 167,306 41,799 125,327 180 16,348 3,901 12,403 44 14,504 3,034 11,449 2

2009 0–4 173 48 124 1 307 107 199 1 95 38 56 1 6 3 3 0 15 7 8 0

5–9 27 5 22 0 52 13 39 0 22 2 20 0 0 0 0 0 0 0 0 0

10–14 1,728 90 1,638 0 5,961 731 5,226 4 1,649 179 1,468 2 75 6 69 0 166 15 151 0

15–19 82,588 11,007 71,529 52 167,271 39,037 128,094 140 52,069 9,420 42,602 47 3,467 470 2,992 5 4,481 735 3,734 12

20–24 106,157 25,653 80,433 71 157,132 49,312 107,684 136 62,431 16,222 46,162 47 5,873 1,323 4,539 11 5,293 1,204 4,085 4

25–29 41,212 13,399 27,778 35 60,528 23,007 37,472 49 30,647 9,342 21,285 20 3,296 891 2,399 6 2,422 571 1,851 0

30–34 14,933 5,501 9,416 16 23,450 10,302 13,131 17 13,207 4,229 8,965 13 1,609 457 1,149 3 1,017 279 737 1

35–39 6,600 2,797 3,796 7 10,386 5,326 5,054 6 6,105 2,012 4,084 9 926 320 600 6 475 113 362 0

40–44 3,380 1,697 1,680 3 5,102 2,965 2,135 2 2,717 1,062 1,652 3 526 197 329 0 239 71 167 1

45–54 3,087 1,890 1,194 3 4,159 2,455 1,701 3 1,728 714 1,013 1 450 186 261 3 181 62 119 0

55–64 720 481 239 0 862 514 347 1 313 125 188 0 117 46 71 0 36 13 23 0

65+ 165 106 59 0 184 96 88 0 78 34 44 0 32 19 13 0 8 4 4 0

UNK Age 501 113 373 15 716 200 476 40 276 75 187 14 29 7 21 1 14 7 7 0

TOTAL 261,271 62,787 198,281 203 436,110 134,065 301,646 399 171,337 43,454 127,726 157 16,406 3,925 12,446 35 14,347 3,081 11,248 1

2010 0–4 163 56 107 0 273 99 173 1 127 53 74 0 6 1 5 0 15 5 10 0

5–9 18 6 12 0 54 7 47 0 28 2 26 0 0 0 0 0 2 0 2 0

10–14 1,915 116 1,797 2 6,051 783 5,261 7 1,593 198 1,395 0 87 4 83 0 171 12 159 0

15–19 85,610 11,855 73,723 32 170,871 40,666 130,068 137 53,113 9,773 43,302 38 3,499 486 3,012 1 4,488 793 3,690 5

20–24 115,811 28,197 87,560 54 168,198 53,317 114,782 99 66,593 17,220 49,312 61 6,258 1,386 4,866 6 5,852 1,402 4,445 5

25–29 44,495 14,886 29,574 35 61,789 23,694 38,054 41 31,284 9,873 21,388 23 3,509 1,004 2,497 8 2,779 720 2,057 2

30–34 16,789 6,237 10,533 19 24,938 11,025 13,891 22 14,214 4,641 9,564 9 1,689 587 1,101 1 1,146 320 826 0

35–39 7,221 3,148 4,065 8 10,635 5,500 5,127 8 6,519 2,169 4,345 5 1,021 368 649 4 522 157 365 0

40–44 3,807 2,022 1,782 3 5,296 3,075 2,212 9 2,976 1,198 1,769 9 547 225 321 1 234 74 160 0

45–54 3,431 2,153 1,274 4 4,232 2,504 1,725 3 1,901 840 1,060 1 462 198 264 0 203 48 155 0

55–64 718 492 225 1 814 461 353 0 326 140 185 1 106 37 69 0 43 12 31 0

65+ 180 126 53 1 165 85 80 0 79 34 44 1 31 17 14 0 4 2 2 0

UNK Age 307 94 209 4 387 130 247 10 226 72 144 10 31 9 22 0 11 5 6 0

TOTAL 280,465 69,388 210,914 163 453,703 141,346 312,020 337 178,979 46,213 132,608 158 17,246 4,322 12,903 21 15,470 3,550 11,908 1

2011 0–4 139 47 92 0 237 100 136 1 76 29 47 0 6 1 5 0 10 1 9 0

5–9 25 4 20 1 54 12 42 0 23 0 23 0 2 0 2 0 2 0 2 0

10–14 2,121 140 1,974 7 6,560 864 5,693 3 1,796 189 1,604 3 88 7 80 1 185 13 172 0

15–19 93,979 13,454 80,372 153 171,274 41,117 129,976 181 56,789 10,500 46,227 62 3,671 515 3,152 4 5,025 919 4,093 13

20–24 133,173 33,231 99,732 210 178,887 56,770 121,948 169 72,592 18,469 54,030 93 6,690 1,448 5,235 7 6,189 1,383 4,789 17

25–29 50,871 17,182 33,592 97 64,804 25,074 39,663 67 33,425 10,455 22,924 46 3,851 1,156 2,691 4 2,899 771 2,119 9

30–34 19,736 7,554 12,153 29 26,617 11,903 14,693 21 15,439 5,051 10,364 24 1,898 636 1,258 4 1,256 336 918 2

35–39 8,062 3,429 4,620 13 10,976 5,593 5,369 14 7,208 2,377 4,824 7 1,079 374 703 2 551 144 406 1

40–44 4,581 2,398 2,177 6 5,488 3,141 2,341 6 3,427 1,346 2,078 3 582 231 349 2 249 85 164 0

45–54 4,079 2,606 1,470 3 4,654 2,811 1,835 8 2,172 965 1,206 1 513 255 256 2 229 72 157 0

55–64 965 671 294 0 999 599 400 0 379 162 216 1 162 68 94 0 49 15 34 0

65+ 236 156 80 0 169 99 70 0 91 38 52 1 26 15 11 0 5 1 4 0

UNK Age 305 86 212 7 316 103 204 9 206 76 127 3 30 10 20 0 9 4 5 0

TOTAL 318,272 80,958 236,788 526 471,035 148,186 322,370 479 193,623 49,657 143,722 244 18,598 4,716 13,856 26 16,658 3,744 12,872 4

UNK = Unknown

NOTE: These tables should only be used for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for total and sexspecific cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.

In 2011, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 26.1% of reported chlamydia cases.
STD Surveillance 2011 Chlamydia Tables 101

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

United States, 2007–2011

Age

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/ 

Alaska Natives

Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Femal

0–4 1.8 1.2 2.5 10.9 8.6 13.2 2.4 1.8 3.1 0.7 0.4 1.0 3.7 1.0 6.4

2007

5–9 0.3 0.1 0.5 2.9 1.0 4.9 0.7 0.2 1.2 0.2 0.0 0.4 2.7 1.1 4.4

10–14 15.4 1.2 30.3 189.1 42.7 339.8 39.3 8.2 71.6 10.3 1.3 19.6 91.2 12.7 171.9

15–19 577.3 133.4 1,044.6 4,380.7 1,893.9 6,927.5 1,224.0 413.6 2,081.5 335.7 91.8 594.2 1,865.3 598.0 3,159.0

20–24 733.8 329.8 1,158.8 4,475.2 2,650.4 6,338.0 1,508.3 686.3 2,457.4 507.1 208.6 816.0 2,097.9 894.0 3,345.3

25–29 294.2 180.4 409.4 1,912.0 1,435.5 2,366.5 666.1 343.6 1,070.2 244.5 130.6 354.3 1,116.4 503.8 1,740.0

30–34 109.1 76.5 142.0 841.6 770.8 904.9 298.4 164.2 458.4 109.9 68.3 149.0 558.6 293.0 825.4

35–39 47.0 38.1 55.8 366.7 401.4 335.1 145.0 90.6 207.1 61.9 42.0 80.9 258.1 132.5 382.2

40–44 21.4 21.7 21.1 176.7 217.5 140.5 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 77.2 102.3 55.5 29.8 23.4 36.4 17.7 15.0 19.8 46.2 31.1 59.9

55–64 2.3 3.1 1.4 21.9 30.9 14.8 9.1 7.0 11.0 8.1 8.2 8.0 7.3 4.5 9.0

65+ 0.5 0.8 0.3 5.2 7.2 3.8 3.0 3.1 2.9 1.2 1.4 1.1 3.0 3.4 2.7

UNK Age

TOTAL 118.1 54.3 179.6 1,015.7 630.5 1,365.3 335.2 156.3 525.9 98.5 47.7 146.2 524.7 220.2 818.

0–4 1.6 1.1 2.1 11.8 9.2 14.6 2.3 1.8 2.8 1.6 1.0 2.2 3.2 0.0 6.6

2008

5–9 0.4 0.2 0.6 2.2 0.8 3.6 0.6 0.2 1.0 0.1 0.0 0.2 4.1 4.0 4.1

10–14 16.0 1.7 31.1 200.5 46.3 359.4 42.6 8.4 78.4 8.8 2.0 15.7 77.0 10.0 146.0

15–19 616.4 149.4 1,108.1 4,785.4 2,132.7 7,507.3 1,321.7 462.7 2,229.8 386.1 98.0 691.3 2,045.0 654.9 3,457.4

20–24 773.1 358.3 1,209.2 4,814.2 2,915.4 6,746.1 1,662.8 800.5 2,636.4 613.5 264.9 974.9 2,302.2 987.9 3,653.2

25–29 307.1 193.2 422.9 2,005.2 1,515.4 2,480.0 721.2 390.5 1,130.9 286.5 157.8 412.4 1,220.4 581.5 1,873.0

30–34 119.7 85.1 154.5 885.3 806.0 956.6 319.5 180.2 487.9 131.3 82.7 176.3 606.4 303.3 911.0

35–39 50.9 41.8 59.9 387.5 422.3 355.4 162.0 99.5 233.7 69.2 47.7 88.9 283.3 145.6 419.7

40–44 24.1 25.0 23.0 191.3 231.5 155.2 80.0 58.3 104.0 38.7 31.0 45.7 154.0 106.2 198.6

45–54 8.8 10.5 7.2 80.2 105.0 58.8 31.2 24.8 37.8 20.6 18.6 22.2 59.5 36.0 81.0

55–64 2.5 3.3 1.8 23.6 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

UNK Age

TOTAL 125.0 59.3 188.1 1,100.6 693.7 1,469.8 356.4 172.3 552.4 112.9 55.4 166.6 563.4 239.4 875.

0–4 1.5 0.8 2.2 9.8 6.7 12.9 1.7 1.4 2.1 0.5 0.5 0.6 6.8 6.3 7.4

2009

5–9 0.2 0.1 0.4 1.7 0.9 2.6 0.5 0.1 0.9 0.0 0.0 0.0 0.0 0.0 0.0

10–14 14.7 1.5 28.6 196.9 47.5 350.8 40.6 8.6 74.1 8.1 1.3 15.1 85.3 15.2 157.6

15–19 639.0 165.9 1,137.3 4,892.0 2,250.9 7,602.0 1,291.4 451.4 2,190.4 370.4 97.8 656.9 1,990.6 646.6 3,350.5

20–24 802.0 377.9 1,247.4 4,910.8 3,045.2 6,813.7 1,607.4 784.7 2,541.0 591.3 262.5 927.7 2,332.4 1,043.1 3,663.2

25–29 314.8 202.0 430.2 2,002.3 1,528.7 2,468.5 738.5 409.1 1,140.5 273.6 151.4 389.3 1,150.8 537.2 1,776.9

30–34 126.9 93.0 160.9 894.2 819.7 961.5 327.7 190.4 495.7 124.0 73.0 171.2 594.0 324.0 866.1

35–39 52.2 44.0 60.3 394.8 428.7 364.0 162.5 99.4 235.7 69.1 49.0 87.3 286.1 136.9 433.8

40–44 24.6 24.7 24.5 194.1 240.6 153.0 82.2 60.4 106.6 44.8 34.8 54.1 143.3 86.5 197.2

45–54 9.7 12.0 7.5 78.8 100.8 59.8 33.4 27.0 40.2 21.8 19.0 24.1 51.0 36.6 64.3

55–64 2.7 3.7 1.8 24.2 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

UNK Age

TOTAL 129.2 63.2 192.8 1,122.2 722.5 1,485.4 353.9 173.4 546.7 109.7 54.2 161.3 549.8 239.9 848.

0–4 1.5 1.0 2.0 8.9 6.3 11.4 2.5 2.0 3.0 0.6 0.2 1.0 7.2 4.7 9.7

2010

5–9 0.2 0.1 0.2 1.8 0.5 3.2 0.6 0.1 1.1 0.0 0.0 0.0 1.0 0.0 2.0

10–14 16.3 1.9 31.4 192.2 48.9 340.3 35.2 8.6 63.0 8.6 0.8 16.5 80.3 11.1 151.4

15–19 675.7 182.5 1,193.8 4,857.3 2,276.3 7,512.4 1,171.9 416.6 1,980.8 321.3 87.1 567.4 1,946.7 674.2 3,267.6

20–24 912.9 438.2 1,400.7 5,359.9 3,439.3 7,228.9 1,540.7 747.9 2,441.2 507.2 222.5 796.6 2,841.2 1,350.4 4,351.3

25–29 357.3 237.1 479.0 2,209.2 1,765.1 2,616.2 725.8 433.8 1,051.3 258.7 155.3 351.7 1,500.4 784.5 2,201.5

30–34 143.6 105.8 181.7 948.2 885.4 1,003.1 344.6 216.6 482.7 125.2 92.7 153.7 683.4 386.1 973.8

35–39 59.4 51.5 67.2 407.4 448.5 370.4 169.0 110.1 230.4 73.3 56.0 88.2 319.2 196.0 437.6

40–44 28.5 30.2 26.7 198.9 244.5 157.5 86.5 67.9 105.4 44.0 38.4 48.8 139.5 90.5 186.1

45–54 10.9 13.8 8.0 76.7 96.7 59.0 34.8 30.7 38.9 20.8 19.1 22.3 55.9 27.6 81.9

55–64 2.6 3.7 1.6 20.9 26.1 16.6 10.1 9.1 11.0 6.5 5.0 7.7 16.7 9.8 23.0

65+ 0.6 0.9 0.3 4.8 6.3 3.8 2.8 2.9 2.8 2.1 2.7 1.7 2.0 2.3 1.8

UNK Age

TOTAL 140.1 70.5 207.3 1,150.4 751.4 1,512.8 354.6 180.4 533.4 106.9 56.1 153.0 602.0 281.5 910.

0–4 1.3 0.9 1.8 7.7 6.4 9.0 1.5 1.1 1.9 0.6 0.2 1.0 4.8 0.9 8.7

2011

5–9 0.2 0.1 0.4 1.8 0.8 2.8 0.5 0.0 1.0 0.2 0.0 0.4 1.0 0.0 2.0

10–14 18.0 2.3 34.4 208.4 53.9 368.2 39.7 8.2 72.5 8.7 1.4 15.9 86.8 12.0 163.7

15–19 741.7 207.1 1,301.5 4,868.7 2,301.6 7,507.1 1,253.0 447.6 2,114.6 337.1 92.3 593.8 2,179.7 781.4 3,624.4

20–24 1,049.8 516.4 1,595.5 5,700.5 3,662.0 7,680.2 1,679.5 802.2 2,674.8 542.2 232.4 857.0 3,004.8 1,332.1 4,688.0

25–29 408.5 273.6 544.1 2,317.0 1,867.9 2,726.8 775.4 459.3 1,126.9 283.9 178.8 379.0 1,565.2 840.0 2,267.8

30–34 168.8 128.2 209.6 1,012.1 956.0 1,061.0 374.3 235.7 523.1 140.6 100.5 175.6 749.0 405.4 1,082.2

35–39 66.3 56.1 76.4 420.5 456.1 387.9 186.9 120.6 255.8 77.4 56.9 95.5 336.9 179.7 486.7

40–44 34.2 35.8 32.6 206.2 249.8 166.7 99.6 76.3 123.8 46.8 39.5 53.0 148.4 104.0 190.8

45–54 13.0 16.7 9.3 84.4 108.5 62.7 39.8 35.3 44.2 23.1 24.6 21.6 63.0 41.4 82.9

55–64 3.5 5.0 2.1 25.7 33.9 18.9 11.8 10.6 12.9 9.9 9.2 10.5 19.0 12.2 25.2

65+ 0.7 1.1 0.4 4.9 7.3 3.4 3.3 3.2 3.3 1.8 2.4 1.3 2.5 1.1 3.6

UNK Age

TOTAL 159.0 82.3 232.7 1,194.4 787.7 1,563.0 383.6 193.8 578.2 115.3 61.2 164.3 648.3 296.9 983.

UNK = Unknown

NOTE: These tables should only be used for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for total and sexspecific cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.

In 2011, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 26.1% of reported chlamydia cases.

No population data are available for unknown sex and age; therefore, rates are not calculated.
102 Chlamydia Tables STD Surveillance 2011

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

States, 2007-2011

Age Cases Rate per 100,000 Populati

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 1,231.1

16 48,233 2,296.7

17 73,089 3,428.0

18 100,399 4,573.2

19 107,099 4,774.3

20 99,175 4,485.9

21 84,674 3,973.3

22 69,755 3,342.6

23 56,264 2,734.2

24 46,126 2,212.0

25 37,155 1,768.4

2011

15 25,792 1,248.5

16 48,942 2,330.5

17 75,143 3,524.3

18 104,501 4,760.0

19 112,440 5,012.4

20 107,958 4,883.2

21 95,195 4,467.0

22 77,799 3,728.1

23 62,339 3,029.4

24 50,243 2,409.4

25 40,711 1,937.7

NOTE: This table should be used only for age comparisons. Cases with unknown sex are not included in this table.
STD Surveillance 2011 Gonorrhea Tables 103

Table 13. Gonorrhea—Reported Cases and Rates by State, Ranked by Rates, United States, 2011

Rank* State Cases Rate per 100,000 Populat

1 Louisiana 9,169 202.3

2 Mississippi 5,814 195.9

3 Alabama 9,132 191.1

4 North Carolina 17,454 183.0

5 South Carolina 8,350 180.5

6 Georgia 16,428 169.6

7 Arkansas 4,687 160.7

8 Ohio 16,726 145.0

9 Alaska 984 138.5

10 Illinois 17,037 132.8

11 Michigan 12,901 130.5

12 Missouri 7,802 130.3

13 Texas 30,930 123.0

14 Tennessee 7,667 120.8

15 Oklahoma 4,215 112.4

16 Maryland 6,458 111.9

17 Pennsylvania 13,770 108.4

18 New York 20,706 106.9

19 Florida 19,689 104.7

U.S. TOTAL† 321,849 104

20 Kentucky 4,521 104.2

21 Indiana 6,569 101.3

22 Delaware 827 92.1

23 New Mexico 1,839 89.3

24 Wisconsin 4,789 84.2

25 New Jersey 7,348 83.6

26 Virginia 6,518 81.5

27 Kansas 2,209 77.4

28 Nevada 2,000 74.1

29 Nebraska 1,352 74.0

30 South Dakota 602 73.9

31 California 27,516 73.9

32 Arizona 4,564 71.4

33 Connecticut 2,449 68.5

34 Iowa 1,920 63.0

35 Hawaii 685 50.4

36 Colorado 2,363 47.0

37 Minnesota 2,284 43.1

38 West Virginia 796 43.0

39 Washington 2,737 40.7

40 Oregon 1,489 38.9

41 North Dakota 251 37.3

42 Massachusetts 2,353 35.9

43 Rhode Island 360 34.2

44 Maine 272 20.5

45 Idaho 162 10.3

46 Utah 277 10.0

47 New Hampshire 130 9.9

48 Montana 85 8.6

49 Wyoming 46 8.2

50 Vermont 48 7.7

* States were ranked by rate, then case count, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 2,569 cases and a rate of 426.9, but excludes outlying areas (Guam with 96 cases and rate of 53.1, 

Puerto Rico with 341 cases and rate of 9.2, and Virgin Islands with 139 cases and rate of 126.7).
104 Gonorrhea Tables STD Surveillance 2011

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

United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 10,885 9,740 7,498 7,933 9,132 235.2 208.9 159.2 166.0 191.1

Alaska 579 578 990 1,273 984 84.7 84.2 141.7 179.2 138.5

Arizona 5,062 3,449 3,250 3,249 4,564 79.9 53.1 49.3 50.8 71.4

Arkansas 4,168 4,514 4,460 4,769 4,687 147.0 158.1 154.4 163.6 160.7

California 31,294 25,787 23,228 26,441 27,516 85.6 70.2 62.8 71.0 73.9

Colorado 3,376 3,757 2,823 2,787 2,363 69.4 76.1 56.2 55.4 47.0

Connecticut 2,327 2,801 2,558 2,569 2,449 66.4 80.0 72.7 71.9 68.5

Delaware 1,293 1,045 971 1,010 827 149.5 119.7 109.7 112.5 92.1

District of Columbia 2,373 2,656 2,561 2,104 2,569 403.4 448.8 427.1 349.7 426.9

Florida 23,327 23,326 20,878 20,163 19,689 127.8 127.3 112.6 107.2 104.7

Georgia 17,835 16,272 13,687 15,852 16,428 186.9 168.0 139.2 163.6 169.6

Hawaii 659 610 631 759 685 51.3 47.4 48.7 55.8 50.4

Idaho 269 187 110 147 162 17.9 12.3 7.1 9.4 10.3

Illinois 20,813 20,674 19,962 15,777 17,037 161.9 160.2 154.6 123.0 132.8

Indiana 8,790 8,769 6,835 6,496 6,569 138.5 137.5 106.4 100.2 101.3

Iowa 1,928 1,700 1,658 1,803 1,920 64.5 56.6 55.1 59.2 63.0

Kansas 2,282 2,274 2,505 2,084 2,209 82.2 81.2 88.9 73.0 77.4

Kentucky 3,449 4,548 3,827 4,345 4,521 81.3 106.5 88.7 100.1 104.2

Louisiana 11,137 9,455 8,996 8,912 9,169 259.4 214.4 200.3 196.6 202.3

Maine 118 96 143 162 272 9.0 7.3 10.8 12.2 20.5

Maryland 6,768 6,666 6,395 7,413 6,458 120.5 118.3 112.2 128.4 111.9

Massachusetts 2,695 2,129 1,976 2,483 2,353 41.8 32.8 30.0 37.9 35.9

Michigan 15,482 17,064 14,704 13,627 12,901 153.7 170.6 147.5 137.9 130.5

Minnesota 3,459 3,037 2,303 2,119 2,284 66.5 58.2 43.7 40.0 43.1

Mississippi 8,314 7,494 7,241 6,195 5,814 284.8 255.0 245.3 208.8 195.9

Missouri 9,876 8,014 6,488 7,159 7,802 168.0 135.6 108.4 119.5 130.3

Montana 122 122 80 102 85 12.7 12.6 8.2 10.3 8.6

Nebraska 1,434 1,460 1,376 1,187 1,352 80.8 81.9 76.6 65.0 74.0

Nevada 2,357 2,172 1,726 1,728 2,000 91.9 83.5 65.3 64.0 74.1

New Hampshire 138 100 113 151 130 10.5 7.6 8.5 11.5 9.9

New Jersey 6,076 5,298 4,762 5,872 7,348 70.0 61.0 54.7 66.8 83.6

New Mexico 1,796 1,403 1,082 1,229 1,839 91.2 70.7 53.8 59.7 89.3

New York 17,697 17,108 17,004 18,320 20,706 91.7 87.8 87.0 94.5 106.9

North Carolina 16,666 15,972 13,870 14,111 17,454 183.9 173.2 147.9 148.0 183.0

North Dakota 116 143 151 204 251 18.1 22.3 23.3 30.3 37.3

Ohio 21,066 16,803 15,988 16,496 16,726 183.7 146.3 138.5 143.0 145.0

Oklahoma 4,827 5,185 4,673 4,369 4,215 133.4 142.4 126.7 116.5 112.4

Oregon 1,236 1,225 1,113 1,076 1,489 33.0 32.3 29.1 28.1 38.9

Pennsylvania 12,706 11,071 10,138 12,883 13,770 102.2 88.9 80.4 101.4 108.4

Rhode Island 402 307 322 291 360 38.0 29.2 30.6 27.6 34.2

South Carolina 10,326 9,442 8,318 7,970 8,350 234.3 210.8 182.4 172.3 180.5

South Dakota 261 375 344 468 602 32.8 46.6 42.3 57.5 73.9

Tennessee 9,564 8,780 7,926 7,121 7,667 155.3 141.3 125.9 112.2 120.8

Texas 32,073 32,199 29,295 31,788 30,930 134.2 132.4 118.2 126.4 123.0

Utah 821 477 341 310 277 31.0 17.4 12.2 11.2 10.0

Vermont 64 37 50 58 48 10.3 6.0 8.0 9.3 7.7

Virginia 6,269 10,337 7,789 7,402 6,518 81.3 133.1 98.8 92.5 81.5

Washington 3,653 3,127 2,285 2,864 2,737 56.5 47.7 34.3 42.6 40.7

West Virginia 930 746 475 579 796 51.3 41.1 26.1 31.2 43.0

Wisconsin 6,752 6,087 5,201 5,091 4,789 120.5 108.2 92.0 89.5 84.2

Wyoming 81 124 74 40 46 15.5 23.3 13.6 7.1 8.2

U.S. TOTAL 355,991 336,742 301,174 309,341 321,849 118.0 110.7 98.1 100.2 104

Northeast 42,223 38,947 37,066 42,789 47,436 77.2 70.9 67.0 77.4 85.8

Midwest 92,259 86,400 77,515 72,511 74,442 139.0 129.8 116.0 108.3 111.2

South 170,204 168,377 148,860 152,036 155,224 154.1 150.7 131.4 132.7 135.5

West 51,305 43,018 37,733 42,005 44,747 73.2 60.7 52.7 58.4 62.2

Guam 141 109 59 97 96 81.2 61.9 33.1 53.6 53.1

Puerto Rico 323 273 230 312 341 8.2 6.9 5.8 8.4 9.2

Virgin Islands 69 120 115 151 139 62.8 109.2 104.7 137.6 126.7

OUTLYING AREAS 533 502 404 560 576 12.6 11.8 9.5 13.9 

TOTAL 356,524 337,244 301,578 309,901 322,425 116.6 109.4 96.9 99.1 103.
STD Surveillance 2011 Gonorrhea Tables 105

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

Alphabetical Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 6,095 5,582 4,240 4,432 5,103 255.5 232.2 174.7 180.2 207.5

Alaska 326 321 516 698 515 99.2 97.7 153.5 204.9 151.2

Arizona 2,342 1,577 1,475 1,553 2,212 74.0 48.6 44.8 48.3 68.8

Arkansas 2,275 2,520 2,562 2,729 2,687 157.4 173.0 173.8 183.9 181.0

California 14,533 11,625 9,430 10,546 10,811 79.5 63.3 51.1 56.3 57.7

Colorado 1,807 1,978 1,502 1,514 1,285 75.0 80.8 60.2 60.4 51.2

Connecticut 1,372 1,686 1,491 1,449 1,378 76.4 94.0 82.8 79.0 75.1

Delaware 699 606 564 621 471 156.9 134.7 123.8 134.1 101.7

District of Columbia 1,077 1,259 1,233 1,073 1,209 347.2 403.6 389.5 338.0 380.8

Florida 11,793 12,279 10,745 10,240 9,999 127.0 131.7 114.1 106.5 104.0

Georgia 9,334 8,687 7,253 8,297 8,589 192.4 176.5 145.2 167.3 173.2

Hawaii 295 298 264 314 273 46.3 46.7 41.2 46.2 40.2

Idaho 152 90 51 68 79 20.4 11.9 6.6 8.7 10.1

Illinois 11,312 11,342 11,248 8,924 9,500 173.5 173.4 171.7 136.5 145.3

Indiana 4,884 5,056 3,985 3,598 3,690 151.7 156.3 122.3 109.2 112.0

Iowa 1,121 1,024 1,049 1,179 1,217 74.1 67.4 68.9 76.7 79.1

Kansas 1,401 1,459 1,541 1,235 1,360 100.1 103.5 108.6 85.9 94.6

Kentucky 1,887 2,511 2,132 2,487 2,596 87.2 115.1 97.1 112.8 117.8

Louisiana 5,822 5,177 5,125 4,824 5,263 263.7 228.1 222.2 208.5 227.4

Maine 45 43 62 75 122 6.7 6.4 9.2 11.1 18.0

Maryland 3,529 3,604 3,457 4,028 3,461 121.7 124.0 117.8 135.1 116.1

Massachusetts 1,282 1,100 976 1,004 1,083 38.6 32.9 28.8 29.7 32.0

Michigan 8,984 10,047 8,536 7,971 7,599 175.7 197.8 168.5 158.3 150.9

Minnesota 1,930 1,657 1,270 1,248 1,294 74.0 63.2 48.0 46.7 48.4

Mississippi 4,901 4,357 4,335 3,602 3,344 325.6 287.6 285.0 236.0 219.1

Missouri 5,481 4,542 3,585 3,951 4,195 182.3 150.2 117.1 129.3 137.3

Montana 75 92 46 56 51 15.7 19.0 9.4 11.4 10.4

Nebraska 847 891 821 675 823 94.6 99.1 90.7 73.4 89.5

Nevada 1,066 1,012 826 830 879 84.7 79.3 63.7 62.1 65.7

New Hampshire 63 49 54 59 59 9.5 7.3 8.0 8.8 8.8

New Jersey 3,059 2,813 2,435 3,115 3,916 68.9 63.5 54.8 69.0 86.8

New Mexico 974 783 570 610 925 97.6 77.8 56.2 58.6 88.8

New York 8,324 8,349 7,927 8,718 9,716 83.8 83.3 78.9 87.2 97.2

North Carolina 8,941 8,876 7,868 8,314 10,076 193.0 188.6 164.2 170.0 206.1

North Dakota 66 93 88 140 149 20.7 29.1 27.3 42.1 44.8

Ohio 11,771 9,784 9,766 10,034 10,009 200.3 166.3 165.3 169.9 169.5

Oklahoma 2,606 2,964 2,809 2,493 2,395 142.4 160.8 150.6 131.6 126.4

Oregon 564 553 505 477 602 29.9 29.0 26.2 24.7 31.1

Pennsylvania 6,945 6,210 5,650 7,268 7,687 108.8 97.2 87.4 111.6 118.0

Rhode Island 169 135 146 121 167 31.0 24.9 27.0 22.2 30.7

South Carolina 5,640 5,704 5,004 4,905 4,981 249.5 248.2 213.8 206.5 209.7

South Dakota 153 247 190 290 399 38.3 61.2 46.7 71.3 98.1

Tennessee 5,247 4,801 4,365 3,884 4,112 166.5 150.7 135.3 119.4 126.4

Texas 16,192 17,029 16,071 17,246 16,476 135.2 139.8 129.6 136.1 130.0

Utah 345 137 70 75 66 26.3 10.1 5.1 5.5 4.8

Vermont 30 19 29 24 24 9.5 6.0 9.2 7.6 7.6

Virginia 3,369 5,847 4,314 4,146 3,693 85.8 147.9 107.6 101.7 90.6

Washington 1,858 1,522 949 1,044 1,066 57.2 46.4 28.5 30.9 31.6

West Virginia 504 425 281 326 467 54.5 45.9 30.3 34.7 49.7

Wisconsin 4,066 3,744 3,113 3,164 2,907 144.3 132.3 109.4 110.5 101.5

Wyoming 41 71 44 19 25 15.9 27.0 16.5 6.9 9.1

U.S. TOTAL 187,594 182,577 162,568 165,693 171,005 122.6 118.5 104.5 105.6 108

Northeast 21,289 20,404 18,770 21,833 24,152 75.8 72.4 66.2 76.7 84.9

Midwest 52,016 49,886 45,192 42,409 43,142 154.4 147.7 133.3 124.7 126.9

South 89,911 92,228 82,358 83,647 84,922 160.0 162.3 143.0 143.2 145.4

West 24,378 20,059 16,248 17,804 18,789 69.7 56.7 45.5 49.3 52.1

Guam 66 58 32 45 44 77.5 67.1 36.5 50.6 49.5

Puerto Rico 165 128 126 141 140 8.0 6.2 6.1 7.3 7.2

Virgin Islands 51 86 90 96 94 88.3 148.8 155.6 165.9 162.5

OUTLYING AREAS 282 272 248 282 278 12.9 12.4 11.2 13.5 

TOTAL 187,876 182,849 162,816 165,975 171,283 121.1 117.0 103.2 104.4 107.

NOTE: Cases reported with unknown sex are not included in this table.
106 Gonorrhea Tables STD Surveillance 2011

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

Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 4,786 4,151 3,250 3,430 3,825 213.5 183.8 142.4 147.8 164.9

Alaska 253 257 474 575 469 71.3 71.9 130.9 155.6 126.9

Arizona 2,718 1,869 1,775 1,696 2,350 85.7 57.4 53.7 53.4 74.0

Arkansas 1,890 1,993 1,898 2,038 1,996 136.0 142.5 134.1 142.4 139.4

California 16,632 14,025 13,705 15,773 16,598 91.0 76.3 74.1 85.2 89.6

Colorado 1,569 1,777 1,319 1,273 1,078 64.0 71.3 52.1 50.5 42.8

Connecticut 955 1,113 1,067 1,120 1,071 55.9 65.2 62.1 64.4 61.6

Delaware 594 439 407 389 356 141.7 103.7 94.7 89.4 81.9

District of Columbia 1,284 1,383 1,328 1,028 1,360 461.7 494.1 469.2 361.7 478.5

Florida 11,527 10,995 10,099 9,906 9,675 128.5 122.1 110.7 107.8 105.3

Georgia 8,401 7,465 6,368 7,421 7,684 179.0 156.7 131.7 156.9 162.5

Hawaii 364 312 367 445 412 56.4 48.0 56.1 65.3 60.5

Idaho 112 97 58 78 83 14.8 12.7 7.5 9.9 10.6

Illinois 9,501 9,331 8,710 6,824 7,513 150.0 146.7 137.0 108.5 119.4

Indiana 3,880 3,693 2,831 2,884 2,867 124.1 117.5 89.5 90.4 89.9

Iowa 807 676 609 624 703 54.7 45.6 41.0 41.4 46.6

Kansas 881 815 964 849 849 64.0 58.6 68.9 60.0 60.0

Kentucky 1,559 2,030 1,690 1,854 1,913 75.0 97.2 79.8 86.8 89.6

Louisiana 5,201 4,233 3,849 3,540 3,739 249.4 197.7 176.1 159.5 168.5

Maine 73 53 81 86 150 11.4 8.3 12.6 13.2 23.1

Maryland 3,238 3,054 2,922 3,377 2,992 119.1 112.0 105.7 121.0 107.2

Massachusetts 1,412 1,026 996 1,479 1,269 45.2 32.5 31.1 46.7 40.1

Michigan 6,447 6,876 6,004 5,634 5,281 130.0 139.6 122.5 116.2 108.9

Minnesota 1,529 1,380 1,033 871 990 59.1 53.1 39.4 33.1 37.6

Mississippi 3,413 3,135 2,906 2,593 2,470 241.4 220.2 203.1 179.9 171.4

Missouri 4,395 3,472 2,903 3,208 3,607 153.1 120.2 99.2 109.4 123.0

Montana 47 29 34 46 34 9.8 6.0 7.0 9.3 6.8

Nebraska 583 568 553 512 528 66.3 64.2 62.0 56.5 58.3

Nevada 1,291 1,160 900 898 1,121 98.8 87.6 66.9 65.9 82.2

New Hampshire 75 51 59 92 71 11.6 7.9 9.0 14.2 10.9

New Jersey 3,014 2,483 2,326 2,727 3,400 70.9 58.4 54.5 63.7 79.4

New Mexico 822 619 512 619 914 84.6 63.3 51.5 60.8 89.8

New York 9,363 8,751 9,072 9,601 10,977 100.0 92.5 95.5 102.4 117.1

North Carolina 7,725 7,023 5,902 5,712 7,300 174.5 155.5 128.6 123.0 157.1

North Dakota 50 50 62 64 101 15.6 15.5 19.1 18.8 29.7

Ohio 9,164 6,693 6,068 6,421 6,717 163.9 119.4 107.7 114.0 119.3

Oklahoma 2,221 2,212 1,857 1,873 1,708 124.3 123.0 101.9 100.9 92.0

Oregon 672 672 608 599 887 36.1 35.7 32.0 31.6 46.8

Pennsylvania 5,758 4,860 4,484 5,615 6,078 95.2 80.2 73.0 90.7 98.2

Rhode Island 232 172 176 170 193 45.3 33.8 34.4 33.4 38.0

South Carolina 4,665 3,712 3,289 3,056 3,351 217.3 170.2 148.1 135.8 148.9

South Dakota 107 128 153 177 202 27.0 31.9 37.7 43.4 49.6

Tennessee 4,317 3,979 3,560 3,235 3,555 143.6 131.4 116.0 104.6 114.9

Texas 15,819 15,150 13,215 14,524 14,448 132.6 124.8 106.8 116.5 115.8

Utah 476 340 271 235 211 35.6 24.6 19.3 16.9 15.2

Vermont 34 18 21 33 24 11.1 5.9 6.9 10.7 7.8

Virginia 2,895 4,477 3,465 3,248 2,814 76.5 117.3 89.4 82.7 71.7

Washington 1,795 1,600 1,334 1,818 1,671 55.7 48.9 40.1 54.3 49.9

West Virginia 426 321 194 253 329 48.0 36.1 21.7 27.7 36.0

Wisconsin 2,673 2,332 2,061 1,926 1,880 96.0 83.4 73.4 68.2 66.6

Wyoming 40 53 30 21 21 15.1 19.6 10.8 7.3 7.3

U.S. TOTAL 167,685 153,103 137,819 142,470 149,835 112.8 102.1 91.0 93.9 98

Northeast 20,916 18,527 18,282 20,923 23,233 78.6 69.3 67.9 77.9 86.5

Midwest 40,017 36,014 31,951 29,994 31,238 122.4 109.8 97.0 91.1 94.9

South 79,961 75,752 66,199 67,477 69,515 147.4 138.0 118.8 120.2 123.8

West 26,791 22,810 21,387 24,076 25,849 76.3 64.3 59.6 67.2 72.1

Guam 75 51 27 52 52 84.9 56.9 29.8 56.6 56.6

Puerto Rico 158 145 104 171 201 8.3 7.6 5.5 9.6 11.3

Virgin Islands 18 34 25 55 45 34.6 65.3 48.1 106.0 86.7

OUTLYING AREAS 251 230 156 278 298 12.3 11.3 7.6 14.4 

TOTAL 167,936 153,333 137,975 142,748 150,133 111.4 100.9 89.9 92.9 97.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2011 Gonorrhea Tables 107

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

(MSAs)* in Alphabetical Order, United States, 2007–2011

MSAs

Cases Rates per 100,000 Populati

2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 9,060 8,084 7,466 8,337 8,567 171.6 150.4 136.4 158.2 162.6

Austin-Round Rock, TX 2,075 2,388 1,973 1,932 2,009 129.8 144.5 115.7 112.6 117.1

Baltimore-Towson, MD 4,156 4,146 3,869 4,369 3,634 155.8 155.4 143.8 161.2 134.1

Birmingham-Hoover, AL 3,129 2,891 1,970 2,363 2,550 282.3 258.7 174.2 209.5 226.1

Boston-Cambridge-Quincy, MA-NH 1,770 1,464 1,352 1,881 1,671 39.5 32.4 29.5 41.3 36.7

Buffalo-Cheektowaga-Tonawanda, NY 2,289 1,898 1,574 1,227 1,543 202.9 168.8 140.1 108.1 135.9

Charlotte-Gastonia-Concord, NC-SC 2,388 3,249 3,165 2,424 3,328 144.6 190.9 181.3 137.9 189.3

Chicago-Naperville-Joliet, IL-IN-WI 14,979 16,181 15,864 12,380 13,188 157.3 169.1 165.6 130.9 139.4

Cincinnati-Middletown, OH-KY-IN 4,583 3,926 3,219 3,379 3,516 214.8 182.2 148.2 158.6 165.1

Cleveland-Elyria-Mentor, OH 4,286 2,770 3,089 3,608 3,930 204.4 132.6 147.7 173.7 189.2

Columbus, OH 4,136 3,853 3,192 3,351 3,022 235.8 217.3 177.2 182.5 164.5

Dallas-Fort Worth-Arlington, TX 10,064 9,197 7,930 8,766 8,732 163.8 146.0 123.0 137.6 137.0

Denver-Aurora, CO 2,238 2,625 1,995 2,344 1,662 90.8 104.7 78.2 92.2 65.3

Detroit-Warren-Livonia, MI 8,554 10,850 9,366 9,160 8,924 191.5 245.2 212.7 213.2 207.7

Hartford-West Hartford-East Hartford, CT 920 1,029 961 1,126 1,036 77.4 86.4 80.4 92.9 85.5

Houston-Baytown-Sugar Land, TX 7,757 7,290 6,232 7,652 6,864 137.8 127.3 106.2 128.7 115.4

Indianapolis, IN 4,543 4,194 2,975 2,969 2,962 268.0 244.5 170.6 169.1 168.7

Jacksonville, FL 3,113 2,979 2,015 2,128 2,040 239.3 226.8 151.7 158.1 151.6

Kansas City, MO-KS 3,683 3,268 3,192 3,213 2,920 185.5 163.2 154.4 157.9 143.5

Las Vegas-Paradise, NV 2,112 1,918 1,553 1,604 1,740 115.0 102.8 81.6 82.2 89.2

Los Angeles-Long Beach-Santa Ana, CA 11,059 9,832 9,774 11,156 11,105 85.9 76.4 75.9 87.0 86.6

Louisville, KY-IN 1,908 2,300 2,125 2,272 2,462 154.7 184.8 168.8 177.0 191.8

Memphis, TN-MS-AR 4,756 4,475 4,536 4,086 3,849 371.4 348.1 347.6 310.5 292.5

Miami-Fort Lauderdale-Miami Beach, FL 5,152 5,471 5,239 5,506 5,352 95.2 101.0 94.4 98.9 96.2

Milwaukee-Waukesha-West Allis, WI 4,960 446 3,588 3,425 3,349 321.2 28.8 230.0 220.1 215.2

Minneapolis-St. Paul-Bloomington, MN-WI 2,834 2,345 1,800 1,665 1,880 88.3 72.6 55.0 50.8 57.3

Nashville-Davidson-Murfreesboro, TN 1,692 1,541 1,225 1,292 1,654 111.2 99.4 77.4 81.3 104.0

New Orleans-Metairie-Kenner, LA 2,713 2,045 2,082 1,991 2,069 263.3 180.3 175.0 170.5 177.2

New York-Newark-Edison, NY-NJ-PA 15,396 15,116 15,254 17,507 20,855 81.8 79.5 80.0 92.6 110.4

Oklahoma City, OK 2,373 2,403 2,066 1,700 1,845 198.9 199.2 168.3 135.7 147.2

Orlando, FL 2,743 2,704 2,663 2,495 2,277 135.0 131.6 127.9 116.9 106.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 8,669 7,724 7,407 9,694 10,123 148.7 132.3 124.1 162.5 169.7

Phoenix-Mesa-Scottsdale, AZ 3,333 2,211 2,317 2,335 3,340 79.7 51.6 53.1 55.7 79.7

Pittsburgh, PA 2,599 2,569 1,866 2,069 2,473 110.3 109.3 79.2 87.8 105.0

Portland-Vancouver-Beaverton, OR-WA 1,053 1,033 826 926 1,318 48.4 46.8 36.8 41.6 59.2

Providence-New Bedford-Fall River, RI-MA 621 455 427 382 475 38.8 28.5 26.7 23.9 29.7

Richmond, VA 2,199 2,698 1,900 1,742 1,441 181.3 220.1 153.5 138.4 114.5

Riverside-San Bernardino-Ontario, CA 3,166 2,199 1,921 1,924 2,330 77.6 53.4 46.4 45.5 55.1

Rochester, NY 1,207 1,345 1,465 1,319 1,066 117.1 130.1 141.5 125.1 101.1

Sacramento-Arden-Arcade-Roseville, CA 2,315 1,771 1,124 1,676 1,913 110.7 83.9 52.8 78.0 89.0

Salt Lake City, UT 573 346 244 204 199 52.1 31.0 21.6 18.1 17.7

San Antonio, TX 2,601 3,113 3,697 3,729 3,731 130.7 153.2 178.4 174.0 174.1

San Diego-Carlsbad-San Marcos, CA 2,385 2,066 1,829 2,021 2,173 80.2 68.8 59.9 65.3 70.2

San Francisco-Oakland-Fremont, CA 5,695 5,065 4,375 4,867 5,009 135.5 118.5 101.3 112.3 115.5

San Jose-Sunnyvale-Santa Clara, CA 893 712 563 586 680 49.5 39.1 30.6 31.9 37.0

Seattle-Tacoma-Bellevue, WA 2,572 2,182 1,700 2,189 1,971 77.7 65.2 49.9 63.6 57.3

St. Louis, MO-IL 6,483 5,003 3,620 4,137 5,017 231.2 177.6 128.0 147.1 178.4

Tampa-St. Petersburg-Clearwater, FL 3,819 3,852 3,818 3,516 3,655 140.2 140.9 139.0 126.3 131.3

Virginia Beach-Norfolk-Newport News, VA-NC 2,504 4,935 3,647 3,429 2,810 151.0 297.6 217.8 205.1 168.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 4,665 5,557 5,321 5,234 5,477 87.9 103.7 97.2 93.8 98.1

U.S. MSAs TOTAL 208,773 197,714 181,371 189,287 195,736 128.3 120.4 109.1 114.1 117

* 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.
108 Gonorrhea Tables STD Surveillance 2011

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

Areas (MSAs)* in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 4,515 3,967 3,633 3,954 4,136 169.1 145.8 131.1 146.2 152.9

Austin-Round Rock, TX 992 1,177 980 910 935 127.1 145.9 117.4 106.3 109.2

Baltimore-Towson, MD 2,179 2,302 2,181 2,397 1,941 157.6 166.6 156.5 170.5 138.1

Birmingham-Hoover, AL 1,761 1,655 1,056 1,323 1,417 307.0 286.0 180.6 226.6 242.7

Boston-Cambridge-Quincy, MA-NH 773 720 624 708 730 33.6 31.0 26.5 30.1 31.1

Buffalo-Cheektowaga-Tonawanda, NY 1,258 1,059 878 669 828 215.3 181.9 151.0 113.9 140.9

Charlotte-Gastonia-Concord, NC-SC 1,188 1,697 1,750 1,334 1,776 141.1 196.0 196.6 147.6 196.5

Chicago-Naperville-Joliet, IL-IN-WI 7,813 8,594 8,712 6,741 7,015 161.7 177.1 179.0 139.3 145.0

Cincinnati-Middletown, OH-KY-IN 2,884 2,696 2,181 2,330 2,264 264.2 244.5 196.4 214.0 208.0

Cleveland-Elyria-Mentor, OH 2,180 1,469 1,808 2,082 2,371 200.3 135.5 166.6 193.0 219.8

Columbus, OH 2,142 2,062 1,873 1,917 1,552 241.1 229.8 205.2 205.0 166.0

Dallas-Fort Worth-Arlington, TX 4,905 4,953 4,556 4,788 4,645 160.5 158.2 142.2 148.2 143.8

Denver-Aurora, CO 1,128 1,345 1,035 1,261 885 91.9 107.9 81.4 98.6 69.2

Detroit-Warren-Livonia, MI 4,721 6,226 5,204 5,217 5,114 206.7 275.1 230.8 235.6 231.0

Hartford-West Hartford-East Hartford, CT 522 609 551 633 596 85.6 99.8 90.0 101.7 95.8

Houston-Baytown-Sugar Land, TX 3,805 3,749 3,302 4,174 3,805 135.5 131.2 112.8 139.6 127.3

Indianapolis, IN 2,385 2,290 1,603 1,545 1,572 276.7 262.4 180.6 171.8 174.8

Jacksonville, FL 1,532 1,587 1,048 1,152 1,121 230.4 236.4 154.1 167.0 162.5

Kansas City, MO-KS 2,040 1,888 1,821 1,810 1,596 201.8 185.3 173.1 174.2 153.6

Las Vegas-Paradise, NV 954 880 746 779 742 105.8 96.0 79.8 80.4 76.6

Los Angeles-Long Beach-Santa Ana, CA 5,001 4,214 3,641 3,947 3,944 77.1 65.0 56.2 60.7 60.7

Louisville, KY-IN 1,026 1,228 1,133 1,263 1,413 162.3 192.2 175.9 192.3 215.2

Memphis, TN-MS-AR 2,789 2,472 2,537 2,285 2,191 420.2 370.2 374.6 333.9 320.2

Miami-Fort Lauderdale-Miami Beach, FL 2,444 2,661 2,439 2,480 2,361 87.9 95.6 85.9 86.4 82.2

Milwaukee-Waukesha-West Allis, WI 2,972 300 2,098 2,070 1,980 376.2 37.9 262.8 259.0 247.8

Minneapolis-St. Paul-Bloomington, MN-WI 1,500 1,210 928 950 1,028 93.0 74.6 56.4 57.2 61.9

Nashville-Davidson-Murfreesboro, TN 800 783 625 597 759 103.7 99.4 77.7 73.5 93.4

New Orleans-Metairie-Kenner, LA 1,322 984 1,098 1,014 1,110 246.6 166.6 177.8 169.2 185.2

New York-Newark-Edison, NY-NJ-PA 6,979 7,089 6,886 8,124 9,670 71.8 72.3 70.1 82.9 98.7

Oklahoma City, OK 1,202 1,294 1,188 962 1,034 198.8 211.5 190.6 151.3 162.7

Orlando, FL 1,377 1,424 1,364 1,171 1,090 134.3 137.3 129.7 107.5 100.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,416 4,098 3,811 5,125 5,361 146.7 135.9 123.6 166.0 173.7

Phoenix-Mesa-Scottsdale, AZ 1,497 988 1,022 1,071 1,568 72.3 46.7 47.4 50.8 74.4

Pittsburgh, PA 1,530 1,524 1,161 1,274 1,501 125.2 125.0 95.2 104.6 123.2

Portland-Vancouver-Beaverton, OR-WA 446 420 322 371 482 40.9 38.0 28.6 32.9 42.8

Providence-New Bedford-Fall River, RI-MA 282 209 196 159 232 34.1 25.4 23.8 19.2 28.1

Richmond, VA 1,122 1,436 1,010 994 808 179.7 227.9 158.5 153.0 124.4

Riverside-San Bernardino-Ontario, CA 1,705 1,237 1,024 976 1,196 83.6 60.2 49.6 46.0 56.3

Rochester, NY 608 744 744 714 525 115.2 140.6 140.5 131.8 96.9

Sacramento-Arden-Arcade-Roseville, CA 1,190 917 557 907 990 112.0 85.6 51.7 82.8 90.4

Salt Lake City, UT 229 88 37 41 42 42.4 16.0 6.6 7.3 7.5

San Antonio, TX 1,279 1,557 1,921 1,886 1,835 126.0 150.3 182.0 173.0 168.3

San Diego-Carlsbad-San Marcos, CA 961 803 620 535 609 64.9 53.9 40.7 34.7 39.5

San Francisco-Oakland-Fremont, CA 2,174 1,863 1,421 1,710 1,531 102.8 86.7 65.5 77.8 69.7

San Jose-Sunnyvale-Santa Clara, CA 385 312 248 249 243 43.7 35.2 27.6 27.2 26.5

Seattle-Tacoma-Bellevue, WA 1,205 965 604 686 649 72.7 57.7 35.4 39.7 37.6

St. Louis, MO-IL 3,539 2,756 1,908 2,188 2,701 244.5 189.6 130.8 150.9 186.2

Tampa-St. Petersburg-Clearwater, FL 1,973 2,006 1,907 1,834 1,887 141.1 143.0 135.4 127.7 131.4

Virginia Beach-Norfolk-Newport News, VA-NC 1,355 2,875 2,008 1,858 1,559 159.8 339.3 234.4 218.1 183.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,268 2,711 2,637 2,673 2,695 83.5 98.8 94.3 93.3 94.0

U.S. MSAs TOTAL 105,253 102,093 92,637 95,838 98,035 127.3 122.4 109.8 113.0 115

* 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 2011 Gonorrhea Tables 109

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

(MSAs)* in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 4,484 4,054 3,786 4,306 4,338 171.9 152.6 140.0 167.9 169.2

Austin-Round Rock, TX 1,081 1,208 991 1,022 1,073 132.2 142.8 113.9 118.8 124.8

Baltimore-Towson, MD 1,976 1,841 1,675 1,968 1,690 153.7 143.2 129.2 150.8 129.5

Birmingham-Hoover, AL 1,367 1,235 913 1,024 1,094 255.7 229.1 167.2 188.2 201.0

Boston-Cambridge-Quincy, MA-NH 996 742 726 1,173 940 45.7 33.7 32.5 53.2 42.7

Buffalo-Cheektowaga-Tonawanda, NY 1,031 839 696 558 715 189.6 154.7 128.3 101.8 130.5

Charlotte-Gastonia-Concord, NC-SC 1,199 1,542 1,405 1,083 1,542 148.1 184.5 164.3 126.8 180.6

Chicago-Naperville-Joliet, IL-IN-WI 7,161 7,586 7,141 5,610 6,150 152.6 160.9 151.5 121.4 133.0

Cincinnati-Middletown, OH-KY-IN 1,674 1,224 1,019 1,043 1,251 160.6 116.3 96.0 100.1 120.1

Cleveland-Elyria-Mentor, OH 2,091 1,295 1,254 1,517 1,559 207.4 128.9 124.6 151.9 156.1

Columbus, OH 1,985 1,788 1,289 1,431 1,470 229.2 204.2 145.0 158.7 163.1

Dallas-Fort Worth-Arlington, TX 5,123 4,243 3,374 3,975 4,086 165.9 133.9 104.0 126.5 130.1

Denver-Aurora, CO 1,110 1,278 958 1,083 777 89.7 101.5 74.8 85.6 61.4

Detroit-Warren-Livonia, MI 3,786 4,502 4,005 3,924 3,794 173.4 208.2 186.4 188.5 182.2

Hartford-West Hartford-East Hartford, CT 398 418 410 493 440 68.7 72.0 70.3 83.5 74.6

Houston-Baytown-Sugar Land, TX 3,930 3,525 2,926 3,465 3,056 139.4 122.8 99.5 117.2 103.3

Indianapolis, IN 2,150 1,902 1,369 1,421 1,383 258.1 225.7 159.9 165.8 161.4

Jacksonville, FL 1,581 1,392 966 973 919 248.7 216.8 149.1 148.4 140.2

Kansas City, MO-KS 1,643 1,380 1,371 1,403 1,324 168.6 140.3 135.0 140.8 132.9

Las Vegas-Paradise, NV 1,158 1,038 807 825 998 123.9 109.3 83.3 84.0 101.6

Los Angeles-Long Beach-Santa Ana, CA 6,023 5,543 6,081 7,156 7,124 94.2 86.7 95.0 113.1 112.6

Louisville, KY-IN 881 1,070 990 1,007 1,043 146.5 176.6 161.1 160.7 166.4

Memphis, TN-MS-AR 1,967 2,003 1,998 1,800 1,658 318.9 324.1 318.4 284.9 262.4

Miami-Fort Lauderdale-Miami Beach, FL 2,706 2,801 2,799 3,024 2,987 102.8 106.4 103.4 112.3 110.9

Milwaukee-Waukesha-West Allis, WI 1,975 145 1,470 1,354 1,368 261.8 19.1 193.1 178.9 180.8

Minneapolis-St. Paul-Bloomington, MN-WI 1,334 1,135 872 715 852 83.6 70.6 53.7 44.2 52.6

Nashville-Davidson-Murfreesboro, TN 892 758 600 694 895 119.0 99.4 77.1 89.3 115.1

New Orleans-Metairie-Kenner, LA 1,352 1,050 976 919 953 273.5 193.2 170.5 161.7 167.7

New York-Newark-Edison, NY-NJ-PA 8,406 8,017 8,363 9,358 11,149 92.4 87.1 90.5 102.8 122.5

Oklahoma City, OK 1,171 1,103 876 736 775 199.0 185.5 145.0 119.2 125.5

Orlando, FL 1,366 1,277 1,297 1,320 1,186 135.6 125.5 125.8 126.4 113.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,250 3,626 3,593 4,565 4,756 150.9 128.4 124.5 158.6 165.2

Phoenix-Mesa-Scottsdale, AZ 1,834 1,222 1,295 1,264 1,770 86.9 56.5 58.6 60.6 84.9

Pittsburgh, PA 1,069 1,045 704 795 971 94.3 92.3 62.0 69.8 85.3

Portland-Vancouver-Beaverton, OR-WA 607 611 504 555 836 56.0 55.5 45.2 50.5 76.1

Providence-New Bedford-Fall River, RI-MA 338 246 231 223 243 43.7 31.9 29.7 28.8 31.4

Richmond, VA 1,074 1,261 886 745 628 182.4 211.7 147.4 122.4 103.2

Riverside-San Bernardino-Ontario, CA 1,450 961 895 944 1,126 71.0 46.7 43.1 44.9 53.6

Rochester, NY 599 601 721 605 541 119.2 119.1 142.5 118.1 105.6

Sacramento-Arden-Arcade-Roseville, CA 1,098 835 558 756 917 106.7 80.4 53.2 71.8 87.0

Salt Lake City, UT 344 258 207 163 157 61.5 45.5 36.2 28.8 27.7

San Antonio, TX 1,322 1,556 1,775 1,843 1,896 135.5 156.3 174.6 175.1 180.1

San Diego-Carlsbad-San Marcos, CA 1,415 1,254 1,206 1,482 1,552 94.7 83.0 78.7 95.4 99.9

San Francisco-Oakland-Fremont, CA 3,493 3,179 2,933 3,127 3,454 167.2 149.5 136.5 146.3 161.6

San Jose-Sunnyvale-Santa Clara, CA 506 398 314 333 430 54.8 42.7 33.4 36.1 46.7

Seattle-Tacoma-Bellevue, WA 1,367 1,216 1,094 1,501 1,322 82.7 72.7 64.2 87.7 77.2

St. Louis, MO-IL 2,944 2,247 1,712 1,949 2,316 217.1 164.8 125.0 143.1 170.0

Tampa-St. Petersburg-Clearwater, FL 1,842 1,822 1,887 1,678 1,761 138.9 136.9 141.0 124.5 130.7

Virginia Beach-Norfolk-Newport News, VA-NC 1,148 2,058 1,633 1,569 1,249 141.6 253.7 199.6 191.4 152.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,385 2,823 2,681 2,554 2,779 92.1 107.9 100.0 94.0 102.3

U.S. MSAs TOTAL 103,082 95,153 88,232 93,031 97,293 128.8 117.7 107.8 114.6 119

* 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.
110 Gonorrhea Tables STD Surveillance 2011

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

Number of Reported Cases, United States, 2011

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Perc

1 Cook County, IL 10,864 209.1 3

2 Los Angeles County, CA 10,121 103.1 6

3 Wayne County, MI 7,353 403.9 8

4 Philadelphia County, PA 6,761 443.1 10

5 Harris County, TX 5,764 140.8 12

6 Dallas County, TX 5,226 220.7 14

7 Kings County, NY 4,548 181.6 15

8 Bronx County, NY 3,767 272.0 16

9 Bexar County, TX 3,488 203.4 17

10 Cuyahoga County, OH 3,484 272.2 19

11 New York County, NY 3,446 217.3 20

12 Shelby County, TN 3,382 364.6 21

13 Fulton County, GA 3,335 362.3 22

14 Milwaukee County, WI 3,236 341.4 23

15 Maricopa County, AZ 3,228 84.6 24

16 Franklin County, OH 2,831 243.3 25

17 Marion County, IN 2,785 308.3 25

18 Hamilton County, OH 2,719 338.9 26

19 Washington, D.C. 2,569 426.9 27

20 Baltimore (City), MD 2,521 406.0 28

21 Jefferson County, AL 2,393 363.4 29

22 Queens County, NY 2,367 106.1 29

23 Miami-Dade County, FL 2,356 94.4 30

24 Hillsborough County, FL 2,343 190.6 31

25 Mecklenburg County, NC 2,281 248.0 32

26 San Francisco County, CA 2,251 279.5 32

27 Tarrant County, TX 2,220 122.7 33

28 San Diego County, CA 2,173 70.2 34

29 Jefferson County, KY 2,152 290.4 34

30 Broward County, FL 2,135 122.1 35

31 Essex County, NJ 2,024 258.2 36

32 Guilford County, NC 2,019 413.4 36

33 Jackson County, MO 2,012 298.4 37

34 St. Louis (City), MO 1,952 611.3 37

35 Allegheny County, PA 1,931 157.8 38

36 Duval County, FL 1,834 212.2 39

37 St. Louis County, MO 1,831 183.3 39

38 DeKalb County, GA 1,793 259.1 40

39 Sacramento County, CA 1,778 125.3 40

40 Clark County, NV 1,740 89.2 41

41 Orleans County, LA 1,718 499.7 41

42 Orange County, FL 1,669 145.6 42

43 Prince George's County, MD 1,607 186.1 42

44 Alameda County, CA 1,590 105.3 43

45 Caddo County, LA 1,567 614.6 43

46 Travis County, TX 1,516 148.0 44

47 Oklahoma County, OK 1,509 210.0 44

48 Cumberland County, NC 1,507 471.8 45

49 Wake County, NC 1,420 157.6 45

50 San Bernardino County, CA 1,408 69.2 46

51 Erie County, NY 1,382 150.4 46

52 King County, WA 1,377 71.3 47

53 Pulaski County, AR 1,257 328.4 47

54 Davidson County, TN 1,243 198.3 47

55 Mobile County, AL 1,238 299.8 48

56 Camden County, NJ 1,189 231.5 48

57 Montgomery County, OH 1,175 219.6 48

58 Hennepin County, MN 1,172 101.7 49

59 Montgomery County, AL 1,169 509.7 49

60 Fresno County, CA 1,164 125.1 49

61 Hinds County, MS 1,116 455.0 50

62 Tulsa County, OK 1,080 179.0 50

63 Bell County, TX 1,077 347.2 51

64 Pinellas County, FL 1,034 112.8 51

65 Monroe County, NY 1,016 136.5 51

66 East Baton Rouge County, LA 1,015 230.6 51

67 Richland County, SC 1,010 262.7 52

68 Oakland County, MI 991 82.4 52

69 Bernalillo County, NM 987 149.0 52

70 Orange County, CA 984 32.7 53

* Accounting for 53% of reported gonorrhea cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2011.
STD Surveillance 2011 Gonorrhea Tables 111

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

and Sex, United States, 2007–2011

Age

Group

Cases Rates per 100,00

Total Male Female Unknown Sex Total Male Female Unknown S

0–4 353 140 211 2 1.7 1.3 2.1

2007

5–9 140 35 105 0 0.7 0.3 1.1

10–14 3,946 619 3,313 14 19.4 6.0 33.4

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

TOTAL 355,991 167,685 187,594 712 118.0 112.8 122.

0–4 310 119 190 1 1.5 1.1 1.9

2008

5–9 142 36 105 1 0.7 0.4 1.1

10–14 3,660 596 3,059 5 18.3 5.8 31.2

15–19 97,069 30,468 66,326 275 451.2 276.3 632.5

20–24 108,747 46,796 61,647 304 516.4 431.5 603.6

25–29 56,654 28,928 27,563 163 265.6 264.4 265.2

30–34 27,561 16,077 11,387 97 140.6 161.4 118.1

35–39 16,378 10,552 5,773 53 78.0 99.8 55.4

40–44 11,020 7,809 3,170 41 51.2 72.7 29.5

45–54 11,123 8,612 2,481 30 25.1 39.4 11.0

55–64 2,622 2,186 423 13 7.8 13.5 2.4

65+ 655 545 103 7 1.7 3.3 0.5

Unknown Age 801 379 350 72

TOTAL 336,742 153,103 182,577 1,062 110.7 102.1 118.

0–4 226 83 141 2 1.1 0.8 1.4

2009

5–9 90 13 77 0 0.4 0.1 0.8

10–14 2,983 507 2,471 5 14.9 5.0 25.3

15–19 86,996 27,444 59,353 199 403.9 248.3 566.0

20–24 100,645 43,986 56,436 223 467.3 396.5 540.3

25–29 49,855 26,016 23,719 120 230.0 234.1 224.6

30–34 24,607 14,364 10,178 65 123.7 142.1 104.1

35–39 13,971 8,997 4,928 46 68.0 86.9 48.4

40–44 8,975 6,504 2,446 25 42.8 61.9 23.3

45–54 9,294 7,311 1,954 29 20.8 33.3 8.6

55–64 2,212 1,848 363 1 6.4 11.0 2.0

65+ 554 446 108 0 1.4 2.7 0.5

Unknown Age 766 300 394 72

TOTAL 301,174 137,819 162,568 787 98.1 91.0 104.

0–4 247 70 167 10 1.2 0.7 1.7

2010

5–9 64 10 53 1 0.3 0.1 0.5

10–14 3,016 486 2,498 32 14.6 4.6 24.7

15–19 88,250 28,002 59,867 381 400.4 247.7 557.6

20–24 105,619 46,708 58,574 337 489.3 424.1 554.1

25–29 50,890 26,818 23,907 165 241.2 252.2 228.4

30–34 25,401 14,809 10,510 82 127.2 148.1 105.5

35–39 13,769 8,812 4,907 50 68.2 87.8 48.4

40–44 9,262 6,745 2,495 22 44.3 64.9 23.8

45–54 9,555 7,490 2,043 22 21.2 33.8 8.9

55–64 2,194 1,852 338 4 6.0 10.5 1.8

65+ 520 411 105 4 1.3 2.4 0.5

Unknown Age 554 257 229 68

TOTAL 309,341 142,470 165,693 1,178 100.2 93.9 105.

0–4 182 43 136 3 0.9 0.4 1.4

2011

5–9 82 15 66 1 0.4 0.1 0.7

10–14 3,223 548 2,648 27 15.6 5.2 26.2

15–19 88,139 28,102 59,747 290 399.9 248.6 556.5

20–24 111,730 49,633 61,756 341 517.6 450.6 584.2

25–29 53,245 28,288 24,821 136 252.3 266.0 237.2

30–34 27,157 16,044 11,044 69 136.0 160.5 110.8

35–39 14,109 8,972 5,096 41 69.9 89.3 50.3

40–44 9,686 6,955 2,708 23 46.4 66.9 25.8

45–54 10,473 8,222 2,222 29 23.3 37.1 9.7

55–64 2,747 2,270 471 6 7.5 12.9 2.5

65+ 587 485 99 3 1.5 2.8 0.4

Unknown Age 489 258 191 40

TOTAL 321,849 149,835 171,005 1,009 104.2 98.7 108.

*No population data are available for unknown sex and age; therefore, rates are not calculated.

NOTE: This table should be used only for age comparisons. Cases in the 0-4 age group may include cases due to perinatal transmission.
112 Gonorrhea Tables STD Surveillance 2011

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

2007–2011

Age

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/ 

Alaska Natives

Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Femal

2007 0–4 47 16 31 0 158 69 89 0 22 9 13 0 1 0 1 0 1 1 0 0

5–9 15 2 13 0 65 10 55 0 13 4 9 0 0 0 0 0 1 0 1 0

10–14 353 15 338 0 2,270 395 1,870 5 269 47 222 0 16 0 16 0 22 2 20 0

15–19 12,053 2,101 9,948 4 57,436 20,121 37,266 49 5,827 1,896 3,922 9 384 95 289 0 516 114 401 1

20–24 16,655 5,173 11,469 13 63,965 30,729 33,188 48 7,845 3,703 4,129 13 614 242 372 0 707 209 498 0

25–29 9,832 4,037 5,792 3 33,334 19,108 14,214 12 4,662 2,574 2,083 5 411 230 181 0 382 150 231 1

30–34 5,003 2,382 2,617 4 15,595 10,306 5,285 4 2,414 1,443 967 4 273 164 109 0 174 67 106 1

35–39 3,760 2,141 1,616 3 9,067 6,611 2,445 11 1,396 902 493 1 141 92 49 0 123 60 63 0

40–44 2,759 1,864 893 2 6,211 4,894 1,313 4 787 539 246 2 89 62 27 0 72 21 51 0

45–54 2,867 2,156 710 1 6,505 5,513 990 2 623 456 167 0 85 49 36 0 61 37 24 0

55–64 712 611 101 0 1,364 1,231 130 3 134 97 36 1 33 24 9 0 11 9 1 1

65+ 188 167 20 1 250 219 31 0 34 30 4 0 9 7 2 0 3 3 0 0

UNK Age 116 41 71 4 297 147 140 10 45 23 22 0 9 5 4 0 3 2 1 0

TOTAL 54,360 20,706 33,619 35 196,517 99,353 97,016 148 24,071 11,723 12,313 35 2,065 970 1,095 0 2,076 675 1,397 

2008 0–4 45 16 29 0 158 58 99 1 17 5 12 0 5 2 3 0 1 0 1 0

5–9 14 2 12 0 63 14 49 0 14 3 11 0 1 1 0 0 1 0 1 0

10–14 330 26 304 0 2,086 355 1,731 0 229 31 198 0 20 3 17 0 24 4 20 0

15–19 10,874 1,917 8,945 12 57,194 19,657 37,500 37 5,890 1,861 4,022 7 407 100 306 1 524 122 400 2

20–24 15,650 4,715 10,920 15 62,868 29,555 33,244 69 7,758 3,640 4,114 4 677 284 391 2 726 245 481 0

25–29 8,935 3,494 5,427 14 30,977 17,151 13,788 38 4,651 2,494 2,150 7 441 225 215 1 405 145 260 0

30–34 4,396 2,043 2,347 6 14,315 9,221 5,074 20 2,344 1,370 973 1 250 133 114 3 187 71 116 0

35–39 2,990 1,672 1,316 2 7,799 5,478 2,311 10 1,390 887 500 3 160 111 49 0 111 50 61 0

40–44 2,238 1,478 756 4 5,062 3,813 1,241 8 823 570 250 3 101 76 25 0 78 34 44 0

45–54 2,366 1,753 613 0 5,236 4,322 909 5 596 430 164 2 121 85 36 0 76 42 34 0

55–64 587 503 83 1 1,166 1,028 134 4 119 84 35 0 33 22 11 0 16 14 2 0

65+ 172 147 25 0 204 185 19 0 28 21 7 0 8 4 4 0 7 6 1 0

UNK Age 82 35 46 1 225 126 95 4 29 15 13 1 5 4 1 0 4 3 1 0

TOTAL 48,679 17,801 30,823 55 187,353 90,963 96,194 196 23,888 11,411 12,449 28 2,229 1,050 1,172 7 2,160 736 1,422 

2009 0–4 17 5 12 0 102 39 63 0 19 5 14 0 0 0 0 0 3 1 2 0

5–9 9 2 7 0 42 7 35 0 10 0 10 0 1 0 1 0 2 0 2 0

10–14 253 22 231 0 1,729 300 1,428 1 171 31 140 0 12 1 11 0 18 3 15 0

15–19 9,430 1,802 7,621 7 51,214 17,688 33,468 58 5,366 1,728 3,633 5 412 92 320 0 558 128 428 2

20–24 13,902 4,456 9,433 13 58,733 27,754 30,891 88 7,180 3,434 3,740 6 604 265 336 3 727 228 497 2

25–29 7,864 3,415 4,430 19 27,264 15,186 12,043 35 4,084 2,288 1,793 3 399 214 184 1 409 160 248 1

30–34 4,030 2,045 1,980 5 12,645 7,998 4,626 21 2,132 1,282 846 4 228 132 96 0 229 97 132 0

35–39 2,601 1,496 1,101 4 6,595 4,641 1,938 16 1,172 737 433 2 149 109 40 0 137 62 75 0

40–44 1,869 1,307 559 3 3,866 2,945 916 5 731 524 206 1 100 75 25 0 78 38 40 0

45–54 2,127 1,669 456 2 3,992 3,284 698 10 562 421 141 0 104 73 30 1 81 48 33 0

55–64 532 450 82 0 896 800 96 0 110 78 32 0 30 17 13 0 25 19 6 0

65+ 157 138 19 0 176 145 31 0 29 19 10 0 7 6 1 0 4 3 1 0

UNK Age 93 22 68 3 275 111 146 18 33 14 18 1 1 1 0 0 0 0 0 0

TOTAL 42,884 16,829 25,999 56 167,529 80,898 86,379 252 21,599 10,561 11,016 22 2,047 985 1,057 5 2,271 787 1,479 

2010 0–4 26 4 22 0 103 33 70 0 22 6 16 0 1 0 1 0 4 1 3 0

5–9 5 1 4 0 28 2 26 0 7 0 7 0 1 0 1 0 0 0 0 0

10–14 268 22 246 0 1,695 300 1,391 4 181 26 155 0 6 1 5 0 15 3 12 0

15–19 9,311 1,821 7,486 4 52,064 17,771 34,246 47 5,673 1,928 3,741 4 407 126 280 1 660 168 492 0

20–24 15,426 5,308 10,107 11 60,257 28,643 31,570 44 8,271 3,957 4,309 5 724 337 387 0 900 290 610 0

25–29 8,776 3,939 4,829 8 26,640 14,860 11,758 22 4,604 2,666 1,927 11 469 286 181 2 546 215 331 0

30–34 4,642 2,407 2,230 5 12,497 7,702 4,778 17 2,418 1,547 867 4 273 172 99 2 278 121 157 0

35–39 2,788 1,693 1,092 3 6,113 4,175 1,930 8 1,336 853 483 0 197 141 56 0 151 72 79 0

40–44 2,231 1,565 666 0 3,735 2,883 848 4 851 611 240 0 114 78 36 0 100 52 48 0

45–54 2,513 1,968 540 5 3,818 3,121 696 1 629 478 151 0 100 77 23 0 79 48 31 0

55–64 582 489 93 0 847 766 81 0 117 90 27 0 25 16 9 0 18 15 3 0

65+ 133 117 16 0 136 118 18 0 38 29 8 1 4 4 0 0 5 2 2 1

UNK Age 73 39 33 1 149 71 72 6 21 10 8 3 2 1 1 0 3 2 1 0

TOTAL 46,774 19,373 27,364 37 168,082 80,445 87,484 153 24,168 12,201 11,939 28 2,323 1,239 1,079 5 2,759 989 1,769 

2011 0–4 27 7 20 0 88 22 65 1 13 3 10 0 1 0 1 0 2 0 2 0

5–9 5 1 4 0 45 8 37 0 9 2 7 0 0 0 0 0 3 0 3 0

10–14 243 29 211 3 1,857 321 1,535 1 215 40 175 0 9 1 7 1 26 3 23 0

15–19 9,556 2,058 7,482 16 50,619 17,148 33,409 62 6,254 2,150 4,098 6 419 113 306 0 637 157 479 1

20–24 16,511 5,906 10,576 29 61,704 29,069 32,557 78 9,206 4,409 4,781 16 740 365 374 1 1,054 369 683 2

25–29 9,729 4,451 5,261 17 26,466 14,890 11,550 26 5,299 3,100 2,194 5 482 292 189 1 593 223 368 2

30–34 5,198 2,829 2,357 12 12,732 7,902 4,813 17 2,801 1,729 1,067 5 289 202 86 1 278 116 160 2

35–39 2,947 1,789 1,153 5 6,082 4,101 1,978 3 1,453 936 516 1 194 125 66 3 137 66 71 0

40–44 2,329 1,644 683 2 3,715 2,797 915 3 938 679 256 3 141 101 40 0 96 44 52 0

45–54 2,832 2,205 624 3 3,929 3,226 697 6 781 601 179 1 116 83 33 0 123 69 54 0

55–64 765 646 119 0 1,021 904 114 3 156 121 35 0 30 18 12 0 16 12 4 0

65+ 177 155 22 0 164 144 20 0 17 15 2 0 6 5 1 0 5 4 1 0

UNK Age 42 24 15 3 93 48 38 7 34 23 11 0 4 3 1 0 2 1 1 0

TOTAL 50,361 21,744 28,527 90 168,515 80,580 87,728 207 27,176 13,808 13,331 37 2,431 1,308 1,116 7 2,972 1,064 1,901 

UNK = Unknown

NOTE: These tables should only be used for race/ethnicity comparisons. See Table 21 for age-specific cases and rates and Tables 14-16 for total and sexspecific cases and rates. Cases in the 0-4 age group may include cases due to perinatal transmission.

In 2011, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 20.4% of reported gonorrhea cases.
STD Surveillance 2011 Gonorrhea Tables 113

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

United States, 2007–2011

Age

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/ 

Alaska Natives

Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Femal

0–4 0.4 0.3 0.6 5.0 4.3 5.7 0.4 0.4 0.5 0.1 0.0 0.2 0.5 1.0 0.0

2007

5–9 0.1 0.0 0.2 2.1 0.6 3.7 0.3 0.2 0.4 0.0 0.0 0.0 0.5 0.0 1.1

10–14 2.9 0.2 5.7 72.2 24.7 121.0 6.8 2.3 11.5 1.8 0.0 3.6 10.9 2.0 20.1

15–19 91.2 31.0 154.7 1,702.4 1,176.9 2,239.4 155.6 98.3 215.9 42.3 20.3 65.7 223.0 97.4 350.6

20–24 127.0 76.9 179.7 2,093.8 1,987.6 2,199.5 212.6 187.0 241.5 64.4 49.7 79.6 317.4 184.3 455.5

25–29 77.7 63.4 92.3 1,155.0 1,353.2 964.3 111.6 110.7 112.6 35.6 40.3 31.0 197.3 153.3 241.1

30–34 43.4 41.0 45.6 619.3 860.8 400.1 60.5 66.3 53.3 20.7 25.5 16.1 106.0 81.4 129.4

35–39 28.1 31.8 24.3 341.2 527.6 174.1 38.3 46.3 29.1 10.6 14.2 7.2 73.6 72.3 75.0

40–44 18.8 25.4 12.1 226.3 381.1 89.9 24.6 32.0 16.2 7.7 11.0 4.5 40.8 24.4 56.5

45–54 9.1 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 41.8 84.7 7.2 5.0 7.5 2.6 2.4 3.8 1.2 4.7 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

UNK Age

TOTAL 27.0 21.0 32.8 515.2 546.1 486.2 52.9 49.8 56.0 14.5 14.0 14.9 82.8 54.7 109.

0–4 0.4 0.3 0.5 5.1 3.7 6.6 0.3 0.2 0.5 0.5 0.4 0.6 0.5 0.0 0.9

2008

5–9 0.1 0.0 0.2 2.1 0.9 3.4 0.3 0.1 0.5 0.1 0.2 0.0 0.5 0.0 1.0

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

15–19 82.9 28.5 140.1 1,678.3 1,137.3 2,232.8 153.0 93.9 215.2 44.7 21.3 69.3 228.6 105.4 352.4

20–24 119.2 70.0 170.8 2,030.5 1,888.3 2,171.4 211.8 187.1 239.6 71.8 59.0 84.9 323.9 214.8 436.9

25–29 69.3 53.6 85.1 1,047.5 1,175.1 920.6 112.3 108.6 116.6 38.8 39.9 37.6 199.6 141.2 259.4

30–34 38.0 35.1 40.8 564.5 762.3 382.6 58.0 61.8 53.3 19.5 21.3 17.4 112.4 85.1 139.8

35–39 22.8 25.4 20.2 294.3 438.2 165.1 37.3 44.4 28.8 11.8 16.8 7.1 66.5 60.2 72.7

40–44 15.8 20.8 10.7 187.9 302.2 86.6 25.1 32.9 16.2 8.6 13.3 4.1 45.5 40.6 50.2

45–54 7.4 11.1 3.8 100.5 179.7 32.4 12.0 16.9 6.7 5.9 8.8 3.4 21.7 25.2 18.6

55–64 2.3 4.0 0.6 34.3 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

UNK Age

TOTAL 24.1 18.0 30.0 489.0 497.7 480.1 50.9 47.0 54.9 15.4 14.9 15.7 83.9 58.1 108.

0–4 0.1 0.1 0.2 3.3 2.4 4.1 0.3 0.2 0.5 0.0 0.0 0.0 1.4 0.9 1.8

2009

5–9 0.1 0.0 0.1 1.4 0.5 2.4 0.2 0.0 0.4 0.1 0.0 0.2 1.0 0.0 2.0

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

15–19 73.0 27.2 121.2 1,497.8 1,019.9 1,986.2 133.1 82.8 186.8 44.0 19.1 70.3 247.9 112.6 384.0

20–24 105.0 65.6 146.3 1,835.6 1,713.9 1,954.6 184.9 166.1 205.9 60.8 52.6 68.7 320.4 197.5 445.7

25–29 60.1 51.5 68.6 901.9 1,009.1 793.3 98.4 100.2 96.1 33.1 36.4 29.9 194.3 150.5 238.1

30–34 34.2 34.6 33.8 482.2 636.4 338.7 52.9 57.7 46.8 17.6 21.1 14.3 133.8 112.6 155.1

35–39 20.6 23.6 17.5 250.7 373.6 139.6 31.2 36.4 25.0 11.1 16.7 5.8 82.5 75.1 89.9

40–44 13.6 19.0 8.2 147.1 238.9 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 75.6 134.8 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

UNK Age

TOTAL 21.2 16.9 25.3 431.1 436.0 425.4 44.6 42.1 47.2 13.7 13.6 13.7 87.0 61.3 111.

0–4 0.2 0.1 0.4 3.3 2.1 4.6 0.4 0.2 0.6 0.1 0.0 0.2 1.9 0.9 2.9

2010

5–9 0.0 0.0 0.1 0.9 0.1 1.8 0.1 0.0 0.3 0.1 0.0 0.2 0.0 0.0 0.0

10–14 2.3 0.4 4.3 53.8 18.7 90.0 4.0 1.1 7.0 0.6 0.2 1.0 7.0 2.8 11.4

15–19 73.5 28.0 121.2 1,480.0 994.8 1,978.0 125.2 82.2 171.1 37.4 22.6 52.7 286.3 142.8 435.7

20–24 121.6 82.5 161.7 1,920.2 1,847.7 1,988.2 191.4 171.9 213.3 58.7 54.1 63.4 437.0 279.3 597.1

25–29 70.5 62.7 78.2 952.5 1,107.0 808.4 106.8 117.1 94.7 34.6 44.2 25.5 294.8 234.3 354.2

30–34 39.7 40.8 38.5 475.2 618.6 345.0 58.6 72.2 43.8 20.2 27.2 13.8 165.8 146.0 185.1

35–39 22.9 27.7 18.1 234.2 340.5 139.4 34.6 43.3 25.6 14.1 21.4 7.6 92.3 89.9 94.7

40–44 16.7 23.3 10.0 140.3 229.3 60.4 24.7 34.6 14.3 9.2 13.3 5.5 59.6 63.6 55.8

45–54 8.0 12.6 3.4 69.2 120.5 23.8 11.5 17.5 5.5 4.5 7.4 1.9 21.7 27.6 16.4

55–64 2.1 3.6 0.7 21.8 43.3 3.8 3.6 5.9 1.6 1.5 2.2 1.0 7.0 12.2 2.2

65+ 0.4 0.8 0.1 4.0 8.8 0.9 1.4 2.5 0.5 0.3 0.6 0.0 2.5 2.3 1.8

UNK Age

TOTAL 23.4 19.7 26.9 426.2 427.6 424.2 47.9 47.6 48.0 14.4 16.1 12.8 107.4 78.4 135.

0–4 0.3 0.1 0.4 2.9 1.4 4.3 0.3 0.1 0.4 0.1 0.0 0.2 1.0 0.0 1.9

2011

5–9 0.0 0.0 0.1 1.5 0.5 2.5 0.2 0.1 0.3 0.0 0.0 0.0 1.4 0.0 2.9

10–14 2.1 0.5 3.7 59.0 20.0 99.3 4.8 1.7 7.9 0.9 0.2 1.4 12.2 2.8 21.9

15–19 75.4 31.7 121.2 1,438.9 959.9 1,929.6 138.0 91.6 187.5 38.5 20.2 57.6 276.3 133.5 424.2

20–24 130.2 91.8 169.2 1,966.3 1,875.1 2,050.4 213.0 191.5 236.7 60.0 58.6 61.2 511.7 355.4 668.6

25–29 78.1 70.9 85.2 946.3 1,109.3 794.1 122.9 136.2 107.8 35.5 45.2 26.6 320.2 243.0 393.8

30–34 44.5 48.0 40.7 484.1 634.6 347.6 67.9 80.7 53.8 21.4 31.9 12.0 165.8 140.0 188.6

35–39 24.2 29.3 19.1 233.0 334.4 142.9 37.7 47.5 27.4 13.9 19.0 9.0 83.8 82.4 85.1

40–44 17.4 24.5 10.2 139.6 222.4 65.1 27.2 38.5 15.2 11.3 17.3 6.1 57.2 53.8 60.5

45–54 9.0 14.1 3.9 71.2 124.5 23.8 14.3 22.0 6.6 5.2 8.0 2.8 33.9 39.7 28.5

55–64 2.8 4.8 0.8 26.3 51.1 5.4 4.9 7.9 2.1 1.8 2.4 1.3 6.2 9.8 3.0

65+ 0.5 1.1 0.1 4.8 10.7 1.0 0.6 1.3 0.1 0.4 0.8 0.1 2.5 4.6 0.9

UNK Age

TOTAL 25.2 22.1 28.0 427.3 428.3 425.4 53.8 53.9 53.6 15.1 17.0 13.2 115.7 84.4 145.

UNK = Unknown

NOTE: These tables should only be used for race/ethnicity comparisons. See Table 21 for age-specific cases and rates and Tables 14-16 for total and sexspecific cases and rates. Cases in the 0-4 age group may include cases due to perinatal transmission.

In 2011, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 20.4% of reported gonorrhea cases.

No population data are available for unknown sex and age; therefore, rates are not calculated.
114 Syphilis Tables STD Surveillance 2011

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

Alphabetical Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 1,006 1,187 1,138 781 758 21.7 25.5 24.2 16.3 15.9

Alaska 16 9 4 15 11 2.3 1.3 0.6 2.1 1.5

Arizona 1,245 1,394 1,084 905 906 19.6 21.4 16.4 14.2 14.2

Arkansas 371 508 552 534 464 13.1 17.8 19.1 18.3 15.9

California 6,323 6,911 6,033 6,115 6,782 17.3 18.8 16.3 16.4 18.2

Colorado 157 352 269 342 367 3.2 7.1 5.4 6.8 7.3

Connecticut 148 173 179 234 189 4.2 4.9 5.1 6.5 5.3

Delaware 63 60 87 44 124 7.3 6.9 9.8 4.9 13.8

District of Columbia 416 370 431 495 552 70.7 62.5 71.9 82.3 91.7

Florida 3,918 4,585 3,860 4,070 4,142 21.5 25.0 20.8 21.6 22.0

Georgia 2,254 2,833 2,717 2,347 1,895 23.6 29.2 27.6 24.2 19.6

Hawaii 58 68 88 73 32 4.5 5.3 6.8 5.4 2.4

Idaho 14 26 31 20 42 0.9 1.7 2.0 1.3 2.7

Illinois 1,220 1,565 1,915 2,236 2,426 9.5 12.1 14.8 17.4 18.9

Indiana 216 351 324 412 468 3.4 5.5 5.0 6.4 7.2

Iowa 65 75 65 68 70 2.2 2.5 2.2 2.2 2.3

Kansas 97 125 151 110 76 3.5 4.5 5.4 3.9 2.7

Kentucky 153 218 239 311 335 3.6 5.1 5.5 7.2 7.7

Louisiana 1,808 2,024 1,964 2,484 2,043 42.1 45.9 43.7 54.8 45.1

Maine 21 27 15 41 24 1.6 2.1 1.1 3.1 1.8

Maryland 1,171 1,088 993 1,015 1,278 20.8 19.3 17.4 17.6 22.1

Massachusetts 399 479 473 639 770 6.2 7.4 7.2 9.8 11.8

Michigan 473 546 635 683 762 4.7 5.5 6.4 6.9 7.7

Minnesota 186 266 217 350 367 3.6 5.1 4.1 6.6 6.9

Mississippi 708 745 745 823 748 24.3 25.4 25.2 27.7 25.2

Missouri 484 542 514 512 414 8.2 9.2 8.6 8.5 6.9

Montana 8 10 5 5 9 0.8 1.0 0.5 0.5 0.9

Nebraska 30 36 45 33 36 1.7 2.0 2.5 1.8 2.0

Nevada 396 325 306 412 430 15.4 12.5 11.6 15.3 15.9

New Hampshire 52 41 37 43 33 4.0 3.1 2.8 3.3 2.5

New Jersey 926 1,009 890 947 971 10.7 11.6 10.2 10.8 11.0

New Mexico 180 189 208 151 212 9.1 9.5 10.3 7.3 10.3

New York 5,001 5,515 4,623 4,860 4,786 25.9 28.3 23.7 25.1 24.7

North Carolina 1,093 999 1,524 1,233 1,254 12.1 10.8 16.2 12.9 13.2

North Dakota 2 4 8 6 5 0.3 0.6 1.2 0.9 0.7

Ohio 549 763 795 1,076 954 4.8 6.6 6.9 9.3 8.3

Oklahoma 216 257 296 272 270 6.0 7.1 8.0 7.3 7.2

Oregon 59 97 132 173 252 1.6 2.6 3.5 4.5 6.6

Pennsylvania 844 902 1,027 1,007 1,125 6.8 7.2 8.1 7.9 8.9

Rhode Island 76 55 64 79 84 7.2 5.2 6.1 7.5 8.0

South Carolina 411 412 507 580 639 9.3 9.2 11.1 12.5 13.8

South Dakota 12 6 10 12 14 1.5 0.7 1.2 1.5 1.7

Tennessee 1,212 1,284 1,317 1,193 1,025 19.7 20.7 20.9 18.8 16.2

Texas 5,506 6,336 6,975 6,413 6,169 23.0 26.0 28.1 25.5 24.5

Utah 45 40 55 133 64 1.7 1.5 2.0 4.8 2.3

Vermont 11 18 1 4 10 1.8 2.9 0.2 0.6 1.6

Virginia 736 789 755 800 726 9.5 10.2 9.6 10.0 9.1

Washington 367 438 322 535 712 5.7 6.7 4.8 8.0 10.6

West Virginia 27 44 32 26 9 1.5 2.4 1.8 1.4 0.5

Wisconsin 170 187 166 186 202 3.0 3.3 2.9 3.3 3.6

Wyoming 6 9 7 6 6 1.1 1.7 1.3 1.1 1.1

U.S. TOTAL 40,925 46,292 44,830 45,844 46,042 13.6 15.2 14.6 14.8 14

Northeast 7,478 8,219 7,309 7,854 7,992 13.7 15.0 13.2 14.2 14.4

Midwest 3,504 4,466 4,845 5,684 5,794 5.3 6.7 7.2 8.5 8.7

South 21,069 23,739 24,132 23,421 22,431 19.1 21.2 21.3 20.4 19.6

West 8,874 9,868 8,544 8,885 9,825 12.7 13.9 11.9 12.3 13.7

Guam 37 45 12 11 26 21.3 25.6 6.7 6.1 14.4

Puerto Rico 1,269 797 725 723 671 32.2 20.2 18.3 19.4 18.0

Virgin Islands 5 1 2 4 7 4.6 0.9 1.8 3.6 6.4

OUTLYING AREAS 1,311 843 739 738 704 31.0 19.9 17.4 18.4 

TOTAL 42,236 47,135 45,569 46,582 46,746 13.8 15.3 14.6 14.9 14.

* See Syphilis Morbidity Reporting in the Appendix for definition.
STD Surveillance 2011 Syphilis Tables 115

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

Areas (MSAs)†

 in Alphabetical Order, United States, 2007–2011

MSAs

Cases Rates per 100,000 Populati

2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 1,904 2,243 2,187 1,916 1,549 36.1 41.7 39.9 36.4 29.4

Austin-Round Rock, TX 234 344 352 362 428 14.6 20.8 20.6 21.1 24.9

Baltimore-Towson, MD 650 685 567 531 710 24.4 25.7 21.1 19.6 26.2

Birmingham-Hoover, AL 483 504 412 234 276 43.6 45.1 36.4 20.7 24.5

Boston-Cambridge-Quincy, MA-NH 324 383 411 544 607 7.2 8.5 9.0 11.9 13.3

Buffalo-Cheektowaga-Tonawanda, NY 28 20 40 43 48 2.5 1.8 3.6 3.8 4.2

Charlotte-Gastonia-Concord, NC-SC 301 224 345 287 347 18.2 13.2 19.8 16.3 19.7

Chicago-Naperville-Joliet, IL-IN-WI 1,116 1,452 1,797 2,085 2,266 11.7 15.2 18.8 22.0 24.0

Cincinnati-Middletown, OH-KY-IN 77 105 227 484 436 3.6 4.9 10.5 22.7 20.5

Cleveland-Elyria-Mentor, OH 83 127 170 182 151 4.0 6.1 8.1 8.8 7.3

Columbus, OH 222 311 252 245 236 12.7 17.5 14.0 13.3 12.9

Dallas-Fort Worth-Arlington, TX 1,643 1,780 2,148 1,955 1,814 26.7 28.3 33.3 30.7 28.5

Denver-Aurora, CO 120 269 223 293 319 4.9 10.7 8.7 11.5 12.5

Detroit-Warren-Livonia, MI 339 304 411 459 520 7.6 6.9 9.3 10.7 12.1

Hartford-West Hartford-East Hartford, CT 51 71 67 85 55 4.3 6.0 5.6 7.0 4.5

Houston-Baytown-Sugar Land, TX 2,048 2,088 2,038 1,891 1,876 36.4 36.5 34.7 31.8 31.5

Indianapolis, IN 95 189 156 233 267 5.6 11.0 8.9 13.3 15.2

Jacksonville, FL 198 308 235 228 188 15.2 23.5 17.7 16.9 14.0

Kansas City, MO-KS 268 237 220 145 141 13.5 11.8 10.6 7.1 6.9

Las Vegas-Paradise, NV 364 299 273 389 402 19.8 16.0 14.3 19.9 20.6

Los Angeles-Long Beach-Santa Ana, CA 3,581 3,572 3,278 3,003 3,247 27.8 27.7 25.5 23.4 25.3

Louisville, KY-IN 77 91 123 197 187 6.2 7.3 9.8 15.3 14.6

Memphis, TN-MS-AR 761 748 777 758 586 59.4 58.2 59.5 57.6 44.5

Miami-Fort Lauderdale-Miami Beach, FL 1,863 2,408 1,969 2,259 2,315 34.4 44.5 35.5 40.6 41.6

Milwaukee-Waukesha-West Allis, WI 127 138 117 121 117 8.2 8.9 7.5 7.8 7.5

Minneapolis-St. Paul-Bloomington, MN-WI 170 223 182 309 326 5.3 6.9 5.6 9.4 9.9

Nashville-Davidson-Murfreesboro, TN 240 277 302 258 226 15.8 17.9 19.1 16.2 14.2

New Orleans-Metairie-Kenner, LA 560 491 462 684 663 54.3 43.3 38.8 58.6 56.8

New York-Newark-Edison, NY-NJ-PA 5,503 6,097 5,087 5,335 5,255 29.2 32.1 26.7 28.2 27.8

Oklahoma City, OK 114 161 210 148 114 9.6 13.3 17.1 11.8 9.1

Orlando, FL 583 460 408 391 485 28.7 22.4 19.6 18.3 22.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 778 812 959 930 1,029 13.3 13.9 16.1 15.6 17.2

Phoenix-Mesa-Scottsdale, AZ 866 857 682 645 675 20.7 20.0 15.6 15.4 16.1

Pittsburgh, PA 122 98 70 72 92 5.2 4.2 3.0 3.1 3.9

Portland-Vancouver-Beaverton, OR-WA 51 64 114 153 220 2.3 2.9 5.1 6.9 9.9

Providence-New Bedford-Fall River, RI-MA 100 71 76 95 111 6.2 4.4 4.7 5.9 6.9

Richmond, VA 129 226 207 213 157 10.6 18.4 16.7 16.9 12.5

Riverside-San Bernardino-Ontario, CA 340 452 416 428 527 8.3 11.0 10.0 10.1 12.5

Rochester, NY 76 51 52 66 59 7.4 4.9 5.0 6.3 5.6

Sacramento-Arden-Arcade-Roseville, CA 117 243 212 183 258 5.6 11.5 10.0 8.5 12.0

Salt Lake City, UT 35 35 40 95 48 3.2 3.1 3.5 8.5 4.3

San Antonio, TX 420 598 739 730 736 21.1 29.4 35.7 34.1 34.4

San Diego-Carlsbad-San Marcos, CA 788 828 495 607 609 26.5 27.6 16.2 19.6 19.7

San Francisco-Oakland-Fremont, CA 783 1,044 932 1,150 1,271 18.6 24.4 21.6 26.5 29.3

San Jose-Sunnyvale-Santa Clara, CA 159 156 141 183 159 8.8 8.6 7.7 10.0 8.7

Seattle-Tacoma-Bellevue, WA 309 359 256 439 589 9.3 10.7 7.5 12.8 17.1

St. Louis, MO-IL 252 322 294 403 271 9.0 11.4 10.4 14.3 9.6

Tampa-St. Petersburg-Clearwater, FL 612 680 631 503 516 22.5 24.9 23.0 18.1 18.5

Virginia Beach-Norfolk-Newport News, VA-NC 232 248 236 236 212 14.0 15.0 14.1 14.1 12.7

Washington-Arlington-Alexandria, DC-VA-MD-WV 1,163 956 1,004 1,191 1,315 21.9 17.8 18.3 21.3 23.6

U.S. MSAs TOTAL 31,459 34,709 33,002 34,376 35,011 19.3 21.1 19.9 20.7 21

* 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.
116 Syphilis Tables STD Surveillance 2011

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

United States, 2011

Rank* State Cases Rate per 100,000 Populat

1 Louisiana 447 9.9

2 Maryland 452 7.8

3 Georgia 678 7.0

4 Illinois 881 6.9

5 Florida 1,257 6.7

6 California 2,443 6.6

7 Mississippi 191 6.4

8 Arkansas 182 6.2

9 New York 1,083 5.6

10 Nevada 136 5.0

11 Washington 328 4.9

12 South Carolina 221 4.8

13 Alabama 228 4.8

14 Texas 1,169 4.6

U.S. TOTAL† 13,970 4

15 North Carolina 431 4.5

16 Tennessee 278 4.4

17 Rhode Island 46 4.4

18 Arizona 274 4.3

19 Massachusetts 266 4.1

20 Ohio 440 3.8

21 New Mexico 71 3.4

22 Delaware 27 3.0

23 Kentucky 129 3.0

24 Pennsylvania 373 2.9

25 Michigan 286 2.9

26 Indiana 173 2.7

27 Virginia 213 2.7

28 Colorado 133 2.6

29 New Jersey 232 2.6

30 Minnesota 139 2.6

31 Oregon 97 2.5

32 Missouri 136 2.3

33 Oklahoma 84 2.2

34 Connecticut 65 1.8

35 Vermont 9 1.4

36 New Hampshire 18 1.4

37 Wisconsin 65 1.1

38 Hawaii 14 1.0

39 Maine 12 0.9

40 Kansas 24 0.8

41 Idaho 13 0.8

42 Montana 7 0.7

43 Alaska 5 0.7

44 Iowa 20 0.7

45 Nebraska 10 0.5

46 Utah 14 0.5

47 West Virginia 4 0.2

48 North Dakota 1 0.1

South Dakota 0 0.0

Wyoming 0 0.0

* States were ranked by rate, then case count, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 165 cases and a rate of 27.4, but excludes outlying areas (Guam with 5 cases and rate of 2.8, Puerto 

Rico with 254 cases and rate of 6.8, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2011 Syphilis Tables 117

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

Alphabetical Order, United States and Outlying Areas, 2007–2011

State/Area

Cases Rates per 100,000 Populati

2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 380 449 417 260 228 8.2 9.6 8.9 5.4 4.8

Alaska 7 1 0 3 5 1.0 0.1 0.0 0.4 0.7

Arizona 296 317 231 230 274 4.7 4.9 3.5 3.6 4.3

Arkansas 122 206 275 205 182 4.3 7.2 9.5 7.0 6.2

California 2,038 2,204 1,900 2,065 2,443 5.6 6.0 5.1 5.5 6.6

Colorado 57 128 105 138 133 1.2 2.6 2.1 2.7 2.6

Connecticut 39 34 65 98 65 1.1 1.0 1.8 2.7 1.8

Delaware 18 16 27 9 27 2.1 1.8 3.1 1.0 3.0

District of Columbia 178 146 163 134 165 30.3 24.7 27.2 22.3 27.4

Florida 913 1,044 1,041 1,184 1,257 5.0 5.7 5.6 6.3 6.7

Georgia 680 914 953 795 678 7.1 9.4 9.7 8.2 7.0

Hawaii 9 29 33 35 14 0.7 2.3 2.5 2.6 1.0

Idaho 1 7 3 6 13 0.1 0.5 0.2 0.4 0.8

Illinois 464 554 750 908 881 3.6 4.3 5.8 7.1 6.9

Indiana 54 140 158 175 173 0.9 2.2 2.5 2.7 2.7

Iowa 21 16 23 19 20 0.7 0.5 0.8 0.6 0.7

Kansas 28 30 32 19 24 1.0 1.1 1.1 0.7 0.8

Kentucky 56 93 92 139 129 1.3 2.2 2.1 3.2 3.0

Louisiana 533 707 741 546 447 12.4 16.0 16.5 12.0 9.9

Maine 9 10 4 32 12 0.7 0.8 0.3 2.4 0.9

Maryland 345 378 314 328 452 6.1 6.7 5.5 5.7 7.8

Massachusetts 155 216 238 285 266 2.4 3.3 3.6 4.4 4.1

Michigan 123 210 230 235 286 1.2 2.1 2.3 2.4 2.9

Minnesota 59 116 71 149 139 1.1 2.2 1.3 2.8 2.6

Mississippi 133 184 237 228 191 4.6 6.3 8.0 7.7 6.4

Missouri 239 224 173 152 136 4.1 3.8 2.9 2.5 2.3

Montana 8 7 4 3 7 0.8 0.7 0.4 0.3 0.7

Nebraska 4 15 5 12 10 0.2 0.8 0.3 0.7 0.5

Nevada 111 77 91 130 136 4.3 3.0 3.4 4.8 5.0

New Hampshire 30 20 14 22 18 2.3 1.5 1.1 1.7 1.4

New Jersey 227 226 212 244 232 2.6 2.6 2.4 2.8 2.6

New Mexico 46 44 61 53 71 2.3 2.2 3.0 2.6 3.4

New York 1,068 1,217 1,182 1,098 1,083 5.5 6.2 6.0 5.7 5.6

North Carolina 323 287 579 396 431 3.6 3.1 6.2 4.2 4.5

North Dakota 1 0 4 3 1 0.2 0.0 0.6 0.4 0.1

Ohio 194 351 360 528 440 1.7 3.1 3.1 4.6 3.8

Oklahoma 65 86 97 92 84 1.8 2.4 2.6 2.5 2.2

Oregon 18 26 57 71 97 0.5 0.7 1.5 1.9 2.5

Pennsylvania 263 272 341 369 373 2.1 2.2 2.7 2.9 2.9

Rhode Island 36 18 20 41 46 3.4 1.7 1.9 3.9 4.4

South Carolina 91 98 123 155 221 2.1 2.2 2.7 3.4 4.8

South Dakota 7 1 0 4 0 0.9 0.1 0.0 0.5 0.0

Tennessee 367 413 403 277 278 6.0 6.6 6.4 4.4 4.4

Texas 1,160 1,405 1,644 1,230 1,169 4.9 5.8 6.6 4.9 4.6

Utah 20 25 31 65 14 0.8 0.9 1.1 2.4 0.5

Vermont 10 11 0 4 9 1.6 1.8 0.0 0.6 1.4

Virginia 230 266 299 279 213 3.0 3.4 3.8 3.5 2.7

Washington 154 181 139 266 328 2.4 2.8 2.1 4.0 4.9

West Virginia 6 13 8 6 4 0.3 0.7 0.4 0.3 0.2

Wisconsin 66 65 44 49 65 1.2 1.2 0.8 0.9 1.1

Wyoming 4 3 3 0 0 0.8 0.6 0.6 0.0 0.0

U.S. TOTAL 11,466 13,500 13,997 13,774 13,970 3.8 4.4 4.6 4.5 4

Northeast 1,837 2,024 2,076 2,193 2,104 3.4 3.7 3.8 4.0 3.8

Midwest 1,260 1,722 1,850 2,253 2,175 1.9 2.6 2.8 3.4 3.2

South 5,600 6,705 7,413 6,263 6,156 5.1 6.0 6.5 5.5 5.4

West 2,769 3,049 2,658 3,065 3,535 4.0 4.3 3.7 4.3 4.9

Guam 8 6 2 1 5 4.6 3.4 1.1 0.6 2.8

Puerto Rico 169 167 227 228 254 4.3 4.2 5.7 6.1 6.8

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 177 173 229 229 259 4.2 4.1 5.4 5.7

TOTAL 11,643 13,673 14,226 14,003 14,229 3.8 4.4 4.6 4.5 4.
118 Syphilis Tables STD Surveillance 2011

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

Region in Alphabetical Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 143 171 137 75 54 6.0 7.1 5.6 3.0 2.2

Alaska 1 0 0 0 1 0.3 0.0 0.0 0.0 0.3

Arizona 64 56 22 20 15 2.0 1.7 0.7 0.6 0.5

Arkansas 50 81 104 82 76 3.5 5.6 7.1 5.5 5.1

California 115 110 79 74 103 0.6 0.6 0.4 0.4 0.5

Colorado 2 3 6 2 4 0.1 0.1 0.2 0.1 0.2

Connecticut 2 0 1 5 5 0.1 0.0 0.1 0.3 0.3

Delaware 1 6 11 1 1 0.2 1.3 2.4 0.2 0.2

District of Columbia 5 7 10 2 7 1.6 2.2 3.2 0.6 2.2

Florida 153 193 147 147 134 1.6 2.1 1.6 1.5 1.4

Georgia 53 96 101 82 58 1.1 2.0 2.0 1.7 1.2

Hawaii 1 7 6 7 0 0.2 1.1 0.9 1.0 0.0

Idaho 1 1 0 0 1 0.1 0.1 0.0 0.0 0.1

Illinois 39 38 55 108 81 0.6 0.6 0.8 1.7 1.2

Indiana 8 16 13 20 13 0.2 0.5 0.4 0.6 0.4

Iowa 3 3 6 3 5 0.2 0.2 0.4 0.2 0.3

Kansas 6 5 9 1 0 0.4 0.4 0.6 0.1 0.0

Kentucky 9 14 4 8 19 0.4 0.6 0.2 0.4 0.9

Louisiana 209 307 349 251 179 9.5 13.5 15.1 10.8 7.7

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 47 77 42 26 49 1.6 2.6 1.4 0.9 1.6

Massachusetts 10 6 5 16 23 0.3 0.2 0.1 0.5 0.7

Michigan 27 60 40 23 26 0.5 1.2 0.8 0.5 0.5

Minnesota 1 5 0 9 5 0.0 0.2 0.0 0.3 0.2

Mississippi 35 66 73 69 45 2.3 4.4 4.8 4.5 2.9

Missouri 27 29 15 3 6 0.9 1.0 0.5 0.1 0.2

Montana 2 1 0 0 1 0.4 0.2 0.0 0.0 0.2

Nebraska 0 3 0 3 1 0.0 0.3 0.0 0.3 0.1

Nevada 12 14 7 7 7 1.0 1.1 0.5 0.5 0.5

New Hampshire 0 0 0 1 1 0.0 0.0 0.0 0.1 0.1

New Jersey 16 21 26 16 13 0.4 0.5 0.6 0.4 0.3

New Mexico 15 6 6 3 2 1.5 0.6 0.6 0.3 0.2

New York 32 52 55 47 37 0.3 0.5 0.5 0.5 0.4

North Carolina 60 44 108 55 31 1.3 0.9 2.3 1.1 0.6

North Dakota 0 0 1 1 0 0.0 0.0 0.3 0.3 0.0

Ohio 28 63 63 132 107 0.5 1.1 1.1 2.2 1.8

Oklahoma 24 25 24 16 12 1.3 1.4 1.3 0.8 0.6

Oregon 2 2 1 1 0 0.1 0.1 0.1 0.1 0.0

Pennsylvania 34 21 42 36 34 0.5 0.3 0.6 0.6 0.5

Rhode Island 2 0 1 2 3 0.4 0.0 0.2 0.4 0.6

South Carolina 10 12 10 9 24 0.4 0.5 0.4 0.4 1.0

South Dakota 2 1 0 0 0 0.5 0.2 0.0 0.0 0.0

Tennessee 113 119 122 49 34 3.6 3.7 3.8 1.5 1.0

Texas 297 450 490 333 255 2.5 3.7 4.0 2.6 2.0

Utah 0 1 0 2 0 0.0 0.1 0.0 0.1 0.0

Vermont 0 0 0 2 0 0.0 0.0 0.0 0.6 0.0

Virginia 16 25 22 20 18 0.4 0.6 0.5 0.5 0.4

Washington 6 5 6 5 6 0.2 0.2 0.2 0.1 0.2

West Virginia 2 4 2 0 0 0.2 0.4 0.2 0.0 0.0

Wisconsin 6 14 10 6 5 0.2 0.5 0.4 0.2 0.2

Wyoming 1 2 1 0 0 0.4 0.8 0.4 0.0 0.0

U.S. TOTAL 1,692 2,242 2,232 1,780 1,501 1.1 1.5 1.4 1.1 1

Northeast 96 100 130 125 116 0.3 0.4 0.5 0.4 0.4

Midwest 147 237 212 309 249 0.4 0.7 0.6 0.9 0.7

South 1,227 1,697 1,756 1,225 996 2.2 3.0 3.0 2.1 1.7

West 222 208 134 121 140 0.6 0.6 0.4 0.3 0.4

Guam 4 1 1 1 2 4.7 1.2 1.1 1.1 2.2

Puerto Rico 56 29 23 18 17 2.7 1.4 1.1 0.9 0.9

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 60 30 24 19 19 2.7 1.4 1.1 0.9

TOTAL 1,752 2,272 2,256 1,799 1,520 1.1 1.5 1.4 1.1 1.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2011 Syphilis Tables 119

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

Region in Alphabetical Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 237 278 280 185 174 10.6 12.3 12.3 8.0 7.5

Alaska 6 1 0 3 4 1.7 0.3 0.0 0.8 1.1

Arizona 230 261 208 210 257 7.2 8.0 6.3 6.6 8.1

Arkansas 72 125 171 123 106 5.2 8.9 12.1 8.6 7.4

California 1,921 2,092 1,821 1,990 2,327 10.5 11.4 9.8 10.7 12.6

Colorado 55 125 99 136 129 2.2 5.0 3.9 5.4 5.1

Connecticut 37 34 64 93 60 2.2 2.0 3.7 5.3 3.4

Delaware 17 10 16 8 26 4.1 2.4 3.7 1.8 6.0

District of Columbia 173 139 153 132 158 62.2 49.7 54.1 46.4 55.6

Florida 760 850 894 1,037 1,123 8.5 9.4 9.8 11.3 12.2

Georgia 626 818 852 713 620 13.3 17.2 17.6 15.1 13.1

Hawaii 8 22 27 28 14 1.2 3.4 4.1 4.1 2.1

Idaho 0 6 3 6 12 0.0 0.8 0.4 0.8 1.5

Illinois 425 516 695 800 800 6.7 8.1 10.9 12.7 12.7

Indiana 46 124 145 155 160 1.5 3.9 4.6 4.9 5.0

Iowa 18 13 17 16 15 1.2 0.9 1.1 1.1 1.0

Kansas 22 25 23 18 24 1.6 1.8 1.6 1.3 1.7

Kentucky 47 79 88 131 110 2.3 3.8 4.2 6.1 5.2

Louisiana 324 400 392 284 268 15.5 18.7 17.9 12.8 12.1

Maine 9 10 4 32 12 1.4 1.6 0.6 4.9 1.8

Maryland 298 301 272 302 403 11.0 11.0 9.8 10.8 14.4

Massachusetts 145 210 233 269 243 4.6 6.7 7.3 8.5 7.7

Michigan 96 150 190 212 260 1.9 3.0 3.9 4.4 5.4

Minnesota 58 111 71 140 134 2.2 4.3 2.7 5.3 5.1

Mississippi 98 118 164 159 146 6.9 8.3 11.5 11.0 10.1

Missouri 212 195 158 149 130 7.4 6.8 5.4 5.1 4.4

Montana 6 6 4 3 6 1.3 1.2 0.8 0.6 1.2

Nebraska 4 12 5 9 9 0.5 1.4 0.6 1.0 1.0

Nevada 99 63 84 123 129 7.6 4.8 6.2 9.0 9.5

New Hampshire 30 20 14 21 17 4.6 3.1 2.1 3.2 2.6

New Jersey 211 205 186 228 219 5.0 4.8 4.4 5.3 5.1

New Mexico 31 38 55 50 69 3.2 3.9 5.5 4.9 6.8

New York 1,036 1,165 1,127 1,051 1,045 11.1 12.3 11.9 11.2 11.1

North Carolina 263 243 471 341 400 5.9 5.4 10.3 7.3 8.6

North Dakota 1 0 3 2 1 0.3 0.0 0.9 0.6 0.3

Ohio 166 288 297 396 333 3.0 5.1 5.3 7.0 5.9

Oklahoma 41 61 73 76 72 2.3 3.4 4.0 4.1 3.9

Oregon 16 24 56 70 97 0.9 1.3 3.0 3.7 5.1

Pennsylvania 229 251 299 333 339 3.8 4.1 4.9 5.4 5.5

Rhode Island 34 18 19 39 43 6.6 3.5 3.7 7.7 8.5

South Carolina 81 86 113 146 197 3.8 3.9 5.1 6.5 8.8

South Dakota 5 0 0 4 0 1.3 0.0 0.0 1.0 0.0

Tennessee 254 294 281 228 244 8.4 9.7 9.2 7.4 7.9

Texas 863 955 1,154 896 914 7.2 7.9 9.3 7.2 7.3

Utah 20 24 31 63 14 1.5 1.7 2.2 4.5 1.0

Vermont 10 11 0 2 9 3.3 3.6 0.0 0.6 2.9

Virginia 214 241 277 259 195 5.7 6.3 7.1 6.6 5.0

Washington 148 176 133 261 322 4.6 5.4 4.0 7.8 9.6

West Virginia 4 9 6 6 4 0.5 1.0 0.7 0.7 0.4

Wisconsin 60 51 34 43 60 2.2 1.8 1.2 1.5 2.1

Wyoming 3 1 2 0 0 1.1 0.4 0.7 0.0 0.0

U.S. TOTAL 9,769 11,255 11,764 11,981 12,453 6.6 7.5 7.8 7.9 8

Northeast 1,741 1,924 1,946 2,068 1,987 6.5 7.2 7.2 7.7 7.4

Midwest 1,113 1,485 1,638 1,944 1,926 3.4 4.5 5.0 5.9 5.8

South 4,372 5,007 5,657 5,026 5,160 8.1 9.1 10.2 9.0 9.2

West 2,543 2,839 2,523 2,943 3,380 7.2 8.0 7.0 8.2 9.4

Guam 4 5 1 0 3 4.5 5.6 1.1 0.0 3.3

Puerto Rico 113 138 204 210 237 6.0 7.3 10.7 11.8 13.3

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 117 143 205 210 240 5.8 7.0 10.0 10.9 

TOTAL 9,886 11,398 11,969 12,191 12,693 6.6 7.5 7.8 7.9 8.

NOTE: Cases reported with unknown sex are not included in this table.
120 Syphilis Tables STD Surveillance 2011

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 608 765 809 651 581 11.5 14.2 14.8 12.4 11.0

Austin-Round Rock, TX 74 107 99 107 114 4.6 6.5 5.8 6.2 6.6

Baltimore-Towson, MD 211 270 204 212 308 7.9 10.1 7.6 7.8 11.4

Birmingham-Hoover, AL 189 188 145 82 89 17.1 16.8 12.8 7.3 7.9

Boston-Cambridge-Quincy, MA-NH 131 173 203 240 191 2.9 3.8 4.4 5.3 4.2

Buffalo-Cheektowaga-Tonawanda, NY 11 3 10 11 14 1.0 0.3 0.9 1.0 1.2

Charlotte-Gastonia-Concord, NC-SC 103 58 138 106 145 6.2 3.4 7.9 6.0 8.2

Chicago-Naperville-Joliet, IL-IN-WI 427 535 732 881 853 4.5 5.6 7.6 9.3 9.0

Cincinnati-Middletown, OH-KY-IN 34 62 124 272 228 1.6 2.9 5.7 12.8 10.7

Cleveland-Elyria-Mentor, OH 29 64 71 82 55 1.4 3.1 3.4 3.9 2.6

Columbus, OH 76 135 115 120 122 4.3 7.6 6.4 6.5 6.6

Dallas-Fort Worth-Arlington, TX 265 328 502 342 317 4.3 5.2 7.8 5.4 5.0

Denver-Aurora, CO 46 103 92 120 116 1.9 4.1 3.6 4.7 4.6

Detroit-Warren-Livonia, MI 91 100 151 146 203 2.0 2.3 3.4 3.4 4.7

Hartford-West Hartford-East Hartford, CT 15 8 25 32 15 1.3 0.7 2.1 2.6 1.2

Houston-Baytown-Sugar Land, TX 501 456 432 330 322 8.9 8.0 7.4 5.5 5.4

Indianapolis, IN 26 80 81 108 91 1.5 4.7 4.6 6.1 5.2

Jacksonville, FL 44 67 57 49 47 3.4 5.1 4.3 3.6 3.5

Kansas City, MO-KS 149 102 80 43 57 7.5 5.1 3.9 2.1 2.8

Las Vegas-Paradise, NV 102 72 86 125 126 5.6 3.9 4.5 6.4 6.5

Los Angeles-Long Beach-Santa Ana, CA 1,061 920 858 766 876 8.2 7.1 6.7 6.0 6.8

Louisville, KY-IN 32 36 57 105 92 2.6 2.9 4.5 8.2 7.2

Memphis, TN-MS-AR 208 234 189 165 120 16.2 18.2 14.5 12.5 9.1

Miami-Fort Lauderdale-Miami Beach, FL 414 509 518 652 630 7.6 9.4 9.3 11.7 11.3

Milwaukee-Waukesha-West Allis, WI 53 45 28 29 35 3.4 2.9 1.8 1.9 2.2

Minneapolis-St. Paul-Bloomington, MN-WI 57 105 67 140 127 1.8 3.3 2.0 4.3 3.9

Nashville-Davidson-Murfreesboro, TN 84 85 92 73 84 5.5 5.5 5.8 4.6 5.3

New Orleans-Metairie-Kenner, LA 168 170 138 92 101 16.3 15.0 11.6 7.9 8.6

New York-Newark-Edison, NY-NJ-PA 1,208 1,353 1,301 1,219 1,162 6.4 7.1 6.8 6.5 6.1

Oklahoma City, OK 36 61 70 55 39 3.0 5.1 5.7 4.4 3.1

Orlando, FL 145 126 109 103 174 7.1 6.1 5.2 4.8 8.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 205 214 289 307 302 3.5 3.7 4.8 5.1 5.1

Phoenix-Mesa-Scottsdale, AZ 193 211 169 161 213 4.6 4.9 3.9 3.8 5.1

Pittsburgh, PA 60 38 29 36 49 2.5 1.6 1.2 1.5 2.1

Portland-Vancouver-Beaverton, OR-WA 11 21 53 66 90 0.5 1.0 2.4 3.0 4.0

Providence-New Bedford-Fall River, RI-MA 44 25 28 47 55 2.7 1.6 1.7 2.9 3.4

Richmond, VA 38 92 97 89 52 3.1 7.5 7.8 7.1 4.1

Riverside-San Bernardino-Ontario, CA 95 157 115 157 182 2.3 3.8 2.8 3.7 4.3

Rochester, NY 16 9 11 16 19 1.6 0.9 1.1 1.5 1.8

Sacramento-Arden-Arcade-Roseville, CA 59 102 73 57 131 2.8 4.8 3.4 2.7 6.1

Salt Lake City, UT 19 23 28 54 9 1.7 2.1 2.5 4.8 0.8

San Antonio, TX 157 195 216 183 188 7.9 9.6 10.4 8.5 8.8

San Diego-Carlsbad-San Marcos, CA 347 345 190 274 293 11.7 11.5 6.2 8.9 9.5

San Francisco-Oakland-Fremont, CA 308 478 438 543 626 7.3 11.2 10.1 12.5 14.4

San Jose-Sunnyvale-Santa Clara, CA 56 42 59 91 68 3.1 2.3 3.2 5.0 3.7

Seattle-Tacoma-Bellevue, WA 138 153 115 236 276 4.2 4.6 3.4 6.9 8.0

St. Louis, MO-IL 112 121 83 118 92 4.0 4.3 2.9 4.2 3.3

Tampa-St. Petersburg-Clearwater, FL 195 191 180 183 199 7.2 7.0 6.6 6.6 7.1

Virginia Beach-Norfolk-Newport News, VA-NC 88 98 102 92 64 5.3 5.9 6.1 5.5 3.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 377 297 324 311 360 7.1 5.5 5.9 5.6 6.4

U.S. MSAs TOTAL 9,116 10,132 10,182 10,479 10,702 5.6 6.2 6.1 6.3 6

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
STD Surveillance 2011 Syphilis Tables 121

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2007–2011

MSAs

Cases Rates per 100,000 Populati

2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 40 51 59 44 40 1.5 1.9 2.1 1.6 1.5

Austin-Round Rock, TX 12 16 14 18 12 1.5 2.0 1.7 2.1 1.4

Baltimore-Towson, MD 40 70 33 19 39 2.9 5.1 2.4 1.4 2.8

Birmingham-Hoover, AL 80 77 44 21 10 13.9 13.3 7.5 3.6 1.7

Boston-Cambridge-Quincy, MA-NH 10 4 3 12 14 0.4 0.2 0.1 0.5 0.6

Buffalo-Cheektowaga-Tonawanda, NY 0 0 0 0 2 0.0 0.0 0.0 0.0 0.3

Charlotte-Gastonia-Concord, NC-SC 20 9 14 6 14 2.4 1.0 1.6 0.7 1.5

Chicago-Naperville-Joliet, IL-IN-WI 31 40 46 107 77 0.6 0.8 0.9 2.2 1.6

Cincinnati-Middletown, OH-KY-IN 6 14 26 107 99 0.5 1.3 2.3 9.8 9.1

Cleveland-Elyria-Mentor, OH 5 13 14 6 3 0.5 1.2 1.3 0.6 0.3

Columbus, OH 11 19 15 11 10 1.2 2.1 1.6 1.2 1.1

Dallas-Fort Worth-Arlington, TX 93 116 153 103 63 3.0 3.7 4.8 3.2 2.0

Denver-Aurora, CO 1 1 3 0 1 0.1 0.1 0.2 0.0 0.1

Detroit-Warren-Livonia, MI 22 27 26 9 20 1.0 1.2 1.2 0.4 0.9

Hartford-West Hartford-East Hartford, CT 1 0 0 3 2 0.2 0.0 0.0 0.5 0.3

Houston-Baytown-Sugar Land, TX 108 114 113 77 69 3.8 4.0 3.9 2.6 2.3

Indianapolis, IN 3 8 6 12 5 0.3 0.9 0.7 1.3 0.6

Jacksonville, FL 11 16 11 11 11 1.7 2.4 1.6 1.6 1.6

Kansas City, MO-KS 25 20 8 1 4 2.5 2.0 0.8 0.1 0.4

Las Vegas-Paradise, NV 11 11 7 6 4 1.2 1.2 0.7 0.6 0.4

Los Angeles-Long Beach-Santa Ana, CA 58 31 22 17 16 0.9 0.5 0.3 0.3 0.2

Louisville, KY-IN 2 3 1 4 7 0.3 0.5 0.2 0.6 1.1

Memphis, TN-MS-AR 87 71 67 33 22 13.1 10.6 9.9 4.8 3.2

Miami-Fort Lauderdale-Miami Beach, FL 60 74 54 55 47 2.2 2.7 1.9 1.9 1.6

Milwaukee-Waukesha-West Allis, WI 5 11 9 5 5 0.6 1.4 1.1 0.6 0.6

Minneapolis-St. Paul-Bloomington, MN-WI 1 5 0 5 5 0.1 0.3 0.0 0.3 0.3

Nashville-Davidson-Murfreesboro, TN 13 14 23 10 3 1.7 1.8 2.9 1.2 0.4

New Orleans-Metairie-Kenner, LA 51 53 36 30 17 9.5 9.0 5.8 5.0 2.8

New York-Newark-Edison, NY-NJ-PA 42 60 69 52 37 0.4 0.6 0.7 0.5 0.4

Oklahoma City, OK 13 16 16 12 6 2.2 2.6 2.6 1.9 0.9

Orlando, FL 13 21 19 7 10 1.3 2.0 1.8 0.6 0.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 14 17 37 33 28 0.5 0.6 1.2 1.1 0.9

Phoenix-Mesa-Scottsdale, AZ 29 24 8 12 9 1.4 1.1 0.4 0.6 0.4

Pittsburgh, PA 25 6 4 2 4 2.0 0.5 0.3 0.2 0.3

Portland-Vancouver-Beaverton, OR-WA 1 0 0 2 0 0.1 0.0 0.0 0.2 0.0

Providence-New Bedford-Fall River, RI-MA 2 0 1 3 3 0.2 0.0 0.1 0.4 0.4

Richmond, VA 3 6 3 6 10 0.5 1.0 0.5 0.9 1.5

Riverside-San Bernardino-Ontario, CA 4 5 5 1 8 0.2 0.2 0.2 0.0 0.4

Rochester, NY 1 0 1 3 0 0.2 0.0 0.2 0.6 0.0

Sacramento-Arden-Arcade-Roseville, CA 2 18 16 12 7 0.2 1.7 1.5 1.1 0.6

Salt Lake City, UT 0 1 0 0 0 0.0 0.2 0.0 0.0 0.0

San Antonio, TX 35 58 42 28 39 3.4 5.6 4.0 2.6 3.6

San Diego-Carlsbad-San Marcos, CA 12 12 6 3 13 0.8 0.8 0.4 0.2 0.8

San Francisco-Oakland-Fremont, CA 12 12 9 20 27 0.6 0.6 0.4 0.9 1.2

San Jose-Sunnyvale-Santa Clara, CA 4 3 5 3 4 0.5 0.3 0.6 0.3 0.4

Seattle-Tacoma-Bellevue, WA 4 2 4 2 3 0.2 0.1 0.2 0.1 0.2

St. Louis, MO-IL 9 16 9 3 3 0.6 1.1 0.6 0.2 0.2

Tampa-St. Petersburg-Clearwater, FL 52 54 29 33 26 3.7 3.8 2.1 2.3 1.8

Virginia Beach-Norfolk-Newport News, VA-NC 10 12 11 3 7 1.2 1.4 1.3 0.4 0.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 12 15 19 13 16 0.4 0.5 0.7 0.5 0.6

U.S. MSAs TOTAL 1,106 1,246 1,120 985 881 1.3 1.5 1.3 1.2 1

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
122 Syphilis Tables STD Surveillance 2011

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2007–2011

MSAs

Cases Rates per 100,000 Populati

2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 567 714 750 607 541 21.7 26.9 27.7 23.7 21.1

Austin-Round Rock, TX 62 91 85 89 102 7.6 10.8 9.8 10.3 11.9

Baltimore-Towson, MD 171 200 171 193 269 13.3 15.6 13.2 14.8 20.6

Birmingham-Hoover, AL 109 111 101 61 79 20.4 20.6 18.5 11.2 14.5

Boston-Cambridge-Quincy, MA-NH 121 169 200 228 177 5.6 7.7 8.9 10.4 8.0

Buffalo-Cheektowaga-Tonawanda, NY 11 3 10 11 12 2.0 0.6 1.8 2.0 2.2

Charlotte-Gastonia-Concord, NC-SC 83 49 124 100 131 10.3 5.9 14.5 11.7 15.3

Chicago-Naperville-Joliet, IL-IN-WI 396 495 686 774 776 8.4 10.5 14.6 16.7 16.8

Cincinnati-Middletown, OH-KY-IN 28 48 98 165 129 2.7 4.6 9.2 15.8 12.4

Cleveland-Elyria-Mentor, OH 24 51 57 76 52 2.4 5.1 5.7 7.6 5.2

Columbus, OH 65 116 100 109 112 7.5 13.2 11.2 12.1 12.4

Dallas-Fort Worth-Arlington, TX 172 212 349 239 254 5.6 6.7 10.8 7.6 8.1

Denver-Aurora, CO 45 102 89 120 115 3.6 8.1 7.0 9.5 9.1

Detroit-Warren-Livonia, MI 69 73 125 137 183 3.2 3.4 5.8 6.6 8.8

Hartford-West Hartford-East Hartford, CT 14 8 25 29 13 2.4 1.4 4.3 4.9 2.2

Houston-Baytown-Sugar Land, TX 393 342 319 253 253 13.9 11.9 10.8 8.6 8.6

Indianapolis, IN 23 72 75 96 86 2.8 8.5 8.8 11.2 10.0

Jacksonville, FL 33 51 46 38 36 5.2 7.9 7.1 5.8 5.5

Kansas City, MO-KS 124 82 72 42 53 12.7 8.3 7.1 4.2 5.3

Las Vegas-Paradise, NV 91 61 79 119 122 9.7 6.4 8.2 12.1 12.4

Los Angeles-Long Beach-Santa Ana, CA 1,002 889 836 749 858 15.7 13.9 13.1 11.8 13.6

Louisville, KY-IN 30 33 56 101 85 5.0 5.4 9.1 16.1 13.6

Memphis, TN-MS-AR 121 163 122 132 98 19.6 26.4 19.4 20.9 15.5

Miami-Fort Lauderdale-Miami Beach, FL 354 435 464 597 583 13.5 16.5 17.1 22.2 21.6

Milwaukee-Waukesha-West Allis, WI 48 34 19 24 30 6.4 4.5 2.5 3.2 4.0

Minneapolis-St. Paul-Bloomington, MN-WI 56 100 67 135 122 3.5 6.2 4.1 8.3 7.5

Nashville-Davidson-Murfreesboro, TN 71 71 69 63 81 9.5 9.3 8.9 8.1 10.4

New Orleans-Metairie-Kenner, LA 117 117 102 55 84 23.7 21.5 17.8 9.7 14.8

New York-Newark-Edison, NY-NJ-PA 1,166 1,293 1,232 1,167 1,124 12.8 14.0 13.3 12.8 12.4

Oklahoma City, OK 23 45 54 43 33 3.9 7.6 8.9 7.0 5.3

Orlando, FL 132 105 90 96 164 13.1 10.3 8.7 9.2 15.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 191 197 252 274 274 6.8 7.0 8.7 9.5 9.5

Phoenix-Mesa-Scottsdale, AZ 162 187 161 149 202 7.7 8.6 7.3 7.1 9.7

Pittsburgh, PA 35 32 25 34 45 3.1 2.8 2.2 3.0 4.0

Portland-Vancouver-Beaverton, OR-WA 10 21 53 64 90 0.9 1.9 4.8 5.8 8.2

Providence-New Bedford-Fall River, RI-MA 42 25 27 44 52 5.4 3.2 3.5 5.7 6.7

Richmond, VA 35 86 94 83 42 5.9 14.4 15.6 13.6 6.9

Riverside-San Bernardino-Ontario, CA 90 150 110 156 171 4.4 7.3 5.3 7.4 8.1

Rochester, NY 15 9 10 13 19 3.0 1.8 2.0 2.5 3.7

Sacramento-Arden-Arcade-Roseville, CA 57 84 57 45 122 5.5 8.1 5.4 4.3 11.6

Salt Lake City, UT 19 22 28 54 9 3.4 3.9 4.9 9.5 1.6

San Antonio, TX 122 137 174 155 149 12.5 13.8 17.1 14.7 14.2

San Diego-Carlsbad-San Marcos, CA 335 333 184 271 279 22.4 22.1 12.0 17.4 18.0

San Francisco-Oakland-Fremont, CA 296 466 429 523 596 14.2 21.9 20.0 24.5 27.9

San Jose-Sunnyvale-Santa Clara, CA 52 39 54 88 64 5.6 4.2 5.7 9.5 6.9

Seattle-Tacoma-Bellevue, WA 134 151 111 234 273 8.1 9.0 6.5 13.7 15.9

St. Louis, MO-IL 103 105 74 115 89 7.6 7.7 5.4 8.4 6.5

Tampa-St. Petersburg-Clearwater, FL 143 137 151 150 173 10.8 10.3 11.3 11.1 12.8

Virginia Beach-Norfolk-Newport News, VA-NC 78 86 91 89 57 9.6 10.6 11.1 10.9 7.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 365 282 305 298 344 14.1 10.8 11.4 11.0 12.7

U.S. MSAs TOTAL 8,005 8,884 9,062 9,487 9,807 10.0 11.0 11.1 11.7 12

* 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 2011 Syphilis Tables 123

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

Independent Cities* Ranked by Number of Reported Cases, United States, 2011

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Perc

1 Los Angeles County, CA 810 8.2 5

2 Cook County, IL 773 14.9 11

3 San Francisco County, CA 388 48.2 14

4 Fulton County, GA 362 39.3 16

5 New York County, NY 353 22.3 19

6 Miami-Dade County, FL 330 13.2 21

7 San Diego County, CA 293 9.5 23

8 Harris County, TX 273 6.7 25

9 Kings County, NY 269 10.7 27

10 Broward County, FL 235 13.4 29

11 King County, WA 234 12.1 30

12 Baltimore (City), MD 233 37.5 32

13 Maricopa County, AZ 208 5.4 34

14 Philadelphia County, PA 207 13.6 35

15 Hamilton County, OH 194 24.2 36

16 Bexar County, TX 184 10.7 38

17 Dallas County, TX 179 7.6 39

18 Washington, D.C. 165 27.4 40

19 Bronx County, NY 153 11.0 41

20 Caddo County, LA 151 59.2 42

21 Wayne County, MI 140 7.7 43

22 Orange County, FL 133 11.6 44

23 Alameda County, CA 133 8.8 45

24 Clark County, NV 126 6.5 46

25 Riverside County, CA 125 5.7 47

26 Hillsborough County, FL 124 10.1 48

27 Tarrant County, TX 124 6.9 49

28 Mecklenburg County, NC 122 13.3 50

29 Sacramento County, CA 119 8.4 51

30 Franklin County, OH 115 9.9 51

31 Shelby County, TN 110 11.9 52

32 Queens County, NY 106 4.8 53

33 Suffolk County, MA 101 14.0 54

34 Travis County, TX 100 9.8 54

35 DeKalb County, GA 98 14.2 55

36 Prince George's County, MD 98 11.4 56

37 Hennepin County, MN 90 7.8 56

38 Marion County, IN 89 9.9 57

39 Orleans County, LA 80 23.3 58

40 Jefferson County, KY 77 10.4 58

41 Denver County, CO 73 12.2 59

42 Jefferson County, AL 71 10.8 59

43 Multnomah County, OR 71 9.7 60

44 Santa Clara County, CA 68 3.8 60

45 Pinellas County, FL 66 7.2 61

46 Orange County, CA 66 2.2 61

47 Palm Beach County, FL 65 4.9 62

48 Richland County, SC 64 16.6 62

49 Contra Costa County, CA 64 6.1 63

50 Davidson County, TN 62 9.9 63

51 Pulaski County, AR 60 15.7 63

52 Hinds County, MS 57 23.2 64

53 Guilford County, NC 57 11.7 64

54 San Bernardino County, CA 57 2.8 65

55 Hudson County, NJ 56 8.8 65

56 East Baton Rouge County, LA 54 12.3 65

57 Cuyahoga County, OH 52 4.1 66

58 Escambia County, FL 50 16.8 66

59 Essex County, NJ 50 6.4 67

60 Jefferson County, TX 46 18.2 67

61 San Joaquin County, CA 46 6.7 67

62 Allegheny County, PA 46 3.8 68

63 St. Louis (City), MO 45 14.1 68

64 Cobb County, GA 45 6.5 68

65 Pima County, AZ 45 4.6 69

66 Wake County, NC 44 4.9 69

67 Polk County, FL 43 7.1 69

68 Baltimore County, MD 42 5.2 69

69 Kern County, CA 42 5.0 70

70 Hampden County, MA 41 8.8 70

* Accounting for 70% of reported primary and secondary syphilis cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2011.
124 Syphilis Tables STD Surveillance 2011

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 2011, United States, 2010–2011

Male Female Male-to-Female

2010 2011 2010 2011 Rate Rat

County/Independent City† Cases Rates Cases Rates Cases Rates Cases Rates

Maricopa County, AZ 146 7.7 198 10.5 9 0.5 8 0.4 15.4 26.3

Alameda County, CA 104 14.0 121 16.3 8 1.0 12 1.6 14.0 10.2

Los Angeles County, CA 676 14.0 795 16.4 13 0.3 15 0.3 46.7 54.7

Riverside County, CA 116 10.6 119 10.9 0 0.0 3 0.3 22.2 36.3

Sacramento County, CA 38 5.5 112 16.1 12 1.7 5 0.7 3.2 23.0

San Diego County, CA 271 17.4 279 18.0 3 0.2 13 0.8 87.0 22.5

San Francisco County, CA 369 90.3 378 92.5 6 1.5 7 1.8 60.2 51.4

Washington, D.C. 132 46.4 158 55.6 2 0.6 7 2.2 77.3 25.3

Broward County, FL 208 24.6 214 25.3 12 1.3 21 2.3 18.9 11.0

Hillsborough County, FL 98 16.4 104 17.4 20 3.2 20 3.2 5.1 5.4

Miami-Dade County, FL 339 28.1 311 25.7 34 2.6 19 1.5 10.8 17.1

Orange County, FL 81 14.4 124 22.0 6 1.0 9 1.5 14.4 14.7

Fulton County, GA 302 67.4 333 74.3 18 3.8 29 6.1 17.7 12.2

Cook County, IL 705 28.0 705 28.0 94 3.5 68 2.5 8.0 11.2

Caddo County, LA 85 70.1 75 61.9 94 70.3 76 56.8 1.0 1.1

Baltimore (City), MD 148 50.6 200 68.4 14 4.3 33 10.0 11.8 6.8

Wayne County, MI 91 10.4 125 14.3 6 0.6 15 1.6 17.3 8.9

Clark County, NV 119 12.1 122 12.4 6 0.6 4 0.4 20.2 31.0

Bronx County, NY 150 23.1 145 22.3 13 1.8 8 1.1 12.8 20.3

Kings County, NY 226 19.1 262 22.2 9 0.7 6 0.5 27.3 44.4

New York County, NY 406 54.5 346 46.5 9 1.1 7 0.8 49.5 58.1

Mecklenburg County, NC 88 19.8 113 25.4 5 1.1 9 1.9 18.0 13.4

Franklin County, OH 101 17.8 106 18.7 9 1.5 9 1.5 11.9 12.5

Hamilton County, OH 146 37.9 109 28.3 99 23.7 85 20.4 1.6 1.4

Philadelphia County, PA 212 29.5 185 25.7 26 3.2 22 2.7 9.2 9.5

Bexar County, TX 153 18.2 145 17.2 27 3.1 39 4.5 5.9 3.8

Dallas County, TX 122 10.4 151 12.9 54 4.5 28 2.3 2.3 5.6

Harris County, TX 217 10.7 218 10.7 55 2.7 55 2.7 4.0 4.0

Tarrant County, TX 105 11.8 94 10.6 46 5.0 30 3.3 2.4 3.2

King County, WA 214 22.2 232 24.1 2 0.2 2 0.2 111.0 121.0

* Cases per 100,000 population.

† Counties and independent cities are in alphabetical order by state.
STD Surveillance 2011 Syphilis Tables 125

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

Population by Age Group and Sex, United States, 2007–2011

Age

Group

Cases Rate

Total Male Female Unknown Sex Total Male Female Unknown S

0–4 2 2 0 0 0.0 0.0 0.0

2007

5–9 0 0 0 0 0.0 0.0 0.0

10–14 13 5 8 0 0.1 0.0 0.1

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

TOTAL 11,466 9,769 1,692 5 3.8 6.6 1.

0–4 1 0 1 0 0.0 0.0 0.0

2008

5–9 2 0 2 0 0.0 0.0 0.0

10–14 27 8 19 0 0.1 0.1 0.2

15–19 903 585 318 0 4.2 5.3 3.0

20–24 2,397 1,877 520 0 11.4 17.3 5.1

25–29 2,256 1,851 404 1 10.6 16.9 3.9

30–34 1,733 1,489 244 0 8.8 15.0 2.5

35–39 1,809 1,568 241 0 8.6 14.8 2.3

40–44 1,776 1,573 202 1 8.3 14.6 1.9

45–54 2,027 1,790 236 1 4.6 8.2 1.0

55–64 458 412 46 0 1.4 2.5 0.3

65+ 105 97 8 0 0.3 0.6 0.0

Unknown Age 6 5 1 0

TOTAL 13,500 11,255 2,242 3 4.4 7.5 1.

0–4 1 0 1 0 0.0 0.0 0.0

2009

5–9 1 0 1 0 0.0 0.0 0.0

10–14 19 4 15 0 0.1 0.0 0.2

15–19 1,005 661 344 0 4.7 6.0 3.3

20–24 2,812 2,242 570 0 13.1 20.2 5.5

25–29 2,405 2,027 377 1 11.1 18.2 3.6

30–34 1,857 1,571 286 0 9.3 15.5 2.9

35–39 1,612 1,409 203 0 7.8 13.6 2.0

40–44 1,643 1,476 167 0 7.8 14.1 1.6

45–54 2,033 1,815 218 0 4.6 8.3 1.0

55–64 517 475 42 0 1.5 2.8 0.2

65+ 90 83 7 0 0.2 0.5 0.0

Unknown Age 2 1 1 0

TOTAL 13,997 11,764 2,232 1 4.6 7.8 1.

0–4 1 0 1 0 0.0 0.0 0.0

2010

5–9 0 0 0 0 0.0 0.0 0.0

10–14 18 7 11 0 0.1 0.1 0.1

15–19 932 617 313 2 4.2 5.5 2.9

20–24 2,907 2,429 474 4 13.5 22.1 4.5

25–29 2,455 2,131 322 2 11.6 20.0 3.1

30–34 1,794 1,597 197 0 9.0 16.0 2.0

35–39 1,454 1,313 140 1 7.2 13.1 1.4

40–44 1,553 1,448 104 1 7.4 13.9 1.0

45–54 2,056 1,877 176 3 4.6 8.5 0.8

55–64 493 457 36 0 1.4 2.6 0.2

65+ 107 102 5 0 0.3 0.6 0.0

Unknown Age 4 3 1 0

TOTAL 13,774 11,981 1,780 13 4.5 7.9 1.

0–4 9 5 4 0 0.0 0.0 0.0

2011

5–9 1 1 0 0 0.0 0.0 0.0

10–14 15 6 9 0 0.1 0.1 0.1

15–19 864 606 258 0 3.9 5.4 2.4

20–24 2,987 2,582 403 2 13.8 23.4 3.8

25–29 2,546 2,277 268 1 12.1 21.4 2.6

30–34 1,846 1,657 187 2 9.2 16.6 1.9

35–39 1,382 1,265 115 2 6.8 12.6 1.1

40–44 1,503 1,408 91 4 7.2 13.5 0.9

45–54 2,123 1,999 120 4 4.7 9.0 0.5

55–64 554 510 43 1 1.5 2.9 0.2

65+ 138 135 3 0 0.3 0.8 0.0

Unknown Age 2 2 0 0

TOTAL 13,970 12,453 1,501 16 4.5 8.2 1.

* No population data are available for unknown sex and age; therefore, rates are not calculated.

NOTE: This table should be used only for age comparisons. Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.
126 Syphilis Tables STD Surveillance 2011

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

Sex, United States, 2007–2011

Age

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/ 

Alaska Natives

Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Femal

2007 0–4 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10–14 0 0 0 0 12 4 8 0 0 0 0 0 0 0 0 0 0 0 0 0

15–19 92 47 45 0 453 287 166 0 88 63 25 0 0 0 0 0 7 2 5 0

20–24 326 260 66 0 1,085 848 237 0 316 277 39 0 14 12 2 0 13 6 7 0

25–29 463 410 53 0 910 744 165 1 335 303 32 0 33 32 1 0 14 7 7 0

30–34 481 430 49 2 583 478 105 0 309 282 26 1 36 33 3 0 18 14 4 0

35–39 657 610 47 0 644 524 120 0 275 263 12 0 29 29 0 0 14 9 5 0

40–44 788 731 56 1 570 454 116 0 248 237 11 0 25 24 1 0 6 4 2 0

45–54 772 723 49 0 584 457 127 0 175 160 15 0 22 22 0 0 9 7 2 0

55–64 204 201 3 0 148 124 24 0 39 36 3 0 2 2 0 0 0 0 0 0

65+ 44 42 2 0 36 29 7 0 5 5 0 0 1 1 0 0 0 0 0 0

UNK Age 1 1 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0

TOTAL 3,829 3,456 370 3 5,028 3,952 1,075 1 1,791 1,627 163 1 162 155 7 0 81 49 32 

2008 0–4 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0

10–14 2 1 1 0 22 7 15 0 2 0 2 0 0 0 0 0 0 0 0 0

15–19 120 71 49 0 632 404 228 0 124 96 28 0 7 5 2 0 2 0 2 0

20–24 440 354 86 0 1,499 1,123 376 0 346 298 48 0 33 33 0 0 11 8 3 0

25–29 560 479 81 0 1,157 888 269 0 395 359 36 0 43 39 4 0 14 11 3 0

30–34 525 473 52 0 736 585 151 0 332 300 32 0 46 46 0 0 11 8 3 0

35–39 653 582 71 0 705 575 130 0 327 300 27 0 28 26 2 0 5 2 3 0

40–44 741 677 63 1 652 531 121 0 267 252 15 0 23 22 1 0 5 4 1 0

45–54 947 887 59 1 742 593 149 0 214 196 18 0 21 21 0 0 5 4 1 0

55–64 218 209 9 0 176 144 32 0 34 32 2 0 7 7 0 0 2 1 1 0

65+ 58 55 3 0 28 23 5 0 10 10 0 0 2 2 0 0 0 0 0 0

UNK Age 1 1 0 0 3 3 0 0 1 1 0 0 0 0 0 0 1 0 1 0

TOTAL 4,265 3,789 474 2 6,354 4,876 1,478 0 2,053 1,844 209 0 210 201 9 0 56 38 18 

2009 0–4 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

10–14 1 0 1 0 16 3 13 0 2 1 1 0 0 0 0 0 0 0 0 0

15–19 106 69 37 0 762 479 283 0 109 90 19 0 9 8 1 0 3 2 1 0

20–24 431 352 79 0 1,885 1,439 446 0 392 358 34 0 36 34 2 0 12 10 2 0

25–29 503 438 64 1 1,400 1,120 280 0 392 370 22 0 34 31 3 0 13 10 3 0

30–34 508 452 56 0 896 697 199 0 333 315 18 0 43 41 2 0 9 7 2 0

35–39 571 511 60 0 646 535 111 0 279 258 21 0 45 41 4 0 11 9 2 0

40–44 707 665 42 0 586 478 108 0 257 245 12 0 22 21 1 0 5 5 0 0

45–54 973 903 70 0 734 606 128 0 235 223 12 0 27 25 2 0 5 3 2 0

55–64 276 267 9 0 178 151 27 0 42 37 5 0 2 2 0 0 1 1 0 0

65+ 45 45 0 0 34 27 7 0 6 6 0 0 0 0 0 0 0 0 0 0

UNK Age 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0

TOTAL 4,121 3,702 418 1 7,140 5,535 1,605 0 2,048 1,904 144 0 218 203 15 0 59 47 12 

2010 0–4 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10–14 0 0 0 0 15 5 10 0 2 2 0 0 0 0 0 0 0 0 0 0

15–19 94 66 28 0 678 425 253 0 119 100 19 0 7 5 2 0 7 7 0 0

20–24 476 420 56 0 1,865 1,498 367 0 441 409 32 0 39 33 6 0 19 18 1 0

25–29 555 509 46 0 1,375 1,125 250 0 415 396 19 0 28 28 0 0 14 13 1 0

30–34 530 496 34 0 833 693 140 0 319 304 15 0 42 40 2 0 7 5 2 0

35–39 554 514 40 0 513 431 82 0 298 284 14 0 29 29 0 0 5 3 2 0

40–44 649 625 24 0 491 426 65 0 314 303 11 0 25 25 0 0 4 4 0 0

45–54 1,062 1,007 55 0 599 495 104 0 272 264 7 1 23 22 1 0 8 5 3 0

55–64 286 274 12 0 139 117 22 0 42 41 1 0 7 7 0 0 0 0 0 0

65+ 64 62 2 0 22 19 3 0 15 15 0 0 1 1 0 0 0 0 0 0

UNK Age 1 0 1 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0

TOTAL 4,272 3,973 299 0 6,532 5,236 1,296 0 2,238 2,119 118 1 201 190 11 0 64 55 9 

2011 0–4 2 1 1 0 7 4 3 0 0 0 0 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10–14 1 0 1 0 12 4 8 0 2 2 0 0 0 0 0 0 0 0 0 0

15–19 110 87 23 0 586 381 205 0 115 95 20 0 11 9 2 0 9 8 1 0

20–24 565 510 55 0 1,791 1,491 300 0 469 432 36 1 41 38 3 0 16 14 1 1

25–29 648 594 54 0 1,288 1,107 181 0 452 428 24 0 45 44 1 0 12 10 2 0

30–34 538 506 32 0 789 664 125 0 371 345 24 2 49 46 3 0 12 11 1 0

35–39 487 465 22 0 491 413 78 0 298 286 11 1 37 36 1 0 6 5 1 0

40–44 667 643 24 0 451 397 53 1 269 259 10 0 30 30 0 0 6 6 0 0

45–54 1,131 1,097 33 1 544 479 65 0 293 278 12 3 32 30 2 0 5 5 0 0

55–64 344 329 15 0 127 104 22 1 50 46 4 0 5 5 0 0 3 3 0 0

65+ 90 89 1 0 29 28 1 0 12 11 1 0 1 1 0 0 1 1 0 0

UNK Age 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 4,583 4,321 261 1 6,117 5,074 1,041 2 2,331 2,182 142 7 251 239 12 0 70 63 6 

UNK = Unknown

NOTE: These tables should only be used for race/ethnicity comparisons. See Table 34 for age-specific cases and rates and Tables 26-28 for total and sexspecific cases and rates.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.

In 2011, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 2.9% of reported primary and secondary syphilis cases.
STD Surveillance 2011 Syphilis Tables 127

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

Age Group, and Sex, United States, 2007–2011

Age

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/ 

Alaska Natives

Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Female UNK Total Male Femal

0–4 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2007

5–9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

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

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

UNK Age

TOTAL 1.9 3.5 0.4 13.2 21.7 5.4 3.9 6.9 0.7 1.1 2.2 0.1 3.2 4.0 2.

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2008

5–9 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 0.0 0.0 0.0 0.7 0.4 1.0 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

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

UNK Age

TOTAL 2.1 3.8 0.5 16.6 26.7 7.4 4.4 7.6 0.9 1.4 2.9 0.1 2.2 3.0 1.

0–4 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2009

5–9 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

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

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

UNK Age

TOTAL 2.0 3.7 0.4 18.4 29.8 7.9 4.2 7.6 0.6 1.5 2.8 0.2 2.3 3.7 0.

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2010

5–9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 0.0 0.0 0.0 0.5 0.3 0.6 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15–19 0.7 1.0 0.5 19.3 23.8 14.6 2.6 4.3 0.9 0.6 0.9 0.4 3.0 6.0 0.0

20–24 3.8 6.5 0.9 59.4 96.6 23.1 10.2 17.8 1.6 3.2 5.3 1.0 9.2 17.3 1.0

25–29 4.5 8.1 0.7 49.2 83.8 17.2 9.6 17.4 0.9 2.1 4.3 0.0 7.6 14.2 1.1

30–34 4.5 8.4 0.6 31.7 55.7 10.1 7.7 14.2 0.8 3.1 6.3 0.3 4.2 6.0 2.4

35–39 4.6 8.4 0.7 19.7 35.1 5.9 7.7 14.4 0.7 2.1 4.4 0.0 3.1 3.7 2.4

40–44 4.9 9.3 0.4 18.4 33.9 4.6 9.1 17.2 0.7 2.0 4.3 0.0 2.4 4.9 0.0

45–54 3.4 6.5 0.3 10.9 19.1 3.6 5.0 9.6 0.3 1.0 2.1 0.1 2.2 2.9 1.6

55–64 1.0 2.0 0.1 3.6 6.6 1.0 1.3 2.7 0.1 0.4 0.9 0.0 0.0 0.0 0.0

65+ 0.2 0.4 0.0 0.6 1.4 0.1 0.5 1.3 0.0 0.1 0.2 0.0 0.0 0.0 0.0

UNK Age

TOTAL 2.1 4.0 0.3 16.6 27.8 6.3 4.4 8.3 0.5 1.2 2.5 0.1 2.5 4.4 0.

0–4 0.0 0.0 0.0 0.2 0.3 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2011

5–9 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 0.0 0.0 0.0 0.4 0.2 0.5 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15–19 0.9 1.3 0.4 16.7 21.3 11.8 2.5 4.0 0.9 1.0 1.6 0.4 3.9 6.8 0.9

20–24 4.5 7.9 0.9 57.1 96.2 18.9 10.9 18.8 1.8 3.3 6.1 0.5 7.8 13.5 1.0

25–29 5.2 9.5 0.9 46.1 82.5 12.4 10.5 18.8 1.2 3.3 6.8 0.1 6.5 10.9 2.1

30–34 4.6 8.6 0.6 30.0 53.3 9.0 9.0 16.1 1.2 3.6 7.3 0.4 7.2 13.3 1.2

35–39 4.0 7.6 0.4 18.8 33.7 5.6 7.7 14.5 0.6 2.7 5.5 0.1 3.7 6.2 1.2

40–44 5.0 9.6 0.4 16.9 31.6 3.8 7.8 14.7 0.6 2.4 5.1 0.0 3.6 7.3 0.0

45–54 3.6 7.0 0.2 9.9 18.5 2.2 5.4 10.2 0.4 1.4 2.9 0.2 1.4 2.9 0.0

55–64 1.3 2.4 0.1 3.3 5.9 1.0 1.6 3.0 0.2 0.3 0.7 0.0 1.2 2.4 0.0

65+ 0.3 0.6 0.0 0.8 2.1 0.0 0.4 0.9 0.1 0.1 0.2 0.0 0.5 1.1 0.0

UNK Age

TOTAL 2.3 4.4 0.3 15.5 27.0 5.0 4.6 8.5 0.6 1.6 3.1 0.1 2.7 5.0 0.

UNK = Unknown

NOTE: These tables should only be used for race/ethnicity comparisons. See Table 34 for age-specific cases and rates and Tables 26-28 for total and sexspecific cases and rates.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.

In 2011, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 2.9% of reported primary and secondary syphilis cases.

No population data are available for unknown sex and age; therefore, rates are not calculated.
128 Syphilis Tables STD Surveillance 2011

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

Alphabetical Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 363 440 419 277 268 7.8 9.4 8.9 5.8 5.6

Alaska 3 2 0 5 3 0.4 0.3 0.0 0.7 0.4

Arizona 269 258 196 166 187 4.2 4.0 3.0 2.6 2.9

Arkansas 115 144 172 202 167 4.1 5.0 6.0 6.9 5.7

California 1,421 1,648 1,621 1,788 2,030 3.9 4.5 4.4 4.8 5.4

Colorado 35 91 63 129 154 0.7 1.8 1.3 2.6 3.1

Connecticut 20 28 40 51 57 0.6 0.8 1.1 1.4 1.6

Delaware 14 23 23 14 49 1.6 2.6 2.6 1.6 5.5

District of Columbia 84 77 158 239 222 14.3 13.0 26.3 39.7 36.9

Florida 1,155 1,252 1,254 1,294 1,212 6.3 6.8 6.8 6.9 6.4

Georgia 423 563 768 636 436 4.4 5.8 7.8 6.6 4.5

Hawaii 11 9 15 15 5 0.9 0.7 1.2 1.1 0.4

Idaho 3 6 3 4 11 0.2 0.4 0.2 0.3 0.7

Illinois 224 271 344 502 581 1.7 2.1 2.7 3.9 4.5

Indiana 39 83 55 103 95 0.6 1.3 0.9 1.6 1.5

Iowa 6 11 9 4 11 0.2 0.4 0.3 0.1 0.4

Kansas 25 54 58 63 34 0.9 1.9 2.1 2.2 1.2

Kentucky 34 47 64 88 109 0.8 1.1 1.5 2.0 2.5

Louisiana 722 809 799 742 488 16.8 18.3 17.8 16.4 10.8

Maine 5 10 10 6 8 0.4 0.8 0.8 0.5 0.6

Maryland 320 313 261 279 332 5.7 5.6 4.6 4.8 5.8

Massachusetts 116 149 135 195 233 1.8 2.3 2.0 3.0 3.6

Michigan 73 99 155 121 132 0.7 1.0 1.6 1.2 1.3

Minnesota 55 47 46 73 121 1.1 0.9 0.9 1.4 2.3

Mississippi 269 232 312 386 313 9.2 7.9 10.6 13.0 10.5

Missouri 120 145 146 133 124 2.0 2.5 2.4 2.2 2.1

Montana 0 1 0 2 1 0.0 0.1 0.0 0.2 0.1

Nebraska 3 0 6 1 3 0.2 0.0 0.3 0.1 0.2

Nevada 174 168 137 178 166 6.8 6.5 5.2 6.6 6.1

New Hampshire 13 4 6 5 5 1.0 0.3 0.5 0.4 0.4

New Jersey 343 415 401 386 452 3.9 4.8 4.6 4.4 5.1

New Mexico 66 45 40 41 56 3.4 2.3 2.0 2.0 2.7

New York 1,149 1,372 1,266 1,358 1,254 6.0 7.0 6.5 7.0 6.5

North Carolina 247 221 357 328 333 2.7 2.4 3.8 3.4 3.5

North Dakota 0 2 0 0 1 0.0 0.3 0.0 0.0 0.1

Ohio 135 224 221 189 160 1.2 2.0 1.9 1.6 1.4

Oklahoma 115 117 172 149 145 3.2 3.2 4.7 4.0 3.9

Oregon 6 18 29 33 63 0.2 0.5 0.8 0.9 1.6

Pennsylvania 309 309 361 355 412 2.5 2.5 2.9 2.8 3.2

Rhode Island 10 7 14 20 20 0.9 0.7 1.3 1.9 1.9

South Carolina 143 192 284 344 345 3.2 4.3 6.2 7.4 7.5

South Dakota 4 3 2 0 0 0.5 0.4 0.2 0.0 0.0

Tennessee 304 312 333 363 256 4.9 5.0 5.3 5.7 4.0

Texas 1,467 1,733 1,932 1,874 1,581 6.1 7.1 7.8 7.5 6.3

Utah 2 10 7 20 8 0.1 0.4 0.3 0.7 0.3

Vermont 1 6 1 0 1 0.2 1.0 0.2 0.0 0.2

Virginia 177 238 233 275 289 2.3 3.1 3.0 3.4 3.6

Washington 76 98 64 109 146 1.2 1.5 1.0 1.6 2.2

West Virginia 9 16 8 4 0 0.5 0.9 0.4 0.2 0.0

Wisconsin 91 78 66 52 57 1.6 1.4 1.2 0.9 1.0

Wyoming 0 1 0 3 0 0.0 0.2 0.0 0.5 0.0

U.S. TOTAL 10,768 12,401 13,066 13,604 13,136 3.6 4.1 4.3 4.4 4

Northeast 1,966 2,300 2,234 2,376 2,442 3.6 4.2 4.0 4.3 4.4

Midwest 775 1,017 1,108 1,241 1,319 1.2 1.5 1.7 1.9 2.0

South 5,961 6,729 7,549 7,494 6,545 5.4 6.0 6.7 6.5 5.7

West 2,066 2,355 2,175 2,493 2,830 2.9 3.3 3.0 3.5 3.9

Guam 3 2 1 0 4 1.7 1.1 0.6 0.0 2.2

Puerto Rico 408 241 164 191 211 10.3 6.1 4.1 5.1 5.7

Virgin Islands 1 0 0 3 0 0.9 0.0 0.0 2.7 0.0

OUTLYING AREAS 412 243 165 194 215 9.7 5.7 3.9 4.8

TOTAL 11,180 12,644 13,231 13,798 13,351 3.7 4.1 4.3 4.4 4.
STD Surveillance 2011 Syphilis Tables 129

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

Areas (MSAs)* in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 363 402 613 529 352 6.9 7.5 11.2 10.0 6.7

Austin-Round Rock, TX 66 109 135 137 137 4.1 6.6 7.9 8.0 8.0

Baltimore-Towson, MD 185 214 153 148 198 6.9 8.0 5.7 5.5 7.3

Birmingham-Hoover, AL 196 199 150 67 90 17.7 17.8 13.3 5.9 8.0

Boston-Cambridge-Quincy, MA-NH 95 124 116 161 176 2.1 2.7 2.5 3.5 3.9

Buffalo-Cheektowaga-Tonawanda, NY 6 10 3 0 7 0.5 0.9 0.3 0.0 0.6

Charlotte-Gastonia-Concord, NC-SC 63 62 78 90 95 3.8 3.6 4.5 5.1 5.4

Chicago-Naperville-Joliet, IL-IN-WI 209 251 324 476 531 2.2 2.6 3.4 5.0 5.6

Cincinnati-Middletown, OH-KY-IN 12 23 42 88 67 0.6 1.1 1.9 4.1 3.1

Cleveland-Elyria-Mentor, OH 21 48 70 20 25 1.0 2.3 3.3 1.0 1.2

Columbus, OH 47 89 64 42 36 2.7 5.0 3.6 2.3 2.0

Dallas-Fort Worth-Arlington, TX 468 496 592 647 500 7.6 7.9 9.2 10.2 7.8

Denver-Aurora, CO 30 68 57 109 139 1.2 2.7 2.2 4.3 5.5

Detroit-Warren-Livonia, MI 47 45 88 76 82 1.1 1.0 2.0 1.8 1.9

Hartford-West Hartford-East Hartford, CT 8 10 13 18 18 0.7 0.8 1.1 1.5 1.5

Houston-Baytown-Sugar Land, TX 468 555 421 370 351 8.3 9.7 7.2 6.2 5.9

Indianapolis, IN 20 56 27 70 65 1.2 3.3 1.5 4.0 3.7

Jacksonville, FL 51 86 82 91 50 3.9 6.5 6.2 6.8 3.7

Kansas City, MO-KS 70 79 64 59 40 3.5 3.9 3.1 2.9 2.0

Las Vegas-Paradise, NV 170 166 135 174 162 9.3 8.9 7.1 8.9 8.3

Los Angeles-Long Beach-Santa Ana, CA 893 910 1,070 991 1,132 6.9 7.1 8.3 7.7 8.8

Louisville, KY-IN 12 20 17 46 43 1.0 1.6 1.4 3.6 3.4

Memphis, TN-MS-AR 222 199 259 256 180 17.3 15.5 19.8 19.5 13.7

Miami-Fort Lauderdale-Miami Beach, FL 440 563 644 749 682 8.1 10.4 11.6 13.5 12.3

Milwaukee-Waukesha-West Allis, WI 65 60 46 35 33 4.2 3.9 2.9 2.2 2.1

Minneapolis-St. Paul-Bloomington, MN-WI 54 43 45 68 112 1.7 1.3 1.4 2.1 3.4

Nashville-Davidson-Murfreesboro, TN 56 54 64 70 37 3.7 3.5 4.0 4.4 2.3

New Orleans-Metairie-Kenner, LA 222 239 243 193 108 21.5 21.1 20.4 16.5 9.2

New York-Newark-Edison, NY-NJ-PA 1,360 1,628 1,530 1,595 1,556 7.2 8.6 8.0 8.4 8.2

Oklahoma City, OK 65 72 123 76 65 5.4 6.0 10.0 6.1 5.2

Orlando, FL 160 148 132 138 142 7.9 7.2 6.3 6.5 6.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 310 305 362 348 398 5.3 5.2 6.1 5.8 6.7

Phoenix-Mesa-Scottsdale, AZ 165 160 131 126 153 3.9 3.7 3.0 3.0 3.6

Pittsburgh, PA 45 43 25 27 30 1.9 1.8 1.1 1.1 1.3

Portland-Vancouver-Beaverton, OR-WA 5 11 22 33 58 0.2 0.5 1.0 1.5 2.6

Providence-New Bedford-Fall River, RI-MA 12 13 16 26 26 0.7 0.8 1.0 1.6 1.6

Richmond, VA 45 81 59 77 69 3.7 6.6 4.8 6.1 5.5

Riverside-San Bernardino-Ontario, CA 49 89 88 86 144 1.2 2.2 2.1 2.0 3.4

Rochester, NY 5 5 6 7 9 0.5 0.5 0.6 0.7 0.9

Sacramento-Arden-Arcade-Roseville, CA 16 39 38 43 51 0.8 1.8 1.8 2.0 2.4

Salt Lake City, UT 2 10 4 12 7 0.2 0.9 0.4 1.1 0.6

San Antonio, TX 115 203 290 305 252 5.8 10.0 14.0 14.2 11.8

San Diego-Carlsbad-San Marcos, CA 156 179 80 177 162 5.2 6.0 2.6 5.7 5.2

San Francisco-Oakland-Fremont, CA 200 281 253 373 396 4.8 6.6 5.9 8.6 9.1

San Jose-Sunnyvale-Santa Clara, CA 25 25 22 29 35 1.4 1.4 1.2 1.6 1.9

Seattle-Tacoma-Bellevue, WA 70 91 56 91 134 2.1 2.7 1.6 2.6 3.9

St. Louis, MO-IL 57 70 90 106 84 2.0 2.5 3.2 3.8 3.0

Tampa-St. Petersburg-Clearwater, FL 294 275 225 117 139 10.8 10.1 8.2 4.2 5.0

Virginia Beach-Norfolk-Newport News, VA-NC 54 69 78 84 108 3.3 4.2 4.7 5.0 6.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 265 224 306 441 402 5.0 4.2 5.6 7.9 7.2

U.S. MSAs TOTAL 8,034 9,201 9,551 10,097 9,868 4.9 5.6 5.7 6.1 5

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
130 Syphilis Tables STD Surveillance 2011

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

Alphabetical Order, United States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 254 286 289 235 252 5.5 6.1 6.1 4.9 5.3

Alaska 6 6 4 7 3 0.9 0.9 0.6 1.0 0.4

Arizona 650 789 629 493 431 10.3 12.1 9.5 7.7 6.7

Arkansas 122 149 95 116 100 4.3 5.2 3.3 4.0 3.4

California 2,777 2,995 2,449 2,223 2,269 7.6 8.1 6.6 6.0 6.1

Colorado 63 133 101 75 80 1.3 2.7 2.0 1.5 1.6

Connecticut 87 109 72 83 67 2.5 3.1 2.0 2.3 1.9

Delaware 31 20 36 19 48 3.6 2.3 4.1 2.1 5.3

District of Columbia 153 147 110 121 164 26.0 24.8 18.3 20.1 27.3

Florida 1,830 2,272 1,547 1,572 1,641 10.0 12.4 8.3 8.4 8.7

Georgia 1,142 1,345 982 898 771 12.0 13.9 10.0 9.3 8.0

Hawaii 38 30 39 23 13 3.0 2.3 3.0 1.7 1.0

Idaho 10 13 24 9 18 0.7 0.9 1.6 0.6 1.1

Illinois 522 720 805 799 946 4.1 5.6 6.2 6.2 7.4

Indiana 121 128 110 134 200 1.9 2.0 1.7 2.1 3.1

Iowa 37 48 33 45 39 1.2 1.6 1.1 1.5 1.3

Kansas 44 41 58 28 18 1.6 1.5 2.1 1.0 0.6

Kentucky 63 77 81 84 95 1.5 1.8 1.9 1.9 2.2

Louisiana 516 485 413 1,163 1,090 12.0 11.0 9.2 25.7 24.0

Maine 7 7 1 3 4 0.5 0.5 0.1 0.2 0.3

Maryland 482 374 387 386 470 8.6 6.6 6.8 6.7 8.1

Massachusetts 128 114 100 158 271 2.0 1.8 1.5 2.4 4.1

Michigan 262 227 246 322 338 2.6 2.3 2.5 3.3 3.4

Minnesota 72 102 99 128 107 1.4 2.0 1.9 2.4 2.0

Mississippi 305 320 188 200 238 10.4 10.9 6.4 6.7 8.0

Missouri 124 171 189 225 153 2.1 2.9 3.2 3.8 2.6

Montana 0 2 1 0 1 0.0 0.2 0.1 0.0 0.1

Nebraska 23 21 34 20 23 1.3 1.2 1.9 1.1 1.3

Nevada 104 71 75 99 125 4.1 2.7 2.8 3.7 4.6

New Hampshire 9 17 17 16 10 0.7 1.3 1.3 1.2 0.8

New Jersey 345 364 270 314 282 4.0 4.2 3.1 3.6 3.2

New Mexico 62 96 107 57 85 3.1 4.8 5.3 2.8 4.1

New York 2,766 2,903 2,160 2,387 2,436 14.3 14.9 11.1 12.3 12.6

North Carolina 516 480 578 499 485 5.7 5.2 6.2 5.2 5.1

North Dakota 1 2 3 3 3 0.2 0.3 0.5 0.4 0.4

Ohio 219 185 206 349 341 1.9 1.6 1.8 3.0 3.0

Oklahoma 33 51 25 31 39 0.9 1.4 0.7 0.8 1.0

Oregon 33 53 46 69 92 0.9 1.4 1.2 1.8 2.4

Pennsylvania 264 313 321 280 335 2.1 2.5 2.5 2.2 2.6

Rhode Island 30 30 29 18 18 2.8 2.9 2.8 1.7 1.7

South Carolina 176 120 100 80 73 4.0 2.7 2.2 1.7 1.6

South Dakota 1 2 8 8 14 0.1 0.2 1.0 1.0 1.7

Tennessee 537 548 568 542 483 8.7 8.8 9.0 8.5 7.6

Texas 2,780 3,071 3,271 3,204 3,312 11.6 12.6 13.2 12.7 13.2

Utah 23 5 17 47 42 0.9 0.2 0.6 1.7 1.5

Vermont 0 1 0 0 0 0.0 0.2 0.0 0.0 0.0

Virginia 328 281 221 245 224 4.3 3.6 2.8 3.1 2.8

Washington 135 159 118 159 236 2.1 2.4 1.8 2.4 3.5

West Virginia 11 14 16 16 5 0.6 0.8 0.9 0.9 0.3

Wisconsin 12 43 56 84 80 0.2 0.8 1.0 1.5 1.4

Wyoming 2 5 4 3 6 0.4 0.9 0.7 0.5 1.1

U.S. TOTAL 18,256 19,945 17,338 18,079 18,576 6.1 6.6 5.6 5.9 6

Northeast 3,636 3,858 2,970 3,259 3,423 6.6 7.0 5.4 5.9 6.2

Midwest 1,438 1,690 1,847 2,145 2,262 2.2 2.5 2.8 3.2 3.4

South 9,279 10,040 8,907 9,411 9,490 8.4 9.0 7.9 8.2 8.3

West 3,903 4,357 3,614 3,264 3,401 5.6 6.1 5.0 4.5 4.7

Guam 24 37 9 10 17 13.8 21.0 5.0 5.5 9.4

Puerto Rico 682 381 328 302 204 17.3 9.6 8.3 8.1 5.5

Virgin Islands 4 1 2 1 7 3.6 0.9 1.8 0.9 6.4

OUTLYING AREAS 710 419 339 313 228 16.8 9.9 8.0 7.8

TOTAL 18,966 20,364 17,677 18,392 18,804 6.2 6.6 5.7 5.9 6.

* 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 2011 Syphilis Tables 131

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

Statistical Areas (MSAs)†

 in Alphabetical Order, United States, 2007–2011

Cases Rates per 100,000 Populati

MSAs 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Atlanta-Sandy Springs-Marietta, GA 929 1,068 756 723 611 17.6 19.9 13.8 13.7 11.6

Austin-Round Rock, TX 94 127 116 118 168 5.9 7.7 6.8 6.9 9.8

Baltimore-Towson, MD 236 186 193 162 196 8.8 7.0 7.2 6.0 7.2

Birmingham-Hoover, AL 93 110 112 84 95 8.4 9.8 9.9 7.4 8.4

Boston-Cambridge-Quincy, MA-NH 98 86 92 142 240 2.2 1.9 2.0 3.1 5.3

Buffalo-Cheektowaga-Tonawanda, NY 9 7 27 32 27 0.8 0.6 2.4 2.8 2.4

Charlotte-Gastonia-Concord, NC-SC 133 100 127 91 106 8.1 5.9 7.3 5.2 6.0

Chicago-Naperville-Joliet, IL-IN-WI 469 650 727 703 866 4.9 6.8 7.6 7.4 9.2

Cincinnati-Middletown, OH-KY-IN 31 20 58 117 131 1.5 0.9 2.7 5.5 6.1

Cleveland-Elyria-Mentor, OH 33 15 29 79 70 1.6 0.7 1.4 3.8 3.4

Columbus, OH 99 84 71 82 76 5.6 4.7 3.9 4.5 4.1

Dallas-Fort Worth-Arlington, TX 881 934 1,020 941 979 14.3 14.8 15.8 14.8 15.4

Denver-Aurora, CO 43 98 74 64 64 1.7 3.9 2.9 2.5 2.5

Detroit-Warren-Livonia, MI 187 154 171 232 229 4.2 3.5 3.9 5.4 5.3

Hartford-West Hartford-East Hartford, CT 27 51 29 34 22 2.3 4.3 2.4 2.8 1.8

Houston-Baytown-Sugar Land, TX 1,032 1,024 1,139 1,149 1,168 18.3 17.9 19.4 19.3 19.6

Indianapolis, IN 49 53 48 55 111 2.9 3.1 2.8 3.1 6.3

Jacksonville, FL 102 153 95 87 89 7.8 11.7 7.2 6.5 6.6

Kansas City, MO-KS 49 55 70 43 44 2.5 2.7 3.4 2.1 2.2

Las Vegas-Paradise, NV 85 52 49 85 111 4.6 2.8 2.6 4.4 5.7

Los Angeles-Long Beach-Santa Ana, CA 1,588 1,722 1,332 1,238 1,222 12.3 13.4 10.3 9.7 9.5

Louisville, KY-IN 33 34 48 46 50 2.7 2.7 3.8 3.6 3.9

Memphis, TN-MS-AR 326 306 316 326 278 25.5 23.8 24.2 24.8 21.1

Miami-Fort Lauderdale-Miami Beach, FL 997 1,326 797 853 984 18.4 24.5 14.4 15.3 17.7

Milwaukee-Waukesha-West Allis, WI 9 32 43 57 49 0.6 2.1 2.8 3.7 3.1

Minneapolis-St. Paul-Bloomington, MN-WI 59 75 70 101 87 1.8 2.3 2.1 3.1 2.7

Nashville-Davidson-Murfreesboro, TN 100 138 145 115 105 6.6 8.9 9.2 7.2 6.6

New Orleans-Metairie-Kenner, LA 157 75 78 391 453 15.2 6.6 6.6 33.5 38.8

New York-Newark-Edison, NY-NJ-PA 2,913 3,089 2,237 2,502 2,522 15.5 16.3 11.7 13.2 13.3

Oklahoma City, OK 12 26 16 17 10 1.0 2.2 1.3 1.4 0.8

Orlando, FL 277 184 165 149 166 13.6 9.0 7.9 7.0 7.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 253 287 304 271 325 4.3 4.9 5.1 4.5 5.4

Phoenix-Mesa-Scottsdale, AZ 486 468 368 345 299 11.6 10.9 8.4 8.2 7.1

Pittsburgh, PA 17 17 16 9 13 0.7 0.7 0.7 0.4 0.6

Portland-Vancouver-Beaverton, OR-WA 34 32 39 54 72 1.6 1.4 1.7 2.4 3.2

Providence-New Bedford-Fall River, RI-MA 44 33 31 22 30 2.7 2.1 1.9 1.4 1.9

Richmond, VA 46 53 50 47 36 3.8 4.3 4.0 3.7 2.9

Riverside-San Bernardino-Ontario, CA 194 202 210 185 201 4.8 4.9 5.1 4.4 4.8

Rochester, NY 55 37 34 43 31 5.3 3.6 3.3 4.1 2.9

Sacramento-Arden-Arcade-Roseville, CA 40 100 94 81 69 1.9 4.7 4.4 3.8 3.2

Salt Lake City, UT 14 2 8 29 32 1.3 0.2 0.7 2.6 2.8

San Antonio, TX 142 190 221 232 286 7.1 9.4 10.7 10.8 13.3

San Diego-Carlsbad-San Marcos, CA 273 292 211 148 154 9.2 9.7 6.9 4.8 5.0

San Francisco-Oakland-Fremont, CA 263 277 239 230 244 6.3 6.5 5.5 5.3 5.6

San Jose-Sunnyvale-Santa Clara, CA 76 84 58 62 54 4.2 4.6 3.2 3.4 2.9

Seattle-Tacoma-Bellevue, WA 99 115 84 112 177 3.0 3.4 2.5 3.3 5.1

St. Louis, MO-IL 82 129 120 177 94 2.9 4.6 4.2 6.3 3.3

Tampa-St. Petersburg-Clearwater, FL 119 212 223 195 175 4.4 7.8 8.1 7.0 6.3

Virginia Beach-Norfolk-Newport News, VA-NC 89 80 55 59 40 5.4 4.8 3.3 3.5 2.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 514 425 362 425 536 9.7 7.9 6.6 7.6 9.6

U.S. MSAs TOTAL 13,990 15,069 12,977 13,544 14,197 8.6 9.2 7.8 8.2 8

* 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.
132 Syphilis Tables STD Surveillance 2011

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

State, Ranked by Rates, United States, 2011

Rank* State† Cases Rate per 100,000 Live Bir

1 Arkansas 15 36.9

2 Maryland 24 31.1

3 Louisiana 18 27.6

4 Texas 107 26.4

5 Alabama 10 15.5

6 Arizona 14 14.1

7 Florida 32 13.8

8 Mississippi 6 13.3

9 Illinois 18 10.2

10 Tennessee 8 9.4

YEAR 2020 TARGET

11 Ohio 13 8.7

U.S. TOTAL‡ 360 8

12 Nevada 3 7.6

13 California 40 7.2

14 Georgia 10 6.8

15 New York 13 5.2

16 Michigan 6 5.0

17 New Jersey 5 4.4

18 North Carolina 5 3.8

19 Oklahoma 2 3.7

20 Kentucky 2 3.4

21 Pennsylvania 5 3.3

22 Washington 2 2.2

23 Missouri 1 1.2

Alaska 0 0.0

Colorado 0 0.0

Connecticut 0 0.0

Delaware 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Indiana 0 0.0

Iowa 0 0.0

Kansas 0 0.0

Maine 0 0.0

Massachusetts 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

Oregon 0 0.0

Rhode Island 0 0.0

South Carolina 0 0.0

South Dakota 0 0.0

Utah 0 0.0

Vermont 0 0.0

Virginia 0 0.0

West Virginia 0 0.0

Wisconsin 0 0.0

Wyoming 0 0.0

* States were ranked by rate, then case count, with rates shown rounded to the nearest tenth. 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 11.0, but excludes outlying areas (Guam with 0 cases and rate of 

0.0, Puerto Rico with 2 cases and rate of 4.4, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2011 Syphilis Tables 133

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, 2007–2011

Cases Rates per 100,000 Live Birt

State/Area* 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 9 12 13 9 10 13.9 18.6 20.1 13.9 15.5

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 30 30 28 16 14 29.1 30.2 28.2 16.1 14.1

Arkansas 12 9 10 11 15 29.0 22.1 24.6 27.0 36.9

California 87 64 63 39 40 15.4 11.6 11.4 7.1 7.2

Colorado 2 0 0 0 0 2.8 0.0 0.0 0.0 0.0

Connecticut 2 2 2 2 0 4.8 5.0 5.0 5.0 0.0

Delaware 0 1 1 2 0 0.0 8.3 8.3 16.5 0.0

District of Columbia 1 0 0 1 1 11.3 0.0 0.0 11.0 11.0

Florida 20 17 18 20 32 8.4 7.3 7.8 8.6 13.8

Georgia 9 11 14 18 10 6.0 7.5 9.5 12.3 6.8

Hawaii 0 0 1 0 0 0.0 0.0 5.1 0.0 0.0

Idaho 0 0 1 1 0 0.0 0.0 4.0 4.0 0.0

Illinois 10 20 16 27 18 5.5 11.3 9.1 15.3 10.2

Indiana 2 0 1 0 0 2.2 0.0 1.1 0.0 0.0

Iowa 1 0 0 0 0 2.4 0.0 0.0 0.0 0.0

Kansas 0 0 3 0 0 0.0 0.0 7.2 0.0 0.0

Kentucky 0 1 2 0 2 0.0 1.7 3.4 0.0 3.4

Louisiana 37 23 11 33 18 55.8 35.2 16.9 50.6 27.6

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 24 23 31 22 24 30.7 29.8 40.1 28.5 31.1

Massachusetts 0 0 0 1 0 0.0 0.0 0.0 1.3 0.0

Michigan 15 10 4 5 6 12.0 8.3 3.3 4.1 5.0

Minnesota 0 1 1 0 0 0.0 1.4 1.4 0.0 0.0

Mississippi 1 9 8 9 6 2.2 20.0 17.8 20.0 13.3

Missouri 1 2 6 2 1 1.2 2.5 7.4 2.5 1.2

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 7 9 3 5 3 17.0 22.8 7.6 12.7 7.6

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 11 4 7 3 5 9.5 3.5 6.2 2.7 4.4

New Mexico 6 4 0 0 0 19.6 13.3 0.0 0.0 0.0

New York 18 23 15 17 13 7.1 9.2 6.0 6.8 5.2

North Carolina 7 11 10 10 5 5.3 8.4 7.6 7.6 3.8

North Dakota 0 0 1 0 0 0.0 0.0 11.2 0.0 0.0

Ohio 1 3 8 10 13 0.7 2.0 5.4 6.7 8.7

Oklahoma 3 3 2 0 2 5.4 5.5 3.7 0.0 3.7

Oregon 2 0 0 0 0 4.1 0.0 0.0 0.0 0.0

Pennsylvania 8 8 4 3 5 5.3 5.4 2.7 2.0 3.3

Rhode Island 0 0 1 0 0 0.0 0.0 8.3 0.0 0.0

South Carolina 1 2 0 1 0 1.6 3.2 0.0 1.6 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 4 11 13 11 8 4.6 12.9 15.2 12.9 9.4

Texas 99 127 128 105 107 24.3 31.3 31.6 25.9 26.4

Utah 0 0 0 1 0 0.0 0.0 0.0 1.8 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 1 4 2 1 0 0.9 3.7 1.9 0.9 0.0

Washington 2 0 1 1 2 2.2 0.0 1.1 1.1 2.2

West Virginia 1 1 0 0 0 4.5 4.7 0.0 0.0 0.0

Wisconsin 1 1 0 1 0 1.4 1.4 0.0 1.4 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 435 446 429 387 360 10.1 10.5 10.1 9.1 8

Northeast 39 37 29 26 23 5.7 5.5 4.3 3.8 3.4

Midwest 31 37 40 45 38 3.4 4.2 4.5 5.0 4.3

South 229 265 263 253 240 13.9 16.4 16.3 15.6 14.8

West 136 107 97 63 59 12.6 10.1 9.1 5.9 5.6

Guam 2 0 0 0 0 57.5 0.0 0.0 0.0 0.0

Puerto Rico 10 8 6 2 2 21.4 17.5 13.2 4.4 4.4

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 12 8 6 2 2 23.2 15.7 11.8 3.9

TOTAL 447 454 435 389 362 10.2 10.6 10.1 9.0 8.

* Mother’s state of residence was used to assign case.
134 Syphilis Tables STD Surveillance 2011

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

Race/Ethnicity of Mother, United States, 2007–2011

Year of 

Birth Race/Ethnicity Cases Rates per 100,000 Live Births 

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 35.9

Hispanics 135 13.0

Asians/Pacific Islanders 7 2.9

American Indians/Alaska Natives 6 13.8

Other 1 NA

Unknown 4 NA

Total 446 10.5

2009

Whites, Non-Hispanic 65 2.8

Blacks, Non-Hispanic 215 34.1

Hispanics 128 12.3

Asians/Pacific Islanders 11 4.5

American Indians/Alaska Natives 5 11.5

Other 2 NA

Unknown 3 NA

Total 429 10.1

2010

Whites, Non-Hispanic 63 2.8

Blacks, Non-Hispanic 216 34.3

Hispanics 91 8.7

Asians/Pacific Islanders 9 3.7

American Indians/Alaska Natives 1 2.3

Other 3 NA

Unknown 4 NA

Total 387 9.1

2011

Whites, Non-Hispanic 50 2.2

Blacks, Non-Hispanic 208 33.0

Hispanics 79 7.6

Asians/Pacific Islanders 14 5.7

American Indians/Alaska Natives 2 4.6

Other 3 NA

Unknown 4 NA

Total 360 8.5

NA = Not applicable.
STD Surveillance 2011 Chancroid Tables 135

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

States and Outlying Areas, 2007–2011

Cases Rates per 100,000 Populati

State/Area 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alabama 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 0 0 0 0 1 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 1 2 1 5 1 0.0 0.0 0.0 0.0 0.0

Colorado 0 2 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 3 0 1 1 0 0.0 0.0 0.0 0.0 0.0

Georgia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Indiana 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 4 0 0 0 0 0.1 0.0 0.0 0.0 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 1 4 3 1 2 0.0 0.1 0.0 0.0 0.0

Michigan 0 0 0 0 1 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 2 0 0 0 0.0 0.0 0.0 0.0 0.0

North Carolina 2 4 6 1 0 0.0 0.0 0.1 0.0 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 0 1 0 0 0 0.0 0.0 0.0 0.0 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 1 1 1 2 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 1 0 0.0 0.0 0.0 0.0 0.0

Texas 5 8 8 12 1 0.0 0.0 0.0 0.0 0.0

Utah 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Washington 0 1 0 1 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 2 0 6 0 0 0.0 0.0 0.1 0.0 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 23 25 28 24 8 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

TOTAL 23 25 28 24 8 0.0 0.0 0.0 0.0 0.
136 Selected STDs STD Surveillance 2011

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

Disease and Therapeutic Index, United States, 1966-2011

Year Genital Herpes Genital Warts

Vaginal 

Trichomoniasis* Other Vaginitis

Pelvic Inflammatory 

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

2006 371,000 422,000 200,000 3,891,000 106,000

2007 317,000 312,000 205,000 3,723,000 146,000

2008 292,000 385,000 204,000 3,571,000 104,000

2009 306,000 357,000 216,000 3,063,000 100,000

2010 232,000 376,000 149,000 3,192,000 113,000

2011 227,000 453,000 168,000 3,102,000 90,000

* 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 2011 Appendix: Interpreting STD Surveillance Data 137

Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance 2011 presents 

surveillance information derived from the official 

statistics for the reported occurrence of nationally 

notifiable sexually transmitted diseases (STDs) in the 

United States, test positivity and prevalence data from 

numerous prevalence monitoring initiatives, sentinel 

surveillance, and national health care services surveys.

Nationally Notifiable STD Surveillance

Nationally notifiable STD surveillance data are 

collected and compiled from reports sent by the STD 

control programs and health departments in all 50 

states, the District of Columbia, selected cities, U.S. 

dependencies and possessions, and independent 

nations in free association with the United States to 

the Division of STD Prevention, National Center for 

HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 

Centers for Disease Control and Prevention (CDC). 

Included among the dependencies, possessions, and 

independent nations are Guam, Puerto Rico, and the 

Virgin Islands. These entities are identified as “outlying 

areas” of the United States in selected figures and 

tables.

Reporting Formats

STD morbidity data presented in this report are 

compiled from a combination of data reported on 

standardized hard copy reporting forms and electronic 

data received through the National Electronic 

Telecommunications System for Surveillance (NETSS).

Summary Report Forms

The following hard copy forms were used to report 

national STD morbidity data:

1. FORM CDC 73.998: Monthly Surveillance Report 

of Early Syphilis. This monthly hard copy reporting 

form was used during 1984–2002 to report 

summary data for primary and secondary syphilis 

and early latent syphilis by county and state.

2. FORM CDC 73.688: Sexually Transmitted 

Disease Morbidity Report. This quarterly hard copy 

reporting form was used during 1963–2002 to 

report summary data for all stages of syphilis, 

congenital syphilis, gonorrhea, chancroid, 

chlamydia, and other STDs by sex and source of 

report (private versus public) for all 50 states, the 

District of Columbia, 64 selected cities (including 

San Juan, Puerto Rico), and outlying areas of the 

United States. 

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that 

year. Congenital syphilis was dropped from this 

aggregate form in 1995 and replaced by the casespecific CDC 73.126 form described later in this 

section.

3. FORM CDC 73.2638: Report of Civilian Cases 

of Primary & Secondary Syphilis, Gonorrhea, and 

Chlamydia by Reporting Source, Sex, Race/Ethnicity, 

and Age Group. This annual hard copy form was 

used during 1981–2002 to report summary data 

for P&S syphilis, gonorrhea, and chlamydia by age, 

race, sex, and source (public versus private) for all 

50 states, seven large cities (Baltimore, Chicago, 

New York City, Los Angeles, Philadelphia, San 

Francisco, and the District of Columbia), and 

outlying areas of the United States. 

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that 

year.

4. FORM CDC 73.126: Congenital Syphilis (CS) Case 

Investigation and Reporting. This 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.

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. 
138 Appendix: Interpreting STD Surveillance Data STD Surveillance 2011

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.

Surveillance data and updates sent to CDC through 

NETSS and on hard copy forms through June 7, 2012, 

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

2000–2011 Rates and Population

CDC’s National Center for Health Statistics (NCHS) 

released bridged-race population counts for the 

2000–2010 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 2010, thus 2010 

population estimates were used to calculate 2010 and 

2011 rates. Once published, the 2011 population 

estimates will be used to calculate rates in the 

upcoming 2012 STD Surveillance Report. 

Population estimates for Guam, Puerto Rico, and the 

Virgin Islands were obtained from the U.S. Census 

Bureau Web site at http://www.census.gov/ipc/www/

idb/tables.html. The 2010–2011 rates for outlying 

areas were calculated by using the 2010 population 

estimates.

Because of the use of the updated population data, 

rates for 2000–2010 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.

1941–2011 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 1941–2011. 

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 2011, live births now are used 

as the denominator for congenital syphilis, and case 

counts are no longer limited to those diagnosed within 

the first year of life. Congenital syphilis morbidity is 

assigned by year of birth. Rates of congenital syphilis for 

1963 through 1988 were calculated by using published 

live birth data.3

 Congenital syphilis rates for 1989 

through 2006 were calculated by using live birth data 

based on information coded by the states and provided 

to the NCHS through the Vital Statistics Cooperative 

Program. Rates for 2007 through 2011 were calculated 

by using live birth data for 2008.
STD Surveillance 2011 Appendix: Interpreting STD Surveillance Data 139

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. 

Reporting of Surveillance Data by 

Metropolitan Statistical Area

Sexually Transmitted Disease Surveillance 2011 continues 

the presentation of STD incidence data and rates for 

the 50 metropolitan statistical areas (MSAs) with the 

largest populations according to 2000 census data. STD 

surveillance reports published before 2005 presented 

data by selected cities; these data were derived from 

county data, which were used to estimate city-specific 

disease rates. Because county data were used to estimate 

city-specific morbidity and because current STD 

project areas’ reporting practices do not support direct 

identification of city-specific morbidity reports, MSAs 

were chosen as a geographic unit smaller than a state or 

territory for presentation of STD morbidity data.

MSAs are defined by the OMB to provide nationally 

consistent definitions for collecting, tabulating, and 

publishing federal statistics for a set of geographic areas.4

An MSA is associated with at least one urbanized area 

that has a population of at least 50,000. The MSA 

comprises the central county or counties containing the 

central county, plus adjacent, outlying counties that have 

a high degree of social and economic integration with 

the central county as measured through commuting. 

The title of an MSA includes the name of the principal 

city with the largest 2000 census population. If there are 

multiple principal cities, the names of the second largest 

and third largest principal cities appear in the title in 

order of descending population size.

The MSA concept has been used as a statistical 

representation of the social and economic links between 

urban cores and outlying, integrated areas. However, 

MSAs do not equate to an urban-rural classification; all 

counties included in MSAs and many other counties 

contain both urban and rural territory and populations. 

STD programs that treat all parts of an MSA as if they 

were as urban as the densely settled core ignore the rural 

conditions that may exist in some parts of the area. In 

short, MSAs are not intended to be a general purpose 

geographic framework for nonstatistical activities or for 

use in program funding formulas.

For more information on the MSA definitions used in 

this report, go to: http://www.census.gov/population/

estimates/metro-city/03mfips.txt.

Management of Unknown, Missing, 

or Invalid Data for Age Group, Race/

Ethnicity, and Sex

The percentage of unknown, missing, or invalid data 

for age group, race/ethnicity, and sex varies from year 

to year, state to state, and by disease for reported STDs 

(Table A1).

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 2011.

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 
140 Appendix: Interpreting STD Surveillance Data STD Surveillance 2011

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–

2011 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.

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 

1995–2011.

Congenital syphilis reporting may be delayed as a 

result of case investigation and validation. Cases 

for previous years are added to CDC’s surveillance 
STD Surveillance 2011 Appendix: Interpreting STD Surveillance Data 141

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 Positivity 

and Prevalence Monitoring

Chlamydia and gonorrhea test positivity were calculated 

for women visiting family planning clinics and prenatal 

clinics, men and women entering NJTP, and men and 

women entering corrections facilities. These data sources 

may include more than one test from the same person if 

that person was tested more than once during a year.

Chlamydia and gonorrhea prevalence were calculated 

for men and women entering NJTP. To increase the 

stability of the estimates, chlamydia or gonorrhea 

prevalence data are presented when valid test results 

for 100 or more students per year are available for the 

population subgroup and state. The majority of NJTP’s 

chlamydia screening tests are conducted by a single 

national contract laboratory, which provides these data 

to CDC. Gonorrhea screening tests for male and female 

students in many training centers are conducted by local 

laboratories; these data are not available to CDC. Test 

results for students at centers that submit specimens to 

the national contract laboratory are included only if the 

number of gonorrhea tests submitted is greater than 

90% of the number of chlamydia tests submitted from 

the same center for the same period.

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. 

Positivity and prevalence data for region- and statespecific figures were published with permission from 

the regional infertility prevention infrastructure and 

NJTP.

STD Surveillance Network (SSuN)

In 2005, CDC established the STD Surveillance 

Network (SSuN) as a dynamic network comprised of 

local enhanced STD surveillance systems that follow 

common protocols. The purpose of SSuN is to improve 

the capacity of national, state, and local STD programs 

to detect, monitor, and respond rapidly to trends in 

STDs through enhanced collection, reporting, analysis, 

visualization, and interpretation of disease information.

Twelve collaborating local or state health departments 

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 42 STD 

clinics within the jurisdictions of SSuN health 

departments. These clinics are located in San Francisco, 

CA (San Francisco City Clinic); Los Angeles, CA (12 

STD clinics in Los Angeles County); Seattle, WA 

(Seattle-King County Clinic); Denver, CO (Denver 

Metro Health Clinic); Chicago, IL (7 public STD 

clinics in Cook County); New Orleans, LA (Delgado 

Personal Health Center); Birmingham, AL (Jefferson 

County STD Clinic); Richmond, VA (Richmond City, 

Henrico County and Chesterfield County Clinics); 

Baltimore, MD (Druid STD Clinic and Eastern STD 

Clinic); Philadelphia, PA (Philadelphia STD Clinics 1 

and 5); New York City, NY (9 public STD clinics in 5 

boroughs); Hartford, CT (Hartford STD Clinic); and 

New Haven, CT (New Haven STD Clinic).

Men who have sex with men (MSM) were defined as 

men who either reported having sex with another man 

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 10 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 10 of the 12 

sites). 
142 Appendix: Interpreting STD Surveillance Data STD Surveillance 2011

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 2011, the antimicrobial agents tested by GISP 

were ceftriaxone, cefixime, cefpodoxime, azithromycin, 

spectinomycin, ciprofloxacin, penicillin, and tetracycline. 

The antimicrobial susceptibility criteria used in GISP for 

2011 are as follows: 

•	 Ceftriaxone, minimum inhibitory concentration 

(MIC) ≥0.5 μg/ml (decreased susceptibility).*

•	 Cefixime, MIC ≥0.5 μg/ml (decreased 

susceptibility).*

•	 Cefpodoxime, MIC ≥1.0 μg/ml (decreased 

susceptibility).*

•	 Azithromycin, MIC ≥2.0 μg/ml (decreased 

susceptibility).*

•	 Spectinomycin, MIC ≥128.0 μg/ml (resistance).

•	 Ciprofloxacin, MIC 0.125–0.5 μg/ml 

(intermediate resistance).

•	 Ciprofloxacin, MIC ≥1.0 μg/ml (resistance).

•	 Penicillin, MIC ≥2.0 μg/ml (resistance).

•	 Tetracycline, MIC ≥2.0 μg/ml (resistance).

The majority of these criteria are also recommended 

by the Clinical and Laboratory Standards Institute 

(CLSI).6

Other Surveillance Data Sources

National Health and Nutrition 

Examination Survey

The National Health and Nutrition Examination 

Survey (NHANES) is a series of cross-sectional 

surveys designed to provide national statistics on the 

health and nutritional status of the general household 

population in the United States. Data are collected 

through household interviews, standardized physical 

examinations, and the collection of biological samples 

in special mobile examination centers. In 1999, 

NHANES became a continuous survey with data 

released every 2 years. The sampling plan of the survey 

is a stratified, multistage, probability cluster design that 

selects a sample representative of the U.S. civilian, noninstitutionalized population. 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 2011). NDTI is a 

probability sample survey of private physicians’ clinical 

management practices. For more information on this 

database, contact IMS Health, e-mail: ServiceCenter@

us.imshealth.com; Telephone: (800) 523-5334.

National Hospital Discharge Survey

The information on patients hospitalized for pelvic 

inflammatory disease (PID) or ectopic pregnancy was 

based on analysis of data from the National Hospital 

Discharge Survey (NHDS) (machine-readable files for 

1980 through 2010. NHDS, which is conducted by 

NCHS, is an ongoing, nationwide sample survey of 

medical records of patients discharged from acute care 

hospitals in the United States. For more information, 

see: http://www.cdc.gov/nchs/nhds.htm. The estimates 

generated by using NHDS data are based on statistical 

surveys and therefore have sampling variability 

associated with the estimates.

Healthy People 2020 Objectives

For three decades, Healthy People has provided 

a comprehensive set of national 10-year health 

promotion and disease prevention objectives aimed at 

improving the health of all Americans.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 

* The Clinical Laboratory Standards Institute criteria for decreased susceptibility and resistance to ceftriaxone, cefixime, cefpodoxime, and 

azithromycin and for susceptibility to azithromycin have not been established for N. gonorrhoeae. 
STD Surveillance 2011 Appendix: Interpreting STD Surveillance Data 143

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:

•	 Attain high-quality, longer lives free of 

preventable disease, disability, injury, and 

premature death.

•	 Achieve health equity, eliminate disparities, and 

improve the health of all groups.

•	 Create social and physical environments that 

promote good health for all.

•	 Promote quality of life, healthy development, 

and healthy behaviors across all life stages.

The topic area, Sexually Transmitted Diseases, contains 

objectives and measures related to STDs. Baselines, 

HP2020 targets, and annual progress toward the 

targets are reported in Table A3. The year 2020 

targets for the diseases addressed in this report are as 

follows: P&S syphilis (males), 6.8 cases per 100,000 

population; P&S syphilis (females), 1.4 cases per 

100,000 population congenital syphilis, 9.1 cases per 

100,000 live births; gonorrhea (females aged 15–44 

years), 257.0 cases per 100,000 population and 

gonorrhea (males aged 15–44 years), 198.0 cases per 

100,000 population. 

The majority of the STD-related HP2020 targets were 

set using a standard percentage improvement with a 

standard default of a “10 percent improvement over 

the baseline.”

Government Performance and Results 

Act of 1993

The Government Performance and Results Act 

(GPRA) of 1993 was enacted by Congress to increase 

confidence in the capability of the federal government 

to increase the effectiveness and accountability of 

federal programs, to improve service delivery, to 

provide federal agencies a uniform tool for internal 

management, and to help Congress make decisions. 

GPRA requires each agency to have a performance 

plan with long-term outcomes and annual, measurable 

performance goals and to report on these plans 

annually, comparing results with annual goals. There 

are two GPRA goals for STD: reducing PID and 

eliminating congenital syphilis. Each of these goals has 

specific measures of progress, which are outlined in 

Table A4.

1 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1980–1988. In: Current population reports [Series 

P-25, No. 1045]. Washington, DC: U.S. Government Printing 

Office; 1990. 

2 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1989. In: Current population reports [Series P-25, 

No. 1057]. Washington, DC: U.S. Government Printing Office; 

1990.

3 Centers for Disease Control and Prevention. Vital statistics of 

the United States 1988. vol.1 - natality. Hyattsville (MD): U.S. 

Department of Health and Human Services; 1990.

4 Office of Management and Budget. Standards for defining 

metropolitan and micropolitan statistical areas. Federal Register. 

2000;65(249):82228-38.

5 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.
144 Appendix: Percentage Unknown STD Surveillance 2011

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

Variables by State and by Nationally Notifiable STD, 2011

State

Primary and Secondary Syphilis Gonorrhea Chlamydi

Percentage 

Unknown

Race

Ethnicit

Percentage 

Unknown

Age

Percentage 

Unknown

Sex

Percentage 

Unknown

Sex Partner

Percentage 

Unknown

Race

Ethnicit

Percentage 

Unknown

Age

Percentage 

Unknown

Sex

Percentage 

Unknown

Race

Ethnicit

Percentage 

Unknown

Age

Percentage 

Unknown

Sex

Alabama 0.4 0.0 0.0 34.6 27.6 0.1 2.2 32.8 0.1 2.6

Alaska* 0.0 0.0 0.0 100.0 1.2 0.0 0.0 2.8 0.0 0.0

Arizona 0.4 0.0 0.7 53.3 15.6 0.0 0.0 20.4 0.0 0.0

Arkansas 0.5 0.0 0.0 12.6 9.6 0.0 0.1 12.8 0.1 0.0

California 3.7 0.0 0.5 7.1 28.0 0.5 0.4 36.0 0.4 0.3

Colorado 0.0 0.0 0.0 0.0 18.2 0.0 0.0 36.6 0.0 0.0

Connecticut 0.0 0.0 0.0 26.2 27.8 0.1 0.0 34.4 0.4 0.0

Delaware 0.0 0.0 0.0 81.5 2.1 0.0 0.0 4.5 0.0 0.0

District of Columbia 3.0 0.0 0.0 20.6 29.3 0.0 0.0 31.3 0.2 0.0

Florida 2.7 0.0 0.0 4.8 10.4 0.0 0.1 13.8 0.0 0.1

Georgia 3.4 0.0 0.0 21.8 33.8 0.1 0.9 44.1 0.1 1.1

Hawaii 0.0 0.0 0.0 7.1 36.8 0.0 0.0 49.3 0.0 0.0

Idaho 23.1 0.0 0.0 0.0 41.4 0.0 0.0 34.5 0.2 0.1

Illinois 2.6 0.0 0.0 13.5 11.4 0.0 0.1 14.2 0.0 0.2

Indiana 2.3 0.0 0.0 4.0 14.7 0.0 0.2 22.3 0.0 0.2

Iowa 0.0 0.0 0.0 10.0 8.8 0.0 0.0 11.7 0.0 0.0

Kansas 0.0 0.0 0.0 0.0 20.6 0.1 0.0 38.4 0.1 0.0

Kentucky 0.0 0.0 0.0 3.9 21.0 0.5 0.3 27.3 0.4 0.4

Louisiana 0.9 0.2 0.0 8.5 24.3 0.1 1.8 28.5 0.1 2.1

Maine 25.0 0.0 0.0 25.0 12.5 0.0 0.0 26.3 0.3 0.0

Maryland 1.8 0.0 0.0 5.8 22.2 0.3 0.1 32.8 0.2 0.0

Massachusetts 4.5 0.0 0.0 14.7 23.0 0.2 0.0 34.5 0.2 0.1

Michigan 1.0 0.0 0.0 4.5 37.5 0.2 0.2 38.2 0.2 0.2

Minnesota 0.7 0.0 0.0 10.1 8.9 0.0 0.0 12.9 0.0 0.0

Mississippi 1.0 0.0 0.0 4.2 15.7 0.1 0.0 18.5 0.1 0.0

Missouri 0.0 0.0 0.0 2.9 16.0 0.0 0.0 26.1 0.0 0.0

Montana* 0.0 0.0 0.0 85.7 11.8 0.0 0.0 6.1 0.9 0.0

Nebraska 30.0 0.0 0.0 30.0 22.0 0.1 0.1 28.9 0.1 0.1

Nevada 7.4 0.0 0.0 5.1 24.7 0.1 0.0 30.8 0.0 0.0

New Hampshire 0.0 0.0 0.0 16.7 6.2 0.0 0.0 20.2 0.0 0.0

New Jersey 1.7 0.0 0.0 21.1 42.3 0.6 0.4 55.5 0.4 0.4

New Mexico 16.9 0.0 0.0 7.0 29.9 0.0 0.0 29.5 0.1 0.1

New York 6.1 0.0 0.1 19.7 36.9 0.4 0.1 42.6 0.6 0.2

North Carolina 0.0 0.0 0.0 100.0 12.6 0.1 0.4 16.2 0.1 0.4

North Dakota* 0.0 0.0 0.0 0.0 31.1 0.0 0.4 31.0 0.0 0.0

Ohio 0.5 0.0 0.0 10.5 21.1 0.1 0.0 28.7 0.2 0.0

Oklahoma 1.2 0.0 0.0 14.3 3.4 0.2 2.7 3.9 0.1 2.7

Oregon 2.1 0.0 0.0 15.5 8.5 0.0 0.0 27.2 0.0 0.0

Pennsylvania 3.8 0.0 0.0 16.9 26.3 0.0 0.0 31.6 0.0 0.1

Rhode Island 10.9 0.0 0.0 0.0 19.2 0.0 0.0 22.4 0.0 0.0

South Carolina 0.5 0.0 0.0 1.4 34.6 0.1 0.2 37.4 0.1 0.2

South Dakota* 0.0 0.0 0.0 0.0 3.3 0.0 0.2 26.0 0.2 0.1

Tennessee 2.5 0.0 0.0 3.6 2.6 0.0 0.0 4.3 0.0 0.0

Texas 0.1 0.0 0.0 1.9 5.0 0.0 0.0 6.3 0.0 0.0

Utah 0.0 0.0 0.0 14.3 0.7 0.0 0.0 0.9 0.0 0.0

Vermont* 0.0 0.0 0.0 0.0 0.0 0.0 0.0 10.5 0.0 0.0

Virginia 0.0 0.0 0.0 4.2 19.8 0.0 0.2 28.9 0.1 0.3

Washington 17.7 0.0 0.0 2.1 18.4 0.0 0.0 22.8 0.0 0.0

West Virginia* 0.0 0.0 0.0 0.0 8.7 0.3 0.0 20.1 0.0 0.0

Wisconsin 0.0 0.0 0.0 13.8 0.2 0.2 0.0 0.2 0.2 0.1

Wyoming* 0.0 0.0 0.0 0.0 28.3 0.0 0.0 18.6 0.0 0.0

U.S. TOTAL 2.9 0.0 0.1 13.6 20.4 0.2 0.3 26.1 0.2 0

* Percentages for primary and secondary syphilis are based on less than 10 cases.

NOTE: Unknown includes unknown, missing, or invalid data values.
STD Surveillance 2011 Appendix: STD Reporting Source 145

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2011

Disease

Non-STD Clinic STD Clinic Tot

Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 265,114 835,170 1,103,267 81,886 70,025 152,324 389,970 1,018,552 1,412,791

Gonorrhea 98,272 132,179 231,142 35,274 17,577 52,957 149,835 171,005 321,849

Primary Syphilis 2,253 213 2,469 1,138 60 1,199 3,535 284 3,823

Secondary Syphilis 6,273 906 7,190 2,278 274 2,553 8,918 1,217 10,147

Early Latent Syphilis 7,498 1,573 9,079 2,729 635 3,366 10,833 2,293 13,136

Late and Late Latent Syphilis§ 9,946 4,589 14,556 2,196 858 3,057 12,780 5,768 18,576

Chancroid 2 4 6 1 0 1 4 4 8

* 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.
146 Appendix: Healthy People 2020 STD Surveillance 2011

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

HP2020 Objectives Baseline

Year Baseline 2010 2011 HP 2020 

Target

1 Reduce the proportion of adolescents and young adults with Chlamydi

trachomatis infections

a. Among females aged 15 to 24 years attending family planning clinics 2008 7.4% 8.0% 8.3% 6.7%

b. Among females aged 24 years and under enrolled in a National Job 

Training Program

2008 12.8% 11.4% 10.3% 11.5%

c. Among males aged 24 years and under enrolled in a National Job Training 

Program

2008 7.0% 7.2% 8.0% 6.3%

2 Reduce Chlamydia rates among females aged 15 to 44 year

(DEVELOPMEN

N/A 1,493.3 1,591.0 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% N/A 74.4%

b. Females aged 21 to 24 years 2008 59.4% 62.3% N/A 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 yea

a. Females aged 16 to 20 years 2008 40.1% 40.8% N/A 65.9%

b. Females aged 21 to 24 years 2008 43.5% 45.7% N/A 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% 4.2% NA 3.59%

6 Reduce gonorrhea rate

a. Females aged 15 to 44 years 2008 285.0 258.7 264.8 257.0

b. Males aged 15 to 44 years 2008 220.4 205.4 217.7 198.0

7 Reduce sustained domestic transmission of primary and secondary

syphilis 

a. Among females 2008 1.5 1.1 1.0 1.4

b. Among males 2008 7.5 7.9 8.2 6.8

8 Reduce congenital syphilis 2008 10.5 9.1 8.5 9.

9 Reduce the proportion of females with human papillomavirus (HPV)

infection (DEVELOPMEN

a. Females with types 6 and 11 N/A N/A N/A N/A

b. Females with types 16 and 18 N/A N/A N/A N/A

c. Females with other types N/A 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 N/A 9.5%

HP2020 

Objective Data Sourc

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 2006-2010 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 2011 Appendix: GPRA Goals 147

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

Measures, and Target

GPRA Goal

Actual Target

2009 2010 2011 2012

Goal 1: Reduction in PID (as measured by initial visits to physicians

in women 15–44 years of age) 100,000 113,000 90,000 100,533

a. Proportion of high-risk women aged 16–20 infected with chlamydia* 12.90 12.65 11.61 12.53

b. Proportion of high-risk women aged 21–24 infected with chlamydia* 8.51 7.69 7.69 7.97

c. Rate of Gonorrhea/100,000 population in women aged 16-20 664.8 658.8 663 714.56

d. Rate of Gonorrhea/100,000 population in women aged 21-24 491.7 505.4 536.9 533.41

e. Black: white ratio of gonorrhea in women 16-24 14.6 13.9 13.6 13.16

f. Proportion of sexually active females 16-20 enrolled in Medicaid 

who are screened for chlamydia infections 54.4 54.6 N/A 60.0

g. Proportion of sexually active females 21-24 enrolled in Medicaid 

who are screened for chlamydia infections 61.6 62.3 N/A 69.4

h. Proportion of sexually active females 16-20 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 41.0 40.8 N/A 48.7

i. Proportion of sexually active females 21-24 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 45.4 45.7 N/A 54.8

Goal 2: Elimination of Congenital Syphili

a. Incidence of P&S syphilis/100,000 population in women aged 15-44 3.1 2.5 2.1 3.0

b. Incidence of congenital syphilis/100,000 live births 10.1 9.1 8.5 10.05

c. Proportion of pregnant women that are screened for syphilis at least 

one month before delivery N/A 84.8 N/A 80.60

GPRA Goal

1 National Disease and Therapeutic Index (IMS Health)

1a, 1b National Job Training Program

1c, 1d, 1e STD Surveillance System (STDSS), NCHHSTP, CDC

1f, 1g, 1h, 1i Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

2a, 2b STD Surveillance System (STDSS), NCHHSTP, CDC

2c Marketscan. Thomson Reuters (Healthcare) Inc.

*Median state-specific chlamydia prevalence/positivity.

GPRA= Government Performance and Results Act; PID= pelvic inflammatory disease; P&S= primary and secondary.
148 Appendix: STD Surveillance Case Definitions STD Surveillance 2011

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 2011 Appendix: STD Surveillance Case Definitions 149

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
150 Appendix: STD Surveillance Case Definitions STD Surveillance 2011

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 2011 Appendix: STD Surveillance Case Definitions 151

Neurosyphilis

Note

Since neurosyphilis can occur at almost any stage of syphilis, between 1996 and 2005, it was classified and 

reported as one of several mutually exclusive stages of syphilis. In 2005, the Division of STD Prevention 

requested that STD control programs discontinue classifying and reporting neurosyphilis as a distinct stage of 

syphilis. Since 2005, if the patient has confirmed or probably neurosyphilis, the case should be reported as the 

appropriate state of syphilis and neurological manifestations should be noted.

Clinical description

Evidence of central nervous system infection with T. pallidum

Laboratory criteria for diagnosis

•	 A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF) Case classification

Case classification

Probable: syphilis of any stage, a negative VDRL in CSF, and both of the following:

•	 Elevated CSF protein or leukocyte count in the absence of other known causes of these abnormalities

•	 Clinical symptoms or signs consistent with neurosyphilis without other known causes for these clinical 

abnormalities

Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis

Syphilis, late, with clinical manifestations other than neurosyphilis (late benign syphilis 

and cardiovascular syphilis)

Clinical description

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions of the 

cardiovascular system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, 

mouth, eye, abdominal organs, reproductive organs, lymph nodes, and skeletal muscle) may be involved. Late 

syphilis usually becomes clinically manifest only after a period of 15–30 years of untreated infection.

Laboratory criteria for diagnosis

Demonstration of T. pallidum in late lesions by fluorescent antibody or special stains (although organisms are 

rarely visualized in late lesions)

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or other structures 

with a reactive treponemal test, in the absence of other known causes of these abnormalities, and without CSF 

abnormalities and clinical symptoms or signs consistent with neurosyphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with clinical 

manifestations.
152 Appendix: STD Surveillance Case Definitions STD Surveillance 2011

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 2011 Appendix: STD Surveillance Case Definitions 153

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).
154 Appendix: STD Surveillance Case Definitions STD Surveillance 2011

Granuloma Inguinale

Clinical description

A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area caused by 

infection with Calymmatobacterium granulomatis. A clinically compatible case would have one or more painless 

or minimally painful granulomatous lesions in the anogenital area.

Laboratory criteria for diagnosis

•	 Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained smears or biopsies of 

granulation tissue

Case classification

Confirmed: a clinically compatible case that is laboratory confirmed

Lymphogranuloma Venereum

Clinical description

Infection with L1, L2, or, L3 serovars of Chlamydia trachomatis may result in a disease characterized by genital 

lesions, suppurative regional lymphadenopathy, or hemorrhagic proctitis. The infection is usually sexually 

transmitted.

Laboratory criteria for diagnosis

•	 Isolation of C. trachomatis, serotype L1, L2, or L3 from clinical specimen, or

•	 Demonstration by immunofluorescence of inclusion bodies in leukocytes of an inguinal lymph node 

(bubo) aspirate, or

•	 Positive microimmunofluorescent serologic test for a lymphogranuloma venereum strain of C. trachomatis

Case classification

Probable: a clinically compatible case with one or more tender fluctuant inguinal lymph nodes or characteristic 

proctogenital lesions with supportive laboratory findings of a single C. trachomatis complement fixation titer 

of >64

Confirmed: a clinically compatible case that is laboratory confirmed

Mucopurulent Cervicitis (Revised 9/96)

Clinical description

Cervical inflammation that is not the result of infection with Neisseria gonorrhoeae or Trichomonas vaginalis. 

Cervical inflammation is defined by the presence of one of the following criteria:

•	 Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on a white, cottontipped swab (positive swab test)

•	 Induced endocervical bleeding (bleeding when the first swab is placed in the endocervix)

Laboratory criteria for diagnosis

•	 No evidence of N. gonorrhoeae by culture, Gram stain, or antigen or nucleic acid detection, and no 

evidence of T. vaginalis on wet mount

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or trichomoniasis

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from infection 

with any of several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea, trichomoniasis, and 
STD Surveillance 2011 Appendix: STD Surveillance Case Definitions 155

chlamydia are excluded, a clinically compatible illness should be classified as MPC. An illness in a female that 

meets the case definition of MPC and C. trachomatis infection should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may 

be diagnosed by the presence of one of the following criteria:

•	 A visible abnormal urethral discharge, or

•	 A positive leukocyte esterase test from a male aged <60 years who does not have a history of kidney 

disease or bladder infection, prostate enlargement, urogenital anatomic anomaly, or recent urinary tract 

instrumentation, or

•	 Microscopic evidence of urethritis (≥5 white blood cells per high-power field) on a Gram stain of a 

urethral smear

Laboratory criteria for diagnosis

•	 No evidence of N. gonorrhoeae infection by culture, Gram stain, or antigen or nucleic acid detection

Case classification

Confirmed: a clinically compatible case in a male in whom gonorrhea is not found, either by culture, Gram 

stain, or antigen or nucleic acid detection

Comment

Nongonococcal urethritis (NGU) is a clinical diagnosis of exclusion. The syndrome may result from infection 

with any of several agents (see Chlamydia trachomatis, Genital Infection). If gonorrhea and chlamydia are 

excluded, a clinically compatible illness should be classified as NGU. An illness in a male that meets the case 

definition of NGU and C. trachomatis infection should be classified as chlamydia.

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and endocervix to 

the endometrium, fallopian tubes, and/or contiguous structures. In a female who has lower abdominal pain and 

who has not been diagnosed as having an established cause other than pelvic inflammatory disease (PID) (e.g., 

ectopic pregnancy, acute appendicitis, and functional pain), all the following clinical criteria must be present:

•	 Lower abdominal tenderness, and

•	 Tenderness with motion of the cervix, and

•	 Adnexal tenderness

In addition to the preceding criteria, at least one of the following findings must also be present:

•	 Meets the surveillance case definition of C. trachomatis infection or gonorrhea

•	 Temperature >100.4 F (>38.0 C)

•	 Leukocytosis >10,000 white blood cells/mm3

•	 Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy

•	 Pelvic abscess or inflammatory complex detected by bimanual examination or by sonography

•	 Patient is a sexual contact of a person known to have gonorrhea, chlamydia, or nongonococcal urethritis

Case classification

Confirmed: a case that meets the clinical case definition

Comment

For reporting purposes, a clinician’s report of PID should be counted as a case.
156 Appendix: Contributors STD Surveillance 2011

Contributors

We gratefully acknowledge the contributions of state STD project directors, STD program managers, state and territorial 

epidemiologists, and laboratory directors. The persons listed were in the positions shown as of August 27, 2012.

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Direct

Alabama Vacant Jane Cheeks Mary McIntyre Sharon Massingale

Alaska Susan Jones Donna Cecere Joe McLaughlin Bernard Jilly

Arizona Carla Chee Roxanne Ereth Kenneth Komatsu Victor Waddell

Arkansas Tina Long Mark Morehead Nathaniel Smith Glen Baker

California Heidi Bauer Romni Neiman Gilberto Chavez Paul Kimsey

Los Angeles Peter Kerndt Yolanda Cavalier Gilberto Chavez Mike Janda

San Francisco Susan Philip Wendy Wolf Gilberto Chavez Mark Pandori

Colorado Ralph Wilmoth Rebecca Jordan Lisa Miller (Acting) David Butcher

Connecticut Matthew Cartter Heidi Jenkins Matthew Cartter John Fontana

Delaware Catherine Mosley Catherine Mosley Marjorie Shannon William Ward

District of Columbia Gregory Pappas Kim Seechuk John Davies-Cole Alpha Diallo (Acting)

Florida Stacy Shiver Daniel George Carina Blackmore Max Salfinger

Georgia Michelle Allen 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 Vacant Raoult Ratard Stephen Martin

Maine James Markiewicz James Markiewicz Stephen Sears Kenneth Pote

Maryland Barbara Conrad Glen Oltoff David Blythe Robert Myers

Baltimore Vacant Vacant David Blythe Jack DeBoy

Massachusetts Brenda Cole Brenda Cole Alfred DeMaria Linda Han)

Michigan Kristine Judd Karen Krzanowski Corrine Miller Sandip Shah (Acting)

Minnesota Christine Jones Peter Carr Ruth Lynfield Joanne Bartkus

Mississippi Nicholas Mosca Vacant Paul Byers Daphne Ware

Missouri Ken Palermo Ingrid Denney George Turabelidze Bill Whitmar

Montana Laurie Kops Vacant Carol Ballew Ron Paul

Nebraska Sandy Klocke Jeri Weberg-Bryce Thomas Safranek Steve Hinrichs

Nevada Richard Whitley Sandra Noffsinger Ishan Azzam L. Dee Brown

New Hampshire Lindsay Pierce Lindsay Pierce Sharon Alroy-Preis Christine Bean

New Jersey Gary Ludwig Patricia Mason Christina Tan Onesia Bishop

New Mexico Daniel Burke Carmelita Garcia Michael Landen (Acting) David Mills

New York Bob Reed Vacant Debra Blog Jill Taylor (Acting)

New York City Susan Blank Vacant Perry Smith Jennifer Rakeman

North Carolina Pete Moore Jacqueline Clymore Megan Davies Lou Turner (Acting)

North Dakota Vacant Krissie Guerard Tracy Miller Myra Kosse

Ohio Jen Keagy Jen Keagy Mary DiOrio 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 Vacant Utpala Bandy Ewa King

South Carolina Dennis Murphy Janice Tapp Linda Bell Jennifer Meredith (Acting)

South Dakota Vacant Amanda Gill Lon Kightlinger Michael Smith

Tennessee Jeanece Seals Vacant Tim Jones David Smalley

Texas Ann Robbins Jim Lee Thomas Erlinger Grace Kubin

Utah Emily Holmes Lynn Meinor Robert Rolfs Robyn Atkinson

Vermont Daniel Daltry Daniel Daltry Patsy Kelso Mary Celotti

Virginia Diana Jordan Theresa Henry David Trump Thomas York

Washington Maria Courogen 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 Vacant Sharmain Mageo Utoofili Mago

Federated States of Micronesia Vita Skilling Vacant Vita Skilling

Government of the Marshall Islands Justina Langidrik Vacant Paul Lalita

Northern Marianas (CNMI) Joseph Villagomz Vacant James Hosfschneider Joseph Villagomez

Guam Josie O’Mallan Vacant Josephine O’Mallan Josie O’Mallan

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia Quinones de Longo Maritza Muniz

Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez Francis Permeteet

Virgin Islands Fern Clark Gritell Martinez Thomas Morris Joseph Mark