What US state has the highest rate of sexually transmitted infections (STIs)/sexually transmitted diseases (STDs)?

The Southeastern United States Has the Highest Rates of STIs/STDs in the Country

The southeastern United States consistently reports the highest rates of sexually transmitted infections (STIs) and sexually transmitted diseases (STDs) in the country, with a geographic overlap between regions with high STD rates and rapidly expanding heterosexual HIV transmission. 1

Current STI/STD Trends in the United States

Geographic Distribution

• The southeastern United States shows disproportionately high rates of notifiable STDs, particularly gonorrhea and syphilis 1
• This regional concentration reflects a concerning pattern where STD rates and heterosexual HIV transmission overlap geographically 1
• The trend of increasing STI rates is particularly pronounced in the American regions, with high-income North America showing significant increases in chlamydia (EAPC 1.23) and gonorrhea (EAPC 0.77) 2

Most Common STIs Nationwide

• Chlamydia remains the most commonly reported infectious disease in the United States 1
• Gonorrhea, syphilis, and trichomoniasis have all shown increasing rates in recent years 3
• From 2015 to 2019, rates of gonorrhea, chlamydia, and syphilis increased across the country 3
• In 2022, more than 2.5 million cases of gonorrhea, chlamydia, and syphilis were reported to the CDC 4

Population Demographics and Risk Factors

High-Risk Populations

• Young adults under 25 years show particularly high infection rates 3
• Sexual and gender minorities, including men and transgender women who have sex with men, experience disproportionate STI burdens 3
• Racial and ethnic minorities, particularly Black and Latinx populations, have higher STI rates 3
• African Americans experience approximately fiftyfold higher rates of primary and secondary syphilis compared to whites 1

Age-Specific Trends

• The population with the highest syphilis incidence has shifted to younger age groups globally (25-29 years in 2010 vs. 20-24 years in 2019) 2
• Sexually active adolescents across the United States, regardless of race or socioeconomic status, have a point prevalence for chlamydial infection of 5-10% 1
• In 1996, routine reporting indicated a gonorrhea case rate of 3% for African-American women aged 15-19 years and men aged 20-24 years 1

Public Health Implications

STI-HIV Connection

• STIs significantly increase the risk of HIV transmission and acquisition 3
• The southeastern United States is experiencing an increasing proportion of AIDS cases, particularly among young women 1
• The shift in the HIV/AIDS epidemic toward African Americans reflects and may be partly attributable to the long-standing disproportionate burden of other STDs in this group 1

Healthcare System Challenges

• Only about half of local public health departments in the United States provide STD preventive services 1
• Access to care is often restricted by limited hours of operation and lack of timely services 1
• Nearly 40% of local health departments providing STD services cannot see potentially infected patients the same day they seek care 1
• In primary care settings, most providers do not routinely obtain sexual histories or screen for STDs 1

Clinical Considerations

Recent Treatment Updates

• Gonorrhea: Ceftriaxone monotherapy given intramuscularly, with dosing based on patient's body weight 5
• Chlamydia: Doxycycline is now the preferred treatment 5
• Syphilis: Treatment depends on duration - single dose of penicillin G benzathine for infections less than one year; three weekly doses for longer or unknown duration 5
• Trichomoniasis: Seven-day regimen of metronidazole for vaginal infections 5

Screening Recommendations

• Syphilis screening should be offered to reproductive-aged persons living in counties with case rates of primary or secondary syphilis >4.6 per 100,000 4
• Pregnant women now require syphilis screening three times during pregnancy regardless of risk: at first prenatal visit, during third trimester, and at delivery 4
• Extragenital screening for gonorrhea and chlamydia at sites such as the anus and pharynx should be considered in women 4

The geographic concentration of STIs in the southeastern United States represents a significant public health challenge that requires targeted interventions, improved access to screening and treatment services, and greater awareness among healthcare providers and the public.