Sexually transmitted infections continue to challenge public health across the United States. According to the Centers for Disease Control and Prevention, there were over 2.4 million reported cases of chlamydia, gonorrhea, and syphilis in 2023—highlighting the urgency of comprehending STD Cases in America and recognizing which states are most affected. While national progress shows signs of stagnation with slight declines in gonorrhea and syphilis, disparities persist across regions and demographics .
But which states rank highest in Most Reported STD Cases in America? Recent analyses using combined rates per 100,000 population—covering chlamydia, gonorrhea, and primary/secondary syphilis—reveal a clear pattern. Below, we highlight the top 20 states nationally, exploring contributing factors and implications.
1. Mississippi
- STD rate ~1,291 per 100,000—the highest in the U.S.
- High rates of chlamydia, gonorrhea, and syphilis; persistent poverty and limited health access contribute heavily.
2. Louisiana
- Roughly 1,058 per 100,000, ranking second .
- Second‑highest combined STI burden; recent initiatives include expanded sex‑ed programs in New Orleans
3. South Carolina
- About 1,000 per 100,000, placing it third.
- Elevated chlamydia rates strain state testing infrastructure.
4. Alaska
- 990.8 per 100,000, fourth nationally.
- Remote communities and access challenges exacerbate STD transmission.
5. North Carolina
- 898.3 per 100,000, fifth place
- Widespread chlamydia and gonorrhea; entrenched rural health disparities.
6. Alabama
- 857.2 per 100,000, sixth
- High gonorrhea and syphilis rates; targeted sexual health interventions ongoing.
7. Oklahoma
- 842.9 per 100,000, seventh
- Rural prevalence elevated by limited prevention resources.
8. Tennessee
- 836.6 per 100,000, eighth .
- Driven by chlamydia’s high volume and increasing syphilis.
9. Georgia
- 826.9 per 100,000, ninth
- Ranked high nationally for gonorrhea and chlamydia; HIV rates also elevated .
10. New Mexico
- 818.4 per 100,000, tenth in line
- Significant congenital syphilis burden and high chlamydia rates.
11. Arkansas
- 808.9 per 100,000, eleventh
- Syphilis rates here are steadily rising.
12. Missouri
- 806.5 per 100,000, twelfth
- Gonorrhea and chlamydia heavily contribute to the state’s STD profile.
13. Illinois
- 799.0 per 100,000, thirteenth
- High detection in populous metro areas like Chicago.
14. Ohio
- 783.5 per 100,000, fourteenth
- Rural areas face chlamydia and gonorrhea challenges.
15. Arizona
- 756.8 per 100,000, fifteenth .
- One of the highest congenital syphilis rates in the country .
16. Maryland
- 749.6 per 100,000, sixteenth .
- Urban transmission hotspots and rising gonorrhea rates.
17. South Dakota
- 738.6 per 100,000, seventeenth .
- Highest primary/secondary syphilis rate nationally
18. New York
- 736.4 per 100,000, eighteenth
- High population density and comprehensive reporting systems reveal elevated case counts.
19. Indiana
- 713.1 per 100,000, nineteenth .
- Rural and urban counties alike are seeing chlamydia-driven STI numbers.
20. Nevada
- Close behind with ~700–740 per 100,000, rounding out the top 20
- Faces congenital syphilis spikes and reduced funding for prevention
Understanding the Numbers: Disease Breakdown
Chlamydia is the leading STD in America, with about 1.65 million cases in 2023. Louisiana led the nation with the highest chlamydia rate (~792 per 100,000), followed by Mississippi and Alaska .
Gonorrhea saw over 600,000 reported cases, a decline of ~7% from 2022 . Yet, states like Alaska, Louisiana, Georgia, and South Dakota experienced some of the highest gonorrhea rates
Syphilis, spanning all stages and including congenital cases, reached over 209,000 cases, the highest annual tally since 1950—though primary/secondary syphilis dropped by 10% . States with the highest primary/secondary syphilis rates include South Dakota, New Mexico, Mississippi, Arkansas, and Alabama.
Congenital syphilis also poses rising threats. In 2023, 3,882 cases occurred—up 3% from 2022—with South Dakota reporting the highest rate per 100,000 live births, followed by New Mexico, Mississippi, Arizona, and Texas . These alarming trends reflect inadequate prenatal screening and evolving disparities.
Why These States Top the List
- Access to Healthcare
Rural and underserved communities—common in states like Mississippi, Alaska, and Louisiana—struggle with limited sexual-health services, clinics, and preventative care. - Socioeconomic Disparities
Poverty, lower education, and limited insurance coverage correlate strongly with higher STD rates, as seen in Southern and some Midwestern states like Mississippi, Alabama, and South Carolina. - Testing & Reporting Practices
Robust reporting systems yield higher case numbers, but they also facilitate better outbreak responses. States with improved surveillance often report more cases—but are also able to track and address spread more effectively. - Funding Cuts
Multiple states saw significant reductions (>75%) in prevention budgets and staffing in recent years, hindering contact tracing, outreach, and early intervention—factors linked to spikes in congenital syphilis - Education & Prevention Gaps
States lacking comprehensive sex education and community-based interventions, such as parts of the South, show higher STD incidence. Recent responses—like New Orleans’ new sex ed initiative—may offer positive precedents
The National Picture: Is the Tide Turning?
Nationally, 2023 saw a modest decline (–1.8%) in total STI cases, primarily driven by reductions in gonorrhea and primary/secondary syphilis. However, chlamydia rates remained unchanged and congenital syphilis edged upward (+3%) .
These mixed trends highlight both progress and persistent challenges. The decline in more infectious syphilis cases is encouraging, yet the spike in congenital syphilis and sustained chlamydia prevalence underscore the need for sustained, multifaceted strategies.
Toward Solutions: Key Strategies & Public Health Takeaways
- Expand Sexual Health Education and Testing
Programs like Louisiana’s New Orleans initiative illustrate how school‑based education and free testing reduce rates . - Bolster Funding for Prevention & Contact Tracing
Restoring and sustaining funding for disease intervention specialists is critical—especially in states like Nevada, Louisiana, and Mississippi that saw severe budget cuts. - Target Prenatal Screening
States with rising congenital syphilis—Arizona, South Dakota, Mississippi—must ensure timely prenatal testing and treatment access. - Focus on High-Risk Demographics
Young adults, LGBTQ+ populations, and racial minorities (particularly Black, Hispanic, and Indigenous communities) remain disproportionately affected . - Enhance Surveillance
Improving data collection can help track infection trends, adapt outreach strategies, and ultimately reduce total STD burden.
Final Thoughts on STD Cases in America
When discussing Most Reported STD Cases in America, the patterns are clear: Southern states and areas with constrained health infrastructure face the greatest burden. But data also show that progress is possible. With improved funding, education, and prenatal screening, the alarming trends, especially congenital syphilis can be confronted head-on.
Yet achieving national reductions in STD cases requires coordinated efforts—from federal investment to local outreach. With over 2.4 million cases in 2023 the fight against STDs in America demands sustained attention.
The 20 states listed above offer both a cautionary tale and a roadmap: targeted resources, education, and innovative public health strategies can transform high burden into hope. The road ahead in tackling STD Cases in America must be fueled by data, equity, and action.
