CDC STI Surveillance Statistics Point to Continuing Struggle in the South

(Innerboody, CDC, Charlotte Observer) —  For our 8th annual study of STI rates, using the latest data published by the Centers for Disease Control and Prevention (CDC), Innerbody Research analyzed statistics on a city-by-city basis and developed our list of the Top 100 metropolitan areas with the highest STI rates. In this year’s report, the metro area with the highest overall STI rate was Detroit, MI, overtaking Philadelphia, PA, which moved to 2nd. Memphis, TN, which had formerly been ranked 2nd, improved to 4th this year, while the metro area that came in 3rd last year — Jackson, MS — improved to 12th in 2025. At the same time, Montgomery, AL (formerly ranked 7th) worsened to 3rd.

In addition to ranking the 100 metro areas with the highest STI rates, below we’ll provide some takeaways from our report; spotlight urban communities whose STI rates have significantly improved or declined; highlight racial disparities that emerge from the CDC data; and, for the first time in years, share analysis of some encouraging developments.

• The South continues to struggle with high infection rates in its metro areas, though there is evidence of positive change.
• Topping our annual study for the first time is Detroit, MI.
• For the second straight year, Provo, UT, comes in 100th, with 99 metro areas having worse STI rates.
• Could the tide be starting to turn in our STI epidemic? Infection rates are near their record-high levels over the past 20 years, but unlike recent years, this year shows a slight decline of nearly 2% in the overall infection rate.
• Despite hopeful signs of improvement in overall national figures, STI rates continue to reveal disturbing disparities that deserve reflection and action, and there is significant room for improvement in all respects as our nation continues to confront the epidemic.

Detroit, MI, was ranked 9th worst for STI rates last year, but in this year’s study, it has unfortunately earned the distinction of the metro area with the highest infection rates. In our years of conducting these studies, Detroit has never before ranked number one. This also comes during a year in which our nationwide list of the hardest-hit metro areas included almost 30% more places located in Detroit’s Census-designated region (East North Central U.S., which includes the states of Michigan, Wisconsin, Illinois, Ohio, and Indiana). Motor City has confronted daunting, highly publicized challenges over the past decade and has exhibited great resilience and spirit; we hope that next year’s study shows a Detroit that has rebounded and risen back upward in our rankings.

Other cities joining Detroit in our top 25 are also located in the Great Lakes region. For instance, in neighborhing Ohio, Cleveland finds itself ranked 13th, which reflects a slight worsening of relative infection rates from last year when it ranked 15th. But elsewhere in the Midwest, Minneapolis, MN, which ranked 17th last year, improved its ranking to 21st in our study this year. And Milwaukee, WI, escaped the top 25 altogether to rank 29th among U.S. metro areas.

The South, as defined by the U.S. Census Bureau, remains relatively fraught with high STI rates in its metro areas this year (more on that below).

Meanwhile, out west, our study shows evidence of improvement in metropolitan STI rates. San Francisco, CA, and Portland, OR, remain in the top 25 for the second year in a row, though their ranks have improved by a couple positions. But more broadly, fewer cities in the West are found within the top 50 worst cities for infection rates, and the total number of top 100 cities that are located in the West dropped from 31 to 25.

It’s also worthwhile to call out a city for remaining remarkably stable in our study, year after year. For the second straight year, Provo, UT, has ranked 100th. And prior to that, it ranked 99th.

The South fights high infection rates

The U.S. South — a region that is home to roughly 39% of the population — accounts for over 60% of the top 25 metropolitan areas with the highest STI rates in this year’s study. But, believe it or not, that’s actually a slight improvement over last year’s study.

The number of Floridian cities in the top 100 has slightly increased, though Miami has improved relative to other cities, ranking 19th now instead of its previous 16th.

Gulf states, in particular, are heavily represented in our top 25 metro areas, accounting for over a third of them. Louisiana alone is home to three of the 25 cities with the highest STI rates, though Montgomery, AL, has jumped several positions and leapfrogged New Orleans, LA, to become the city with the 3rd highest rates. A look into the state-level data from the CDC reveals similar trends seen in the data for major metropolitan areas: seven of the top 10 states with the highest gonorrhea infection rates are located in the South, and the South contributes eight of the top 10 states with the highest rates of chlamydia infection.

However, some metro areas are bucking regional trends. Jackson, MS, which ranked 3rd worst in last year’s study, improved its rank to 12th this year — a dramatic turnaround for a city that has been plagued by high infection rates for several years in our annual studies. And Little Rock, AR, which had the 11th highest STI rates last year, improved its ranking significantly to 27th.

According to the latest data from the CDC, overall STI rates in the United States actually dropped by 1.8% in 2023 compared to 2022. The national infection rates had trended upward for the better part of two decades leading up to the COVID-19 pandemic. This year’s updated data from the CDC gives reason for hope that concerted effort and investment may be helping turn the page at last.

• Nationally, the gonorrhea infection rate dropped by 7% compared to the previous year.
• The rate of chlamydia infection remained effectively unchanged, which still signifies a 9% drop since 2019.
• A 1% increase in overall syphilis infections represents a much slower rate of increase than the staggering 29% increase seen in the previous year-over-year analysis.

Despite the improvement, however, we continue to face an epidemic that requires renewed commitment to maintain improvement and achieve greater momentum (which is what compels us to create our annual study). While a drop of nearly 2% in the national STI rate is something to celebrate, this rate remains 90% higher than it was in 2004. What seems like a scant 1% increase overall in the syphilis infection rate still translates to the highest levels of syphilis infection in our country since 1950.

And hiding beneath that 1% statistic are alarmingly high rates of congenital syphilis. Congenital syphilis cases nationally rose only by about a tenth of the amount they had risen in prior years, yet cases among newborns did rise by 3% since 2022 and by 106% since 2019. Despite the slowing of this surge, these stratospheric rates caused 279 stillbirths and infant deaths over the past year.

And within the overall population, certain groups continue to face disproportionate challenges when it comes to curbing STI rates.

Across racial groups, young people and men who have sex with men (MSM) contend with higher STI rates. A staggering 48% of the total cases of chlamydia, gonorrhea, and primary and secondary syphilis occurred among young people ages 15-24.

But social and racial disparities persist; the STI burden within our cities continues to hit minority racial and ethnic groups the hardest. When comparing infection rates of White people to those of some minority racial and ethnic groups, the CDC data shows dramatic disparities.

• Non-Hispanic Black people make up 12.6% of the U.S. population but suffer 32.4% of the cases of chlamydia, gonorrhea, and primary and secondary syphilis.
• The rate of chlamydia infection in the Native Hawaiian / Pacific Islander racial group, according to the latest Census data, is over three times higher than that among White people.
• The rate of gonorrhea infections among Black / African American males is over eight times the rate among White males.
• The rate of congenital syphilis infections within the Hispanic/Latino population is more than double that of White people, and the infection rate among non-Hispanic Black people is higher still — nearly four times higher than the rate among White people.
• American Indian / Alaska Native populations face congenital syphilis rates nearly twelve times higher than those of the White population in our country.

Health leaders stress that differences in sexual behavior aren’t the explanation for these differences in rates of infection. What can spell the difference between life and death, or illness and health, are timely testing and treatment — but it has to be both. Nearly 90% of newborn syphilis cases are preventable through testing and treatment during pregnancy.

Barriers to timely testing and treatment include lack of health insurance; poverty and housing issues; substance use disorder; and lack of sufficient public health infrastructure. All of these factors continue to affect minority racial and ethnic groups disproportionately.

3 NC Metro Areas Land in Top 100

Three North Carolina metro areas landed in the top 100 cities in the U.S. with the highest STD infection rates, according to a recent study.

Greensboro ranked No. 30 on the list, followed closely by Charlotte at No. 37. Raleigh was ranked lower on the list at No. 67.

No. 30 Greensboro: With 1,086 cases per 100,000 people, Greensboro reported:

• 206 HIV cases
• 9,297 chlamydia cases
• 3,901 gonorrhea cases
• 413 syphilis cases

No. 37 Charlotte: With 1,014 cases per 100,000 people, Charlotte reported:

• 407 HIV cases
• 16,440 chlamydia cases
• 7,238 gonorrhea cases
• 692 syphilis cases

No. 67 Raleigh: With 770 cases per 100,000 people, Raleigh reported:

• 248 HIV cases
• 11,013 chlamydia cases
• 4,297 gonorrhea cases
• 448 syphilis cases

Click here for the full report

Click here for the full CDC STI Statistics