CDC 2016 STDS Report-for508WebSep21 2017 1644

Sexually Transmitted Disease
Surveillance 2016
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Sexually
Transmitted
Disease
Surveillance
2016
Division of STD Prevention
September 2017
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
Atlanta, Georgia, 30329-4027
i
Centers for Disease Control and Prevention: STD Surveillance 2016
This report was prepared by
Surveillance and Data Management Branch

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Jim Braxton
Darlene Davis
Elaine Flagg
Jeremy Grey
LaZetta Grier
Alesia Harvey
Sarah Kidd
Kristen Kreisel
Eloisa Llata
Rodney Presley
Viani Ramirez
Steven Shapiro
Mark Stenger
Elizabeth Torrone
Hillard Weinstock
Emily Weston
Others contributing to the production and dissemination of this publication
Diane Ballard
Gail Bolan
Keith Davis
Lori Elmore
Suzanne Haecker
Jaeyoung Hong
Joseph Kang
Rachel Powell
Raul Romaguera
Salina Smith
Guoyu Tao
Jo Valentine
Publication of this report would not have been possible without the contributions of the state and territorial
health departments, sexually transmitted disease control programs, and public health laboratories that provided
surveillance data to CDC.
ii
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 2016. Atlanta: U.S. Department
of Health and Human Services; 2017.
Web Site
The online version of this report is available at https://www.cdc.gov/std/stats.
Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 19932015
https://www.cdc.gov/std/stats/
STD Data in the NCHHSTP Atlas

https://www.cdc.gov/nchhstp/atlas/
STD Data on Wonder

https://wonder.cdc.gov/std.html
STD Data Management & Information Technology

https://www.cdc.gov/std/Program/data-mgmt.htm
STD Fact Sheets

https://www.cdc.gov/std/healthcomm/fact_sheets.htm
STD Treatment Guidelines

https://www.cdc.gov/STD/treatment/
STD Program Evaluation Guidelines

https://www.cdc.gov/std/program/pupestd.htm
STD Program Operation Guidelines

https://www.cdc.gov/std/program/GL-2001.htm
Recommendations for Public Health Surveillance of Syphilis in the United States

https://www.cdc.gov/std/SyphSurvReco.pdf
Behavioral Surveillance
Youth Risk Behavior Surveillance System:
https://www.cdc.gov/healthyyouth/data/yrbs/index.htm
National Survey of Family Growth

https://www.cdc.gov/nchs/nsfg.htm
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iv
Foreword
Sexually transmitted diseases (STDs) have long been an that are not getting the health care and preventive services
underestimated opponent in the public health battle. A they deserve. This points to our need for public health and
1997 Institute of Medicine (IOM) report described STDs health care action for each of the cases in this report, as
as, hidden epidemics of tremendous health and economic they represent real people, not just numbers.
consequence in the United States, and stated that the
scope, impact, and consequences of STDs are under- We also need to modernize surveillance to move beyond
recognized by the public and healthcare professionals.1 counting only those cases in persons who have access to
Since well before this report was published, and nearly diagnosis and treatment, to develop innovative strategies
two decades later, those facts remain unchanged. to understand the burden of disease in those who may
not access care, and to improve our surveillance systems
It is estimated that there are 20 million new STDs in the to collect the information needed to target prevention
U.S. each year, and half of these are among young people activities. Further, it will be important for us to measure
ages 15 to 24 years. Across the nation, at any given time, and monitor the adverse health consequences of STDs,
there are more than 110 million total (new and existing) such as ocular and neurosyphilis, pelvic inflammatory
infections.2 These infections can lead to long-term health disease, ectopic pregnancy, infertility, HIV, congenital
consequences, such as infertility; they can facilitate HIV syphilis, and neonatal herpes.
transmission; and they have stigmatized entire subgroups
of Americans. It is my hope that a decade from now, we will be reporting
on progress, instead of more health inequity in our society.
Yet not that long ago, gonorrhea rates were at historic This is our challenge and our call to effectively respond to
lows, syphilis was close to elimination, and we were the information shared in this report.
able to point to advances in STD prevention, such as
better chlamydia diagnostic tests and more screening, Gail Bolan, M.D.
contributing to increases in detection and treatment of Director, Division of STD Prevention
chlamydial infections. That progress has since unraveled. National Center for HIV/AIDS, Viral Hepatitis, STD, and
The number of reported syphilis cases is climbing after TB Prevention
being largely on the decline since 1941, and gonorrhea U.S. Centers for Disease Control and Prevention
rates are now increasing. This is especially concerning
given that we are slowly running out of treatment options
to cure Neisseria gonorrhoeae. Many young women
continue to have undiagnosed chlamydial infections,
putting them at risk for infertility.
Beyond the impact on an individuals health, STDs are

also an economic drain on the U.S. healthcare system.
Data suggest the direct cost of treating STDs in the
U.S. is nearly $16 billion annually.3 STD public health
programs are increasingly facing challenges and barriers
in achieving their mission. In 2012, 52% of state and local
STD programs experienced budget cuts. This amounts to
reductions in clinic hours, contact tracing, and screening
for common STDs. CDC estimates that 21 local health References
department STD clinics closed that year. 1. Eng TR, Butler WT, editors; Institute of Medicine (US). Summary: The
hidden epidemic: confronting sexually transmitted diseases. Washington
It is imperative that federal, state, and local programs (DC): National Academy Press; 1997. p. 43.
employ strategies that maximize long-term population 2. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections
impact by reducing STD incidence and promoting sexual, among US women and men: prevalence and incidence estimates, 2008. Sex
reproductive, maternal, and infant health. The resurgence Transm Dis 2013; 40(3):187193. DOI: 10.1097/OLQ.0b013e318286bb53.
Review.
of syphilis, and particularly congenital syphilis, is not an
arbitrary event, but rather a symptom of a deteriorating 3. Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct
medical cost of selected sexually transmitted infections in the United
public health infrastructure and lack of access to health States, 2008. Sex Transm Dis 2013; 40(3):197201. DOI: 10.1097/
care. It is exposing hidden, fragile populations in need OLQ.0b013e318285c6d2.
v
vi
Preface
Sexually Transmitted Disease Surveillance 2016 presents Sexually Transmitted Disease Surveillance 2016 consists
statistics and trends for sexually transmitted diseases of four sections: the National Profile, the Special Focus
(STDs) in the United States through 2016. This annual Profiles, the Tables, and the Appendix. The National
publication is intended as a reference document for policy Profile section contains figures that provide an overview
makers, program managers, health planners, researchers, of STD morbidity in the United States. The accompanying
and others who are concerned with the public health text identifies major findings and trends for selected STDs.
implications of these diseases. The figures and tables in this The Special Focus Profiles section contains figures and
edition supersede those in earlier publications of these data. text that describe STDs in selected populations that are a
focus of national and state prevention efforts. The Tables
The surveillance information in this report is based on section provides statistical information about STDs at
the following sources of data: (1) notifiable disease county, metropolitan statistical area, regional, state, and
reporting from state and local STD programs; (2) projects national levels. The Appendix includes information on
that monitor STD positivity and prevalence in various how to interpret the STD surveillance data used to produce
settings, including the National Job Training Program, the this report, as well as information about Healthy People
STD Surveillance Network, and the Gonococcal Isolate 2020 STD objectives and progress toward meeting these
Surveillance Project; and (3) other national surveys objectives, Government Performance and Results Act
implemented by federal and private organizations. goals and progress toward meeting these goals, and STD
surveillance case definitions.
The STD surveillance systems operated by state and local
STD control programs, which provide the case report data Any comments and suggestions that would improve future
for chlamydia, gonorrhea, syphilis, and chancroid, are publications are appreciated and should be sent to:
the data sources of many of the figures and most of the
statistical tables in this publication. These systems are an Director, Division of STD Prevention
integral part of program management at all levels of STD National Center for HIV/AIDS, Viral Hepatitis, STD, and
prevention and control in the United States. Because of TB Prevention
incomplete diagnosis and reporting, the number of STD Centers for Disease Control and Prevention
cases reported to the Centers for Disease Control and 1600 Clifton Road NE, Mailstop E-02
Prevention (CDC) is less than the actual number of cases Atlanta, Georgia 30329-4027
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.
The collection of information on race/ethnicity has been

standardized since 1997 in the United States from the
Office of Management and Budget (OMB). Following a
revision in the National Electronic Telecommunication
System for Surveillance (NETSS) implementation guide
in April 2008, jurisdictions reporting STD data were to
collect race according to the OMB standard categories:
American Indian or Alaska Native, Asian, Black or
African American, Hispanic or Latino, Native Hawaiian
or Other Pacific Islander, White, and Multirace. While all
states and the District of Columbia collect and report data
for all STDs in formats compliant with these standards
as of 2016, some jurisdictions only recently adopted this
standard and used previous standards to report their case
data to CDC in past years. Consequently, historical trend
and rate data by race/ethnicity displayed in figures and
interpreted in this report for 20122016 include only those
jurisdictions reporting in the current standard consistently
each year from 2012 through 2016.
vii
viii
Guide to Acronyms
AI/AN American Indians/Alaska Natives
CDC Centers for Disease Control and Prevention
CI confidence interval
CIA chemiluminescence immunoassay
CIN2+ cervical intraepithelial neoplasia grades 2 and 3
CS congenital syphilis
CSF cerebrospinal fluid
CSTE Council of State and Territorial Epidemiologists
EIA enzyme immunoassay
EP ectopic pregnancy
FTA-ABS fluorescent treponemal antibody absorbed
GISP Gonococcal Isolate Surveillance Project
HD health department
HEDIS Healthcare Effectiveness Data and Information Set
HMOs health maintenance organizations
HIV human immunodeficiency virus
HP2020 Healthy People 2020
HPV human papillomavirus
HSIL high-grade squamous intraepithelial lesions
HSV herpes simplex virus
IHC immunohistochemistry
LSIL low-grade squamous intraepithelial lesions
MHA-TP microhemagglutination assay for antibody to Treponema pallidum
MICs minimum inhibitory concentrations
MPC mucopurulent cervicitis
MSAs metropolitan statistical areas
MSM gay, bisexual, and other men who have sex with men
MSM-only gay, bisexual, and other men who have sex exclusively with men
MSMW men who have sex with both men and women
MSW men who have sex with women only
NAATs nucleic acid amplification tests
NCHHSTP National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
NCHS National Center for Health Statistics
NHOPI Native Hawaiians/Other Pacific Islanders
NDTI National Disease and Therapeutic Index
NETSS National Electronic Telecommunications System for Surveillance
NGU nongonococcal urethritis
NHANES National Health and Nutrition Examination Survey
NJTP National Job Training Program
NNDSS National Notifiable Diseases Surveillance System
OMB Office of Management and Budget
P&S primary and secondary
PCR polymerase chain reaction
PID pelvic inflammatory disease
RPR rapid plasma reagin
SSuN STD Surveillance Network
STD sexually transmitted disease
STI sexually transmitted infection
TP-PA T. pallidum particle agglutination
VDRL Venereal Disease Research Laboratory
WBC white blood cell
ix
x
Table of Contents
Acknowledgements...................................................................................................................................................................ii
Foreword...................................................................................................................................................................................v
Preface.....................................................................................................................................................................................vii
Guide to Acronyms..................................................................................................................................................................ix
Figures in the National Profile................................................................................................................................................xii
Figures in the Special Focus Profiles.....................................................................................................................................xiv
Tables in the National Profile.................................................................................................................................................xvi
Census Regions of the United States.....................................................................................................................................xix
National Profile
National Overview of STDs, 2016...........................................................................................................................................1
Chlamydia.................................................................................................................................................................................3
Gonorrhea................................................................................................................................................................................11
Syphilis....................................................................................................................................................................................21
Other STDs..............................................................................................................................................................................29
Special Focus Profiles

STDs in Women and Infants...................................................................................................................................................35
STDs in Adolescents and Young Adults.................................................................................................................................43
STDs in Racial and Ethnic Minorities....................................................................................................................................49
STDs in Men Who Have Sex with Men.................................................................................................................................55
Tables
National Summary..................................................................................................................................................................62
Chlamydia...............................................................................................................................................................................64
Gonorrhea................................................................................................................................................................................76
Syphilis....................................................................................................................................................................................88
Chancroid..............................................................................................................................................................................108
Selected STDs.......................................................................................................................................................................109
Appendix
A. Interpreting STD Surveillance Data................................................................................................................................ 111
Table A1. Selected STDs Percentage of Unknown, Missing, or Invalid Values for Selected Variables
by State and by Nationally Notifiable STD, 2016.......................................................................................119
Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2016............................................121
B. National Objectives and Goals........................................................................................................................................123
Table B1. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives..............................................124
Table B2. Government Performance and Results Act (GPRA) Sexually Transmitted Diseases Goals,
Measures, and Target....................................................................................................................................125
C. STD Surveillance Case Definitions.................................................................................................................................127
Contributors...........................................................................................................................................................................137
xi
Figures in the National Profile
Chlamydia
Figure 1. Chlamydia Rates of Reported Cases by Sex, United States, 20002016....................................................4
Figure 2. Chlamydia Rates of Reported Cases by Region, United States, 20072016...............................................4
Figure 3. Chlamydia Rates of Reported Cases by State, United States and Outlying Areas, 2016............................5
Figure 4. Chlamydia Rates of Reported Cases by County, United States, 2016.........................................................5
Figure 5. Chlamydia Rates of Reported Cases by Age Group and Sex, United States, 2016....................................6
Figure 6. Chlamydia Rates of Reported Cases by Race/Ethnicity, United States, 20122016..................................6
Figure 7. Chlamydia Percentage of Reported Cases Among Men by Reporting Source,
United States, 20072016...................................................................................................................................7
Figure 8. Chlamydia Percentage of Reported Cases Among Women by Reporting Source,
United States, 20072016...................................................................................................................................7
Figure 9. Chlamydia Prevalence Among Persons Aged 1439 Years by Sex, Race/Ethnicity, or Age Group,
National Health and Nutrition Examination Survey (NHANES), 20072012.................................................8
Figure 10. Chlamydia Prevalence Among Sexually-Active Women Aged 1439 Years by Race/Ethnicity
and Age Group, National Health and Nutrition Examination Survey (NHANES), 20072012......................8
Figure 11. Chlamydia Proportion of STD Clinic Patients Testing Positive by Age Group, Sex, and Sexual
Behavior, STD Surveillance Network (SSuN), 2016........................................................................................9
Gonorrhea
Figure 12. Gonorrhea Rates of Reported Cases by Year, United States, 19412016........................................... 11
Figure 13. Gonorrhea Rates of Reported Cases by Sex, United States, 20072016............................................. 11
Figure 14. Gonorrhea Rates of Reported Cases by Region, United States, 20072016....................................... 12
Figure 15. Gonorrhea Rates of Reported Cases by State, United States and Outlying Areas, 2016.................... 12
Figure 16. Gonorrhea Rates of Reported Cases by County, United States, 2016................................................. 13
Figure 17. Gonorrhea Rates of Reported Cases by Age Group and Sex, United States, 2016............................. 14
Figure 18. Gonorrhea Rates of Reported Cases Among Women Aged 1544 Years by Age Group,
United States, 20072016......................................................................................................................... 14
Figure 19. Gonorrhea Rates of Reported Cases Among Men Aged 1544 Years by Age Group,
United States, 20072016......................................................................................................................... 14
Figure 20. Gonorrhea Rates of Reported Cases by Race/Ethnicity, United States, 20122016........................... 15
Figure 21. Gonorrhea Percentage of Reported Cases Among Men by Reporting Source,
United States, 20072016......................................................................................................................... 15
Figure 22. Gonorrhea Percentage of Reported Cases Among Women by Reporting Source,
United States, 20072016......................................................................................................................... 16
Figure 23. Estimated Proportion of MSM-Only, MSMW, MSW, and Women Among Gonorrhea Cases by
Jurisdiction, STD Surveillance Network (SSuN), 2016........................................................................... 16
Figure 24. Gonorrhea Proportion of STD Clinic Patients Testing Positive by Age Group, Sex,
and Sexual Behavior, STD Surveillance Network (SSuN), 2016............................................................. 17
Figure 25. Location of Participating Sentinel Sites and Regional Laboratories, Gonococcal Isolate
Surveillance Project (GISP), United States, 2016.................................................................................... 17
Figure 26. Neisseria gonorrhoeae Percentage of Isolates with Elevated Ceftriaxone Minimum Inhibitory
Concentrations (MICs) (0.125 g/ml) and Elevated Cefixime MICs (0.25 g/ml), Gonococcal
Isolate Surveillance Project (GISP), 20062016...................................................................................... 18
Figure 27. Neisseria gonorrhoeae Distribution of Azithromycin Minimum Inhibitory Concentrations (MICs)
by Year, Gonococcal Isolate Surveillance Project (GISP), 20122016.................................................... 18
Figure 28. Neisseria gonorrhoeae Distribution of Isolates with Penicillin, Tetracycline, and/or Ciprofloxacin
Resistance, Gonococcal Isolate Surveillance Project (GISP), 2016......................................................... 19
Figure 29. Distribution of Primary Antimicrobial Drugs Used to Treat Gonorrhea Among Participants,
Gonococcal Isolate Surveillance Project (GISP), 19882016.................................................................. 19
xii
Syphilis
Figure 30. Syphilis Rates of Reported Cases by Stage of Infection, United States, 19412016................................22
Figure 31. Primary and Secondary Syphilis Rates of Reported Cases by Region, United States,
20072016.........................................................................................................................................................22
Figure 32. Primary and Secondary Syphilis Rates of Reported Cases by State, United States and
Outlying Areas, 2016........................................................................................................................................23
Figure 33. Primary and Secondary Syphilis Rates of Reported Cases by County, United States, 2016....................23
Figure 34. Primary and Secondary Syphilis Rates of Reported Cases by Sex and Male-to-Female
Rate Ratios, United States, 19902016............................................................................................................24
Figure 35. Primary and Secondary Syphilis Reported Cases by Sex and Sexual Behavior, 36 States,
20122016.........................................................................................................................................................24
Figure 36. Primary and Secondary Syphilis Distribution of Cases by Sex and Sexual Behavior,
United States, 2016...........................................................................................................................................24
Figure 37. Primary and Secondary Syphilis Rates of Reported Cases by Age Group and Sex,
United States, 2016...........................................................................................................................................25
Figure 38. Primary and Secondary Syphilis Rates of Reported Cases Among Women Aged 1544 Years
by Age Group, United States, 20072016.......................................................................................................25
Figure 39. Primary and Secondary Syphilis Rates of Reported Cases Among Men Aged 1544 Years
by Age Group, United States, 20072016.......................................................................................................26
Figure 40. Primary and Secondary Syphilis Rates of Reported Cases by Race/Ethnicity,
United States, 20122016.................................................................................................................................26
Figure 41. Primary and Secondary Syphilis Reported Cases by Sex, Sexual Behavior, and HIV Status,
United States, 2016...........................................................................................................................................27
Figure 42. Primary and Secondary Syphilis Reported Cases by Reporting Source and Sex,
United States, 20072016.................................................................................................................................27
Figure 43. Primary and Secondary Syphilis Percentage of Reported Cases by Sex, Sexual Behavior,
and Selected Reporting Sources, United States, 2016.....................................................................................28
Figure 44. Congenital Syphilis Reported Cases by Year of Birth and Rates of Reported Cases of Primary
and Secondary Syphilis Among Women, United States, 20072016.............................................................28
Other STDs
Figure 45. Chancroid Reported Cases by Year, United States, 19412016.................................................................29
Figure 46. Human Papillomavirus Cervicovaginal Prevalence of Types 6, 11, 16 and 18 Among Females
Aged 1434 Years by Age Group and Time Period, National Health and Nutrition Examination
Survey (NHANES), 20032006 and 20092012............................................................................................30
Figure 47. Cervical Low- and High-Grade Squamous Intraepithelial Lesions and Intraepithelial Neoplasia
Grades 2 and 3 Prevalence per 1000 Person-Years Among Female Enrollees in Private Health
Plans Aged 1539 Years, by Age Group and Year, 20072014......................................................................31
Figure 48. Genital Warts Prevalence per 1000 Person-Years Among Enrollees in Private Health Plans
Aged 1039 Years by Sex, Age Group, and Year, 20032010........................................................................32
Figure 49. Herpes Simplex Virus Type 2 Seroprevalence Among Non-Hispanic Whites and Non-Hispanic
Blacks by Sex and Age Group, National Health and Nutrition Examination Survey (NHANES),
19881994, 19992002, 20032006, and 20072010....................................................................................33
Figure 50. Trichomonas vaginalis and Other Vaginal Infections Among Females Initial Visits to Physicians
Offices, United States, 19662015...................................................................................................................33
xiii
Figures in the Special Focus Profiles
STDs in Women and Infants
Figure A. Pelvic Inflammatory Disease Initial Visits to Physicians Offices Among Women
Aged 1544 Years, United States, 20062015.................................................................................................36
Figure B. Pelvic Inflammatory Disease Lifetime Prevalence Among Sexually Experienced Women
Aged 1844 Years by Race/Ethnicity and Previous STI Diagnosis, National Health and Nutrition
Examination Survey (NHANES), 20132014.................................................................................................37
Figure C. Ectopic Pregnancy Rates Among Commercially Insured Women with Live Births Aged 1544
Years by Age Group, 20042015.....................................................................................................................38
Figure D. Chlamydia Rates of Reported Cases Among Women by State, United States and
Outlying Areas, 2016........................................................................................................................................38
Figure E. Gonorrhea Rates of Reported Cases Among Women by State, United States and
Outlying Areas, 2016........................................................................................................................................39
Figure F. Chlamydia Positivity Among Women Aged 1439 Years by Race/Ethnicity and Age Group in
Clinics Providing Family Planning and Reproductive Health Services, STD Surveillance
Network (SSuN), 2016.....................................................................................................................................39
Figure G. Chlamydia and Gonorrhea Rates of Reported Cases Among Infants <1 Year of Age by Year and
Specimen Source, United States, 20102015..................................................................................................40
Figure H. Primary and Secondary Syphilis Rates of Reported Cases Among Women by State,
United States and Outlying Areas, 2016..........................................................................................................40
Figure I. Congenital Syphilis Rates of Reported Cases Among Infants by Year of Birth and State,
United States and Outlying Areas, 2016..........................................................................................................41
STDs in Adolescents and Young Adults

Figure J. Chlamydia Rates of Reported Cases Among Women Aged 1524 Years by State, United States
and Outlying Areas, 2016.................................................................................................................................43
Figure K. Chlamydia Rates of Reported Cases Among Men Aged 1524 Years by State, United States
Figure L. Gonorrhea Rates of Reported Cases Among Women Aged 1524 Years by State, United States
Figure M. Gonorrhea Rates of Reported Cases Among Men Aged 1524 Years by State, United States
Figure N. Chlamydia Prevalence Among Women Aged 1624 Years Entering the National Job Training
Program (NJTP) by State of Residence, United States and Outlying Areas, 2016.........................................46
Figure O. Chlamydia Prevalence Among Men Aged 1624 Years Entering the National Job Training
Figure P. Gonorrhea Prevalence Among Women Aged 1624 Years Entering the National Job Training
Figure Q. Gonorrhea Prevalence Among Men Aged 1624 Years Entering the National Job Training
STDs in Racial and Ethnic Minorities

Figure R. Chlamydia Rates of Reported Cases by Race/Ethnicity and Sex, United States, 2016............................50
Figure S. Gonorrhea Rate Ratios by Race/Ethnicity, United States, 20122016......................................................51
Figure T. Gonorrhea Rates of Reported Cases by Race/Ethnicity and Sex, United States, 2016.............................51
Figure U. Gonorrhea Rate Ratios by Race/Ethnicity and Region, United States, 2016............................................52
Figure V. Primary and Secondary Syphilis Rates of Reported Cases by Race/Ethnicity and Sex,
United States, 2016...........................................................................................................................................53
Figure W. Congenital Syphilis Rates of Reported Cases by Year of Birth and Race/Ethnicity of Mother,
United States, 20072016.................................................................................................................................54
xiv
STDs in Men who Have Sex with Men
Figure X. Primary and Secondary Syphilis Reported Cases by Sex, Sexual Behavior, and Race/Ethnicity,
United States, 2016 ..........................................................................................................................................56
Figure Y. Primary and Secondary Syphilis Estimated Rates of Reported Cases Among MSM by State,
United States, 2016...........................................................................................................................................56
Figure Z. Neisseria gonorrhoeae Percentage of Urethral Isolates Obtained from MSM Attending
STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 19892016..................................................57
Figure AA. Neisseria gonorrhoeae Percentage of Urethral Isolates with Elevated Ceftriaxone Minimum
Inhibitory Concentrations (MICs) (0.125 g/ml) by Reported Sex of Sex Partner, Gonococcal
Isolate Surveillance Project (GISP), 20062016.............................................................................................57
Figure BB. Gonorrhea Estimated Rates of Reported Gonorrhea Cases by MSM, MSW, and Women,
STD Surveillance Network (SSuN), 20102015.............................................................................................58
Figure CC. Gonorrhea and Chlamydia Proportion of MSM Attending STD Clinics Testing Positive for
Urogenital Gonorrhea and Chlamydia by Jurisdiction, STD Surveillance Network (SSuN), 2016..............58
Figure DD. Gonorrhea and Chlamydia Proportion of MSM Attending STD Clinics Testing Positive for
Rectal Gonorrhea and Chlamydia by Jurisdiction, STD Surveillance Network (SSuN), 2016.....................59
Figure EE. Gonorrhea Proportion of MSM Attending STD Clinics Testing Positive for Oropharyngeal
Gonorrhea by Jurisdiction, STD Surveillance Network (SSuN), 2016..........................................................59
Figure FF. Proportion of MSM Attending STD Clinics with Primary and Secondary Syphilis, Urogenital
Gonorrhea, or Urogenital Chlamydia by HIV Status, STD Surveillance Network (SSuN), 2016................60
xv
Tables in the National Profile
National Summary
Table 1. Sexually Transmitted Diseases Reported Cases and Rates of Reported Cases per 100,000
Population, United States, 19412016.............................................................................................................62
Chlamydia
Table 2. Chlamydia Reported Cases and Rates of Reported Cases by State, Ranked by Rates,
United States, 2016...........................................................................................................................................64
Table 3. Chlamydia Reported Cases and Rates of Reported Cases by State/Area and Region in
Alphabetical Order, United States and Outlying Areas, 20122016...............................................................65
Table 4. Chlamydia Among Women Reported Cases and Rates of Reported Cases by State/Area and
Region in Alphabetical Order, United States and Outlying Areas, 20122016..............................................66
Table 5. Chlamydia Among Men Reported Cases and Rates of Reported Cases by State/Area and
Table 6. Chlamydia Reported Cases and Rates of Reported Cases in Selected Metropolitan Statistical
Areas (MSAs) in Alphabetical Order, United States, 20122016...................................................................68
Table 7. Chlamydia Among Women Reported Cases and Rates of Reported Cases in Selected
Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016............................69
Table 8. Chlamydia Among Men Reported Cases and Rates of Reported Cases in Selected
Table 9. Chlamydia Reported Cases and Rates of Reported Cases in Counties and Independent Cities
Ranked by Number of Reported Cases, United States, 2016..........................................................................71
Table 10. Chlamydia Reported Cases and Rates of Reported Cases by Age Group and Sex,
United States, 20122016.................................................................................................................................72
Table 11A. Chlamydia Reported Cases by Race/Ethnicity, Age Group, and Sex, United States, 2016......................73
Table 11B. Chlamydia Rates of Reported Cases per 100,000 Population by Race/Ethnicity, Age Group,
and Sex, United States, 2016............................................................................................................................74
Table 12. Chlamydia Among Women Aged 1524 Years Reported Cases and Rates of Reported Cases
by Age, United States, 20122016...................................................................................................................75
Gonorrhea
Table 13. Gonorrhea Reported Cases and Rates of Reported Cases by State, Ranked by Rates,
United States, 2016...........................................................................................................................................76
Table 14. Gonorrhea Reported Cases and Rates of Reported Cases by State/Area and Region in
Alphabetical Order, United States and Outlying Areas, 20122016...............................................................77
Table 15. Gonorrhea Among Women Reported Cases and Rates of Reported Cases by State/Area and
Table 16. Gonorrhea Among Men Reported Cases and Rates of Reported Cases by State/Area and
Table 17. Gonorrhea Reported Cases and Rates of Reported Cases in Selected Metropolitan Statistical
Areas (MSAs) in Alphabetical Order, United States, 20122016...................................................................80
Table 18. Gonorrhea Among Women Reported Cases and Rates of Reported Cases in Selected
Table 19. Gonorrhea Among Men Reported Cases and Rates of Reported Cases in Selected Metropolitan
Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016..................................................82
Table 20. Gonorrhea Reported Cases and Rates of Reported Cases in Counties and Independent Cities
Ranked by Number of Reported Cases, United States, 2016..........................................................................83
Table 21. Gonorrhea Reported Cases and Rates of Reported Cases by Age Group and Sex,
United States, 20122016.................................................................................................................................84
Table 22A. Gonorrhea Reported Cases by Race/Ethnicity, Age Group, and Sex, United States, 2016......................85
xvi
Table 22B. Gonorrhea Rates of Reported Cases per 100,000 Population by Race/Ethnicity, Age Group,
and Sex, United States, 2016............................................................................................................................86
Table 23. Gonorrhea Among Women Aged 1524 Years Reported Cases and Rates of Reported Cases
by Age, United States, 20122016...................................................................................................................87
Syphilis
Table 24. All Stages of Syphilis Reported Cases and Rates of Reported Cases by State/Area and
Table 25. All Stages of Syphilis Reported Cases and Rates of Reported Cases in Selected Metropolitan
Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016..................................................89
Table 26. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases by State,
Ranked by Rates, United States, 2016.............................................................................................................90
Table 27. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases by State/Area
and Region in Alphabetical Order, United States and Outlying Areas, 20122016.......................................91
Table 28. Primary and Secondary Syphilis Among Women Reported Cases and Rates of Reported Cases
by State/Area and Region in Alphabetical Order, United States and Outlying Areas, 20122016................92
Table 29. Primary and Secondary Syphilis Among Men Reported Cases and Rates of Reported Cases by
State/Area and Region in Alphabetical Order, United States and Outlying Areas, 20122016.....................93
Table 30. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases in Selected
Table 31. Primary and Secondary Syphilis Among Women Reported Cases and Rates of Reported Cases
in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016.........95
Table 32. Primary and Secondary Syphilis Among Men Reported Cases and Rates of Reported Cases
in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016.........96
Table 33. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases in Counties and
Independent Cities Ranked by Number of Reported Cases, United States, 2016..........................................97
Table 34. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases by Age Group
and Sex, United States, 20122016..................................................................................................................98
Table 35A. Primary and Secondary Syphilis Reported Cases by Race/Ethnicity, Age Group, and Sex,
United States, 2016...........................................................................................................................................99
Table 35B. Primary and Secondary Syphilis Rates of Reported Cases per 100,000 Population by
Race/Ethnicity, Age Group, and Sex, United States, 2016............................................................................100
Table 36. Early Latent Syphilis Reported Cases and Rates of Reported Cases by State/Area and Region
in Alphabetical Order, United States and Outlying Areas, 20122016.........................................................101
Table 37. Early Latent Syphilis Reported Cases and Rates of Reported Cases in Selected Metropolitan
Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016................................................102
Table 38. Late and Late Latent Syphilis Reported Cases and Rates of Reported Cases by State/Area
and Region in Alphabetical Order, United States and Outlying Areas, 20122016.....................................103
Table 39. Late and Late Latent Syphilis Reported Cases and Rates of Reported Cases in Selected
Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016..........................104
Table 40. Congenital Syphilis Reported Cases and Rates of Reported Cases by State, Ranked by Rates,
United States, 2016.........................................................................................................................................105
Table 41. Congenital Syphilis Reported Cases and Rates of Reported Cases by Year of Birth,
State/Area, and Region in Alphabetical Order, United States and Outlying Areas, 20122016..................106
Table 42. Congenital Syphilis Reported Cases and Rates of Reported Cases per 100,000 Live Births by
Year of Birth and Race/Ethnicity of Mother, United States, 20122016......................................................107
Chancroid
Table 43. Chancroid Reported Cases and Rates of Reported Cases by State/Area in Alphabetical
Order, United States and Outlying Areas, 20122016...................................................................................108
xvii
Selected STDs
Table 44. Selected STDs and Complications Initial Visits to Physicians Offices, National Disease
and Therapeutic Index, United States, 19662015........................................................................................109
Appendix
by State and by Nationally Notifiable STD, 2016.........................................................................................119
Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2016..............................................121
Table B1. Healthy People 2020 (HP 2020) Sexually Transmitted Diseases Objectives...............................................124
Table B2. Government Performance and Results Act (GPRA) Sexually Transmitted Diseases Goals,
Measures, and Target......................................................................................................................................125
xviii
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
xix
xx
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.
National Overview of STDs, 2016

All Americans should have the Transmitted Diseases, surveillance is Rates of chlamydia are highest
opportunity to make choices that a key component of all our efforts to among adolescent and young adult
lead to health and wellness. Working prevent and control these diseases.1 females, the population targeted for
together, interested, committed routine chlamydia screening. Among
public and private organizations, This overview summarizes national young women attending family
communities, and individuals can surveillance data for 2016 on the three planning clinics participating in a
take action to prevent sexually notifiable diseases for which there are sentinel surveillance program who
transmitted diseases (STDs) and federally funded control programs: were tested for chlamydia, 9.2% of
their related health consequences. In chlamydia, gonorrhea, and syphilis. 1519 year olds and 8.0% of 2024
addition to federal, state, and local year olds were positive. Although
public support for STD prevention rates of reported cases among
Chlamydia
activities, local community leaders men are generally lower than rates
can promote STD prevention In 2016, a total of 1,598,354 cases among women, reflecting the larger
education. Health care providers can of Chlamydia trachomatis infection number of women screened for this
assess their patients risks and talk were reported to the CDC, making it infection, increased availability of
to them about testing. Parents can the most common notifiable condition urine testing and extragenital testing
better educate their children about in the United States. This case count has resulted in an increased number
STDs and sexual health. Individuals corresponds to a rate of 497.3 cases of men, including gay, bisexual, and
can use condoms consistently and per 100,000 population, an increase of other men who have sex with men
correctly, and openly discuss ways to 4.7% compared with the rate in 2015. (collectively referred to as MSM)
protect their health with partners and During 20152016, rates of reported being tested and diagnosed with a
providers. As noted in the Institute chlamydia increased in all regions of
chlamydial infection.
of Medicine report, The Hidden the United States.
Epidemic: Confronting Sexually
1
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile
Rates of reported chlamydia varied treatment for gonorrhea.2 In 2016, the particularly among MSM. Among
among different racial and ethnic percentage of isolates with elevated 2016 P&S syphilis cases with known
minority populations. In 2016, rates minimum inhibitory concentrations HIV-status, 47.0% of MSM were
were highest among Blacks and (MICs) of cefixime and ceftriaxone HIV-positive, 10.7% of cases among
American Indians/Alaska Natives. remained low (0.3% and 0.3%, MSW and 4.1% of cases among
However, during 20122016, rates respectively). During 20132016, the women were HIV-positive.
decreased 3.5% among Blacks and percentage of isolates with reduced
6.4% among American Indians/ azithromycin susceptibility increased The 2013 rate of congenital syphilis
Alaska Natives and increased among from 0.6% to 3.6%. Continued (9.2 cases per 100,000 live births)
Whites, Asians, and Native Hawaiian/ monitoring of susceptibility patterns marked the first increase in congenital
Other Pacific Islanders. to these antibiotics is critical. syphilis since 2008. During 2013
2014, the rate increased 27.2%,
Gonorrhea Syphilis during 20142015 the rate increased
6.0%, and then increased 27.6%
In 2009, the national rate of reported In 2000 and 2001, the national rate during 20152016. There were 628
gonorrhea cases reached an historic of reported primary and secondary cases of congenital syphilis reported
low of 98.1 cases per 100,000 (P&S) syphilis cases was 2.1 cases in 2016 compared with 492 cases in
population. During 20092012, the per 100,000 population, the lowest 2015. In 2016, rates of congenital
rate increased slightly each year to rate since reporting began in 1941. syphilis were highest among Blacks
106.7 cases per 100,000 population However, the P&S syphilis rate has (43.1 cases per 100,000 live births),
in 2012 and has increased steadily increased almost every year since followed by American Indians/Alaska
during 20142016. In 2016, 468,514 2001. In 2016, 27,814 P&S syphilis Natives (31.6 cases per 100,000 live
gonorrhea cases were reported for cases were reported, representing a births), and Hispanics (20.5 cases per
a rate of 145.8 cases per 100,000 national rate of 8.7 cases per 100,000 100,000 live births).
population, an increase of 18.5% population and a 17.6% increase from
from2015. 2015. During 20152016, the P&S
syphilis rate increased among both
During 20152016, the rate of men and women in every region of
reported gonorrhea increased the country; overall, the rate increased
22.2% among men and 13.8% 14.7% among men and 35.7%
among women. The magnitude of amongwomen.
the increase among men suggests
either increased transmission or During 20122016, P&S syphilis
increased case ascertainment (e.g., rates were consistently highest
through increased extra-genital among persons aged 2029 years,
screening) among MSM or both. The but rates increased in every 5-year
concurrent increases among cases age group among those aged 1564
reported among women, suggests years. In 2016, rates were highest
parallel increases in heterosexual among Blacks (23.3 per 100,000
transmission, increased screening population) and Native Hawaiian/
among women, or both. Other Pacific Islanders (13.9 per
100,000 population); however, rates
In 2016, the rate of reported cases of increased among all racial and ethnic
gonorrhea remained highest among groups during in 20122016.
Blacks (481.2 cases per 100,000
population) and among American During 20002016, the rise in the
Indians/Alaska Natives (242.9 cases P&S syphilis rate was primarily
per 100,000 population). During attributable to increased cases among
20122016, rates increased among all men and, specifically, among MSM. References
racial and ethnic groups. In 2016, men accounted for almost 1. Eng TR, Butler WT, editors; Institute of
90% of all cases of P&S syphilis. Medicine. The Hidden Epidemic: Confronting
Sexually Transmitted Diseases. Washington DC:
Antimicrobial resistance remains Of those male cases for whom sex The National Academy Press; 1997.
an important consideration in the of sex partner was known, 80.6%
2. Centers for Disease Control and Prevention.
treatment of gonorrhea. Dual therapy were MSM. Reported cases of P&S Sexually transmitted diseases treatment
with ceftriaxone and azithromycin syphilis continued to be characterized guidelines, 2015. MMWR Morb Mortal Wkly
is now the only CDC recommended by a high rate of HIV co-infection, Rep 2015; 64(No. RR-3): 1137.
2
National Profile Centers for Disease Control and Prevention: STD Surveillance 2016
Chlamydia
Background organization (HMO) plans, chlamydia tests, as well as more complete
screening increased from 23.1% reporting. Likewise, decreases in
Chlamydia, caused by infection with
in 2001 to 47.4% in 2015. Among chlamydia case rates may suggest
Chlamydia trachomatis, is the most
sexually-active women aged 1624 decreases in incidence of infection or
common notifiable disease in the
years covered by Medicaid, screening screening coverage.
United States. It is among the most
rates increased from 40.4% in 2001
prevalent of all STDs, and since 1994,
to 58.0% in 2011, then decreased to Chlamydia United States
has comprised the largest proportion
55.2% in 2015.7 Although chlamydia
of all STDs reported to CDC (Table In 2016, a total of 1,598,354
screening has expanded over the
1). Studies also demonstrate the high chlamydial infections were reported
past two decades, many women
prevalence of chlamydial infections to CDC in 50 states and the District
who are at risk are still not being
in the general U.S. population, of Columbia (Table 1). This case
testedreflecting, in part, the lack of
particularly among young women.1 count corresponds to a rate of 497.3
awareness among some health care
providers and the limited resources cases per 100,000 population. During
Chlamydial infections in women 20002011, the rate of reported
available to support these screenings.
are usually asymptomatic.2 chlamydial infection increased from
Untreated infection can result 251.4 to 453.4 cases per 100,000
in pelvic inflammatory disease Interpreting Rates of population (Figure 1, Table 1). During
(PID), which is a major cause of Reported Cases of 20112013, the rate of reported cases
infertility, ectopic pregnancy, and Chlamydia decreased to 443.5 cases per 100,000
chronic pelvic pain. Data from population, followed by an increase in
randomized controlled trials of Trends in rates of reported cases of
chlamydia are influenced by changes the rate of reported cases over each of
chlamydia screening suggested the next 3 years. During 20152016,
that screening programs can lead in incidence of infection, as well as
changes in diagnostic, screening, and the rate increased 4.7%, from 475.0
to a reduction in the incidence of to 497.3 cases per 100,000 population
PID.3,4 As with other inflammatory reporting practices. As chlamydial
infections are usually asymptomatic, (Figure 1, Table 1).
STDs, chlamydial infection could
facilitate the transmission of HIV the number of infections identified
infection.5 In addition, pregnant and reported can increase as more Chlamydia by Region
women infected with chlamydia can people are screened even when In 2016, rates of reported cases of
pass the infection to their infants incidence is flat or decreasing. chlamydia were highest in the South
during delivery, potentially resulting During 20002011, the expanded (529.7 cases per 100,000 population,
in ophthalmia neonatorum, which can use of more sensitive diagnostic 3.0% increase from 2015), followed
lead to blindness, and pneumonia. tests (e.g., nucleic acid amplification by the Midwest (487.5, 5.1% increase
Because of the large burden of disease tests [NAATs]) likely increased the from 2015), West (485.9, 5.8%
and risks associated with infection, number of infections identified and increase from 2015), and Northeast
CDC recommends annual chlamydia reported independently of increases in (454.6, 7.0% increase from 2015)
screening for all sexually active incidence. Also, although chlamydia (Table 3). During 20072012, rates of
women younger than age 25 years and has been a nationally notifiable reported cases of chlamydia increased
women 25 years at increased risk for condition since 1995, it was not until in all regions (Figure 2). During
infection (e.g., women with new or 2000 that all 50 states and the District 20122013, rates decreased in the
multiple sex partners).6 of Columbia required reporting of Northeast, Midwest, and South and
chlamydia cases. National case rates remained stable in the West. During
The Healthcare Effectiveness Data prior to 2000 reflect incomplete 20132016, rates increased in all
and Information Set (HEDIS) reporting. The increased use of regions, with the largest increase
contains a measure which assesses electronic laboratory reporting over occurring in the West (421.1 to 485.9
chlamydia screening coverage the last decade or so also likely cases per 100,000 population, 15.4%
of sexually active young women increased the proportion of diagnosed increase) (Table 3).
who receive medical care through cases reported. Consequently, an
commercial or Medicaid managed increasing chlamydia case rate
care organizations. Among sexually- over time may reflect increases in
active women aged 1624 years incidence of infection, screening
in commercial health maintenance coverage, and use of more sensitive
3
and 10.9% among men (331.8 to
Figure 1. Chlamydia Rates of Reported Cases by Sex, United 368.0 cases per 100,000 males)
States, 20002016 (Tables 7 and 8).
Rate (per 100,000 population)
750
Men Chlamydia by County
625 Women
Total In 2016, 620 (19.7%) of 3,140
500 counties had rates of reported
chlamydia higher than 520 cases
375
per 100,000 population (Figure 4).
250 Seventy counties and independent
125
cities reported 43.4% of all chlamydia
cases in 2016 (Table 9). Of the 70
0 counties and independent cities
2000 2002 2004 2006 2008 2010 2012 2014 2016 reporting the highest number of
chlamydia cases, 47 (67.1%) were
Year
located in the South and West
NOTE: Data collection for chlamydia began in 1984 and chlamydia was made nationally notifiable
in 1995; however, chlamydia was not reportable in all 50 states and the District of Columbia until
(Table9).
2000. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for more
information: https://wwwn.cdc.gov/nndss/conditions/chlamydia-trachomatis-infection/. Chlamydia by Sex
In 2016, 1,072,719 cases of
chlamydia were reported among
Figure 2. Chlamydia Rates of Reported Cases by Region, United females for a rate of 657.3 cases per
States, 20072016 100,000 females (Table 4). After
increasing each year during 2000
2011, the rate of reported chlamydia
600
cases among females decreased
500 during 20112013, followed by an
increase in the rate of reported cases
400
over each of the next three years
300 (Figure 1). The rate among females
200 West increased 0.4% during 20132014,
Midwest
Northeast
3.0% during 20142015, and 2.6%
100 South during 20152016, for a total increase
0 of 6.2% during 20132016.
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
There were 522,870 cases of
chlamydia reported among males in
2016 for a rate of 330.5 cases per
Chlamydia by State Chlamydia by Metropolitan 100,000 males (Table 5). The rate of
In 2016, rates of reported cases of Statistical Area reported cases among males increased
chlamydia by state ranged from 260.6 The rate of reported cases of each year during 20002016, with
cases per 100,000 population in New chlamydia in the 50 most populous the exception of 20122013, where
Hampshire to 771.6 cases per 100,000 metropolitan statistical areas (MSAs) rates remained stable (Figure 1).
population in Alaska (Figure3, Table increased 6.2% during 20152016 During 20152016 alone, the rate
2); the rate in the District of Columbia (489.6 to 520.1 cases per 100,000 among men increased 9.2%; however,
was 1,083.4 cases per 100,000 population, respectively) (Table 6). during 20122016, rates of reported
population (Table 3). During 2015 In 2016, 57.5% of chlamydia cases cases among men increased 26.8%
2016, rates of reported chlamydia were reported by these MSAs. During (compared with a 2.9% increase
cases increased in 44 states and the 20152016, the rate of reported among women) (Tables 4 and 5).
District of Columbia. The rate of cases of chlamydia in these MSAs This pronounced increase among
reported chlamydia cases in 2016 was increased 3.9% among women (639.8 men could be attributed to either
above the U.S. total in 21 states. to 664.5 cases per 100,000 females) increased transmission or improved
case identification (e.g., through
4
Chlamydia by Age
Figure 3. Chlamydia Rates of Reported Cases by State, United
States and Outlying Areas, 2016 The rates of reported cases of
chlamydia are highest among
436
adolescents and young adults aged
428 457 313 1524 years (Table 10). In 2016, the
433 413
VT 270 age-specific rate of reported cases
356
352
505 466
463
553
NH 261 of chlamydia among 1519 year
507 432
416 445
MA 395
RI 467
olds was 1,929.2 cases per 100,000
population and the rate among 2024
521
316 561 466
506 469 261 CT 387
year olds was 2,643.8 cases per
418 473
507 413 NJ 385
Guam 577 DE 567
100,000 population (Table 10).
578
489
512
629
548
562 576 MD 510
615
DC 1083
554
520
672
Among females, the highest age-
772
679
Rate per 100,000 specific rates of reported cases of
482 population
467
<= 395 (n= 11) chlamydia in 2016 were among those
396 - 463 (n= 11) aged 1519 years (3,070.9 cases per
Puerto Rico 207 464 - 507
508 - 562
(n= 12)
(n= 10) 100,000 females) and 2024 years
Virgin Islands 555 >=563 (n= 10) (3,779.0 cases per 100,000 females)
(Figure 5, Table 10). Within these
NOTE: The total rate of reported cases of chlamydia for the United States and outlying areas age groups, rates were highest among
(Guam, Puerto Rico, and Virgin Islands) was 494.2 per 100,000 population. women aged 19 years (4,970.1 cases
per 100,000 females) and 20 years
(4,734.8 cases per 100,000 females)
Figure 4. Chlamydia Rates of Reported Cases by County, (Table 12). The rate of reported cases
United States, 2016 among women aged 1519 and 2024
years increased over the last two and
three years, respectively. The rate
among 1519 year olds increased
2.8% during 20152016, with a total
increase of 4.1% during 20142016
(2,949.3 to 3,070.9 per 100,000
females). The rate among 2024 year
olds increased 0.4% during 2015
2016, with a total increase of 5.1%
Rate per 100,000 during 20132016 (3594.2 to 3779.0
population per 100,000 females) (Table 10).
<=180 (n= 621)
181-265 (n= 658) In 2016, the age-specific rates of
266-358 (n= 631)
reported cases of chlamydia among
359-520 (n= 610)
>520 (n= 620)
men, although substantially lower
than rates among women, were
highest in those aged 2024 years
NOTE: Refer to the NCHHSTP Atlas for further county-level rate information: https://www.cdc.gov/
nchhstp/atlas. (1,558.6 cases per 100,000 males)
(Figure 5, Table 10). Similar to trends
in women, the rate of reported cases
intensified extra-genital screening two times the rate among males in among men aged 1519 and 2024
efforts) among gay, bisexual, and 2016, likely reflecting a larger number years increased over the last two and
other men who have sex with men of women screened for this infection three years, respectively. The rate
(collectively referred to as MSM). (Figure 1, Tables 4 and 5). The lower among 1519 year olds increased
This cannot be assessed, however, as rate among men also suggests that 8.6% during 20152016, with a total
most jurisdictions do not routinely many of the sex partners of women increase of 15.3% during 20142016
report sex of sex partner or anatomic with chlamydia are not receiving (722.4 to 832.6 per 100,000 males).
site of infection. a diagnosis of chlamydia or being
reported as having chlamydia.
Despite this considerable increase in
men, the rate of reported chlamydia
cases among females was still about
5
5.7%, American Indians/Alaska
Figure 5. Chlamydia Rates of Reported Cases by Age Group and Natives: 5.3%, Native Hawaiians/
Sex, United States, 2016 Other Pacific Islanders: 4.7%, Blacks:
Men Rate (per 100,000 population) Women 3.7%, Hispanics 1.9%, and Multirace:
4000 3200 2400 1600 800 0 Age Group 0 800 1600 2400 3200 4000 27.6%) (Figure 6).
12.7 10-14 91.1
832.6 15-19 3070.9
More information on chlamydia rates
1558.6 20-24 3779.0
among race/ethnicity groups can be
1003.4 25-29 1657.8
found in the Special Focus Profiles.
538.0 30-34 688.2
311.3 35-39 341.8 Chlamydia by Reporting
167.3 40-44 154.2
Source
91.9 45-54 57.9
30.1 55-64 15.8 In 2016, 6.4% of chlamydia cases
5.5 65+ 2.2 were reported from STD clinics,
330.5 Total 657.3 78.4% were reported from venues
outside of STD clinics, and
15.2% had an unknown source of
The rate among 2024 year olds During 20122016, 46 states
report (Table A2). Over time, the
increased 5.5% during 20152016, submitted race and ethnicity data
proportion of male cases reported
with a total increase of 18.9% during according to the OMB standards
from STD clinic sites has decreased
20132016 (1,310.9 to 1,558.6 per (see Section A1.5 in the Appendix).
substantially, from 33.1% in 2007
100,000 females) (Table 10). During 20122016, rates of reported
to 11.0% in 2016 (Figure 7). In
chlamydia cases increased among
2016, among women, only 4.2%
Chlamydia by Race/Ethnicity Whites (12.7%), Asians (10.2%),
of chlamydia cases were reported
Native Hawaiians/Other Pacific
Among the 50 states and the District through an STD clinic (Table A2).
Islanders (8.3%), and Multirace
of Columbia that submitted race and A large proportion of cases among
(60.6%), and decreased in American
ethnicity data in 2016 according to women (33.5%) were reported from
Indians/Alaska Natives (6.4%) and
Office of Management and Budget private physicians/HMOs in 2016
Blacks (3.5%) (Figure 6). Rates
(OMB) standards (see Section A1.5 (Figure 8). Among men, 25.9% of
were stable among Hispanics during
in the Appendix), rates of reported cases were reported from private
20122016. During 20152016,
cases of chlamydia were highest physicians/HMOs (Figure 7).
rates increased among all racial/
among Black, American Indian/ ethnic groups (Whites: 6.3%, Asians:
Alaska Native, and Native Hawaiian/
Other Pacific Islander women (Figure
R, Table 11B). Overall, the rate of Figure 6. Chlamydia Rates of Reported Cases by Race/Ethnicity,
reported cases of chlamydia among United States, 20122016
Blacks was 5.6 times the rate among Rate (per 100,000 population) AI/AN* NHOPI*
Whites (1,125.9 and 199.8 cases per 1500
Asians
Blacks
Whites
Multirace
100,000 population, respectively). Hispanics
The rate among American Indians/ 1250
Alaska Natives (749.8 cases per 1000
100,000 population) was 3.8 times
the rate among Whites. The rate 750
among Native Hawaiians/Other 500
Pacific Islanders (653.4 cases per
250
100,000 population) was 3.3 times
the rate among Whites. The rate 0
among Hispanics (374.6 cases per 2012 2013 2014 2015 2016
100,000 population) was 1.9 times the Year
rate among Whites. The rate among
* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.
Asians was lower than the rate among
NOTE: Includes 46 states reporting race/ethnicity data in Office of Management and Budget
Whites (119.3 cases per 100,000 compliant formats during 20122016 (see Section A1.5 in the Appendix).
population).
6
population targeted for screening,
Figure 7. Chlamydia Percentage of Reported Cases Among Men prevalence was 4.7% (95% CI:
by Reporting Source*, United States, 20072016 3.26.1), with the highest prevalence
Percentage among non-Hispanic Black
2007 2008 2009 2010 2011 females (13.5%, 95% CI: 9.217.7)
40
2012 2013 2014 2015 2016 (Figure10).1
30
Chlamydia Positivity in
20 Selected Populations
The STD Surveillance Network
10 (SSuN) is an ongoing collaboration
of 10 state, county, and city health
0 departments collecting enhanced
Private Other HD Family STD Clinic Hosp-Other All Other Missing/Unk clinical and behavioral information
Physician/HMO Clinic Planning Clinic among patients attending 30 STD
* Includes the top five reporting sources for chlamydia cases reported among men, plus those with clinics in the SSuN jurisdictions
reporting sources listed as All Other and Missing/Unknown. (See Section A2.2 of the Appendix).

HMO = health maintenance organization; HD = health department.
NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Laboratory,
Blood Bank, Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic, In 2016, the proportion of STD clinic
Mental Health Provider, Indian Health Service, Military, Emergency Room, HIV Counseling and patients testing positive for chlamydia
Testing Site, and Other. varied by age, sex, and sexual
behavior. Adolescent men who have
sex with women only (MSW) had the
Figure 8. Chlamydia Percentage of Reported Cases Among highest prevalence (28.9%), either
Women by Reporting Source*, United States, 20072016 reflecting disproportionate testing of
men with urethritis or targeted testing
Percentage
of partners of women diagnosed
2007 2008 2009 2010 2011
40 2012 2013 2014 2015 2016
with chlamydia. Prevalence among
all those tested decreased with age,
though the variation in prevalence by
30
age was not as pronounced for MSM
(Figure 11).
20
10
Chlamydia Among Special
Populations
0 More information on chlamydia
Private Other HD Family Laboratory Hosp-Other All Other Missing/Unk among women of reproductive age,
Physician/HMO Clinic Planning Clinic
adolescents and young adults, MSM,
* Includes the top five reporting sources for chlamydia cases reported among women, plus those and minority populations is presented
with reporting sources listed as All Other and Missing/Unknown.

in the Special Focus Profiles.
NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Blood Bank,
Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic, Mental Chlamydia Summary
Health Provider, Indian Health Service, Military, Emergency Room, STD Clinic, HIV Counseling and
Testing Site, and Other. Chlamydia continues to be the
most commonly reported nationally
notifiable disease, with 1,598,354
Chlamydia Prevalence in the measure of chlamydia disease burden cases reported in 2016 and increasing
Population in respondents aged 1439 years. rates of reported cases over each of
During 20072012, the overall the last three years. Rates of reported
The National Health and Nutrition prevalence of chlamydia among
Examination Survey (NHANES; see chlamydia cases increased 4.7%
persons aged 1439 years was 1.7% during 20152016. The Southern
Section A2.4 in the Appendix) is a (95% Confidence Interval [CI]:
nationally representative survey of region of the U.S. reported the highest
1.42.0) (Figure 9). Among sexually rate of chlamydial infection in 2016;
the U.S. civilian, non-institutionalized active females aged 1424 years, the
population that provides an important the Northeast reported the largest rate
7
decreased 66.8% from 33.1% in 2007
Figure 9. Chlamydia Prevalence Among Persons Aged 1439 to 11.0% in 2016; in 2016 alone,
Years by Sex, Race/Ethnicity, or Age Group, National Health and approximately one-third of chlamydia
Nutrition Examination Survey (NHANES), 20072012 cases among women were reported
Prevalence, % from private physicians/HMOs. Racial
8 differences also persist; reported case
rates and prevalence estimates among
6
Blacks continue to be substantially
higher than among all other racial/
4
ethnic groups. Rates of reported cases
of chlamydia were next highest among
2
American Indian/Alaska Native
and Native Hawaiian/Other Pacific
Islander women. Ultimately, both test
0
Non- Non- Mexican positivity and the number of reported
Overall Men Women Hispanic Hispanic Americans 14-19 20-24 25-39
Whites Blacks cases of C. trachomatis infections
Sex Race/Ethnicity Age Group remain high among most age groups,
NOTE: Error bars indicate 95% confidence intervals. racial/ethnic groups, geographic areas,
SOURCE: Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection and both sexes.
among persons aged 1439 years United States, 20072012. MMWR Morb Mortal Wkly Rep
2014; 63(38):834838.
Figure 10. Chlamydia Prevalence Among Sexually-Active Women

Aged 1439 Years by Race/Ethnicity and Age Group, National Health
and Nutrition Examination Survey (NHANES), 20072012
Prevalence, %
20
15
10
0
Non- Non- Mexican
14-19 20-24 25-39 All Hispanic Hispanic Americans
Whites Blacks
Age Group Among 14-24 Year Olds
NOTE: Error bars indicate 95% confidence intervals.
SOURCE: Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection
among persons aged 1439 years United States, 20072012. MMWR Morb Mortal Wkly Rep
2014; 63(38):834838.
increase during 20152016, at 7.0%. coverage in men, especially increased

In 2016, the rate of reported cases of extra-genital screening in MSM.
chlamydia in women was two times
the rate in men. However, during The facilities reporting chlamydial
20122016, the rate in men increased infections have changed over the last
26.8%, whereas the rate in women 10 years or so, with most (78.4%)
increased only 2.9%. Potential reasons chlamydia cases in 2016 reported from
for this considerable increase in male venues outside of STD clinics. The
cases could be due to a true increase proportion of men being diagnosed
in cases or to improved screening with chlamydia in STD clinics
8
References
Figure 11. Chlamydia Proportion* of STD Clinic Patients Testing
1. Torrone E, Papp J, Weinstock H. Prevalence of
Positive by Age Group, Sex, and Sexual Behavior, STD Surveillance Chlamydia trachomatis genital infection among
Network (SSuN), 2016 persons aged 1439 years United States,
20072012. MMWR 2014; 63(38): 834838.
Percentage
2. Stamm WE. Chlamydia trachomatis infections
40 in the adult. In: Holmes, KK, Sparling, PF,
MSM
MSW Stamm, WE, Piot, P, Wasserheit, JN, Corey, L,
30 Women Cohen, MS, Watts, DH. Sexually Transmitted
Diseases. 4th ed. New York, NY: McGraw-Hill;
2008: 575606.
20
3. Scholes D, Stergachis A, Heidrich FE, et al.
Prevention of pelvic inflammatory disease by
10 screening for cervical chlamydial infection. N
Engl J Med 1996; 334(21): 13621366.
0 4. Oakeshott P, Kerry S, Aghaizu A, et al.

Randomised controlled trial of screening for
<=19 20-24 25-29 30-39 >=40 Chlamydia trachomatis to prevent pelvic
Age Group inflammatory disease: the POPI (prevention of
pelvic infection) trial. BMJ 2010; 340: c1642.
* Proportions represent the overall average of the mean value by jurisdiction.
5. Fleming DT, Wasserheit JN. From

Results are based on data obtained from patients with known sexual behavior (n=75,114)
epidemiological synergy to public health policy
attending SSuN STD clinics in 2016 in all SSuN jurisdictions, excluding Florida.
and practice: the contribution of other sexually

MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM);
transmitted diseases to sexual transmission of
MSW = Men who have sex with women only.
HIV infection. Sex Transm Infect 1999; 75(1):
NOTE: See Section A2.2 in the Appendix for SSuN methods. 317.
Sexually transmitted diseases treatment
guidelines, 2015. MMWR Recomm Rep 2015;
64(RR-3): 1137. Erratum in: MMWR 2015;
64(33): 924.
7. National Committee for Quality Assurance. The
State of Healthcare Quality 2016. Available at:
http://www.ncqa.org/report-cards/health-plans/
state-of-health-care-quality. Accessed July 27,
2017.
9
10
Gonorrhea
Background among persons in every age group gonorrhea.3 The emerging threat of
during 20152016 (Table 21). cephalosporin resistance highlights
Gonorrhea is the second most
the need for continued surveillance
commonly reported notifiable disease
N. gonorrhoeae has progressively of N. gonorrhoeae antimicrobial
in the United States. Infections
developed resistance to each of the susceptibility.
due to Neisseria gonorrhoeae, like
antimicrobials used for treatment of
those resulting from Chlamydia
gonorrhea. Declining susceptibility The combination of persistently
trachomatis, are a major cause of
to cefixime (an oral cephalosporin high gonorrhea morbidity in some
pelvic inflammatory disease (PID)
antibiotic) resulted in a change to populations and the threat of
in the United States. PID can lead to
the CDC treatment guidelines, so cephalosporin-resistant gonorrhea
serious outcomes in women, such as
that dual therapy with ceftriaxone reinforces the need to better
tubal infertility, ectopic pregnancy,
(an injectable cephalosporin) and understand the epidemiology of
and chronic pelvic pain. In addition,
azithromycin is now the only CDC- gonorrhea.
epidemiologic and biologic studies
recommended treatment regimen for
provide evidence that gonococcal
infections facilitate the transmission
of HIV infection.1 Together, sexual Figure 12. Gonorrhea Rates of Reported Cases by Year, United
behavior and community prevalence States, 19412016
can increase the risk of acquiring
gonorrhea. Social determinants of
500
health, such as socioeconomic status,
discrimination, and access to quality 400
health care, may contribute to the
burden of gonorrhea in a community.2 300
200
In 2009, the national rate of reported
gonorrhea cases reached a historic 100
low of 98.1 cases per 100,000
population (Figure 12, Table 1). 0
However, during 20092012, the rate 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011 2016
increased slightly each year to 106.7 Year
cases per 100,000 population in 2012.
NOTE: Data collection for gonorrhea began in 1941; however, gonorrhea became nationally
In 2013, the rate decreased slightly to notifiable in 1944. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for
105.3 cases per 100,000 population, more information: https://wwwn.cdc.gov/nndss/conditions/gonorrhea/
followed by a yearly increase during
20132016. In 2016, a total of
468,514 cases were reported for a rate Figure 13. Gonorrhea Rates of Reported Cases by Sex, United
of 145.8 gonorrhea cases per 100,000 States, 20072016
population (Figure 12, Table 1).
The increase in the gonorrhea rate 200 Men
during 20152016 was observed Women
among both males and females; 150
Total
however, the increase was larger
among males (Figure 13). During 100
20152016, the gonorrhea rate
increased in all regions and, during
50
20122016, the largest increase was
observed in the West (95.7%; 72.6 to
0
142.1 cases per 100,000 population)
(Figure 14, Table 14). The rate of 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
gonorrhea continued to increase Year
11
(Figure 14, Table 14). During 2015
Figure 14. Gonorrhea Rates of Reported Cases by Region, United 2016, the gonorrhea rate increased
States, 20072016 in all four regions: 23.8% in the
Rate (per 100,000 population) Midwest, 21.9% in the West, 15.7%
West
200 Midwest in the Northeast, and 15.4% in the
Northeast South (Figure 14, Table 14). During
South
150
20122016, the rate of gonorrhea
in the West increased by 95.7%
(72.6 to 142.1 cases per 100,000
100
population), while other regions had
smaller overall increases during this
50
time period (i.e., 27.8% in the South,
25.0% in the Midwest, and 18.0% in
0 the Northeast).
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
Gonorrhea by State
In 2016, rates of reported gonorrhea
Interpreting Rates of 18.5%, and increased 48.6% since the cases per 100,000 population ranged
Reported Cases of historic low in 2009. by state from 20.1 in Vermont to
Gonorrhea 239.2 in Mississippi; the gonorrhea
Although gonorrhea case reporting
Gonorrhea by Region rate in the District of Columbia was
The South had the highest rate of 479.9 cases per 100,000 population
is useful for monitoring disease
reported gonorrhea cases (166.8 cases (Figure 15, Table 13).
trends, the number of gonorrhea
cases reported to CDC is affected per 100,000 population) among the
four regions of the United States During 20152016, gonorrhea rates
by many factors in addition to the
in 2016, followed by the Midwest increased in 96.1% of states and the
actual occurrence of the infection
(142.9 cases per 100,000 population), District of Columbia and decreased in
within the population. Changes in the
the West (142.1 cases per 100,000 3.9% of states (Table 14).
burden of gonorrhea may be masked
by changes in screening practices population), and the Northeast
(e.g., screening for chlamydia with (108.8 cases per 100,000 population)
tests that also detect N. gonorrhoeae
infections or increased screening at
extra-genital anatomic sites), the use
of diagnostic tests with different test Figure 15. Gonorrhea Rates of Reported Cases by State, United
performance (e.g., the broader use States and Outlying Areas, 2016
of nucleic acid amplification tests
[NAATs]), and changes in reporting 114
84 34
practices. As with other STDs, the
132
108 93
VT 20
reporting of gonorrhea cases to CDC 38 148 113 147
NH 34
is incomplete.4 For these reasons,
47 126
83 114
MA 73
114
supplemental data on gonorrhea 152
70 165 143
176 RI
CT
68
76
prevalence in persons screened in
165 110 50 132
115 189 131 NJ 91
a variety of settings are useful in Guam 82
154 196 DE 180
151 194 MD 159
assessing the burden of disease in 169 193 188
DC 480
selected populations. 173 201
239
155
231
197 Rate per 100,000
103 population
Gonorrhea United States
139
<= 73 (n= 11)
74 - 114 (n= 13)
In 2016, a total of 468,514 cases Puerto Rico 21 115 - 148 (n= 9)
of gonorrhea were reported in the 149 - 180
>=181
(n= 11)
(n= 10)
United States, yielding a rate of
Virgin Islands 34
145.8 cases per 100,000 population

NOTE: The total rate of reported cases of gonorrhea for the United States and outlying areas
(Table1). During 20152016, the rate (Guam, Puerto Rico, and Virgin Islands) was 144.4 per 100,000 population.
of reported gonorrhea cases increased
12
Gonorrhea by Metropolitan rate among males increased 62.6% Gonorrhea by Age
Statistical Area (105.0 to 170.7 cases per 100,000
In 2016, rates of reported gonorrhea
males) and the rate among females
The overall rate of reported gonorrhea cases continued to be highest among
increased 12.1% (107.9 to 121.0 cases
cases in the 50 most populous adolescents and young adults
per 100,000 females). The magnitude
metropolitan statistical areas (MSAs) (Figure17, Table 21). In 2016,
of the increase among males suggest
was 162.2 cases per 100,000 the highest rates among females
either increased transmission or
population in 2016, representing a were observed among those aged
increased case ascertainment (e.g.,
19.6% increase compared with the 2024 years (595.5 cases per 100,000
through increased extra-genital
rate in 2015 (135.6 cases per 100,000 females) and 1519 years (482.1
screening) among gay, bisexual, and
population) (Table 17). In 2016, cases per 100,000 females). Among
other men who have sex with men
61.2% of reported gonorrhea cases males, the rate was highest among
(collectively referred to as MSM).
were reported by these MSAs. Since those aged 2024 years (616.8 cases
However, most jurisdictions do not
2012, the gonorrhea rate among per 100,000 males) and 2529 years
routinely report sex of sex partner or
females in the 50 most populous (545.1 cases per 100,000 males).
site of infection for gonorrhea cases,
MSAs has been lower than the rate so trends in gonorrhea rates among
among males (Tables 18 and 19). In In 2016, persons aged 1544 years
MSM over time cannot be assessed.
2016, the rate among females in these accounted for 91.9% of reported
MSAs was 120.8 cases per 100,000 gonorrhea cases with known age.
females, while the rate among males Gonorrhea by Region Among 1519 year olds, rates
was 204.7 cases per 100,000 males. and Sex decreased by 10.7% during 2012
2015 and increased 11.3% during
In all regions, the rate of gonorrhea
20152016. During 20152016, the
Gonorrhea by County increased among both males and
gonorrhea rate also increased among
females during 20152016 and the
In 2016, 51.0% of reported gonorrhea other age groups: 10.9% among
rate of increase among males was
cases occurred in just 70 counties those aged 2024 years, 22.2%
larger than the rate of increase among
or independent cities (Table 20). In among those aged 2529 years,
females (Tables 15 and 16). The rate
2016, 608 counties (19.5%) in the 26.2% among those aged 3034
of reported gonorrhea cases increased
United States had a rate less than years, 30.3% among those aged
the most in the Midwest (26.7%
or equal to 16 cases per 100,000 3539 years, and 27.0% among those
among males and 21.0% among
population (Figure 16). The rate aged 4044 years (Figures 18 and
females) and in the West (24.1%
ranged from 17 to 38 cases per 19, Table21). Among persons aged
among males and 17.2% among
100,000 population in 631 counties 1544 years, increases were observed
females) (Tables 15 and 16).
(20.1%), ranged from 39 to 71 in all age groups for both men and
cases per 100,000 population in 635 women during 20152016.
counties (20.2%), ranged from 72
to 139 cases per 100,000 population
Figure 16. Gonorrhea Rates of Reported Cases by County,
in 619 counties (19.7%), and was
United States, 2016
more than 139 cases per 100,000
population in 647 counties (20.6%).
As in previous years, counties with
the highest gonorrhea rates were
concentrated in the South.
Gonorrhea by Sex
As was observed during 20132015,
the rate of reported gonorrhea cases
among males was higher than the rate Rate per 100,000
among females in 2016 (Figure13, population
Tables 15 and 16). During 2015 <=16 (n= 608)
2016, the gonorrhea rate among males 17-38 (n= 631)
increased 22.2% (139.7 to 170.7 39-71 (n= 635)
cases per 100,000 males), and the 72-139 (n= 619)
rate among females increased 13.8% >139 (n= 647)
(106.3 to 121.0 cases per 100,000

females). During 20122016, the NOTE: Refer to the NCHHSTP Atlas for further county-level rate information: https://www.cdc.gov/
nchhstp/atlas/.
13
Gonorrhea by Race/Ethnicity
Figure 17. Gonorrhea Rates of Reported Cases by Age Group and
Sex, United States, 2016 In 2016, among the 50 states and the
District of Columbia that submitted
Men Rate (per 100,000 population) Women data in the race and ethnicity
750 600 450 300 150 0 Age Group 0 150 300 450 600 750 categories according to Office of
4.7 10-14 19.1 Management and Budget (OMB)
280.8 15-19 482.1 standards (see Section A1.5 in the
616.8 20-24 595.5 Appendix), the rate of reported
545.1 25-29 351.8 gonorrhea cases remained highest
350.7 30-34 179.0 among Blacks (481.2 cases per
233.4 35-39 100.3 100,000 population) (Table 22B).
140.7 40-44 48.5 The rate among Blacks was 8.6
92.8 45-54 19.8 times the rate among Whites (55.7
35.2 55-64 5.6 cases per 100,000 population). The
6.7 65+ 0.7 gonorrhea rate among American
170.7 Total 121.0 Indians/Alaska Natives (242.9 cases
per 100,000 population) was 4.4
times that of Whites, the rate among
Figure 18. Gonorrhea Rates of Reported Cases Among Women Islanders (165.8 cases per 100,000
Aged 1544 Years by Age Group, United States, 20072016 population) was 3.0 times that of
Whites, the rate among Hispanics
Age Group
Rate (per 100,000 population) 15-19 30-34
(95.9 cases per 100,000 population)
700 20-24 35-39 was 1.7 times that of Whites, the
600 25-29 40-44 rate among Multirace persons (62.3
cases per 100,000 population) was
500
1.1 times that of Whites, and the rate
400 among Asians (28.3 cases per 100,000
300 population) was half the rate of
200
Whites (Table 22B).
100
During 20122016, among the
0 46 states that submitted race and
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 ethnicity data according to OMB
Year standards (see Section A1.5 in the
Appendix) for all five years during
that period, the gonorrhea rate
Figure 19. Gonorrhea Rates of Reported Cases Among Men Aged increased among all race and ethnicity
1544 Years by Age Group, United States, 20072016 groups: 120.4% among Multirace
persons, 91.4% among Native
Age Group
Rate (per 100,000 population) Hawaiians/Other Pacific Islanders,
15-19 30-34
700
20-24 35-39
82.5% among Whites, 81.3% among
600 25-29 40-44 American Indians/Alaska Natives,
500 76.7% among Asians, 61.8% among
Hispanics, and 10.5% among Blacks
400
(Figure 20).
300
200 More information on gonorrhea rates
100 among race/ethnicity groups can be
0
found in the Special Focus Profiles.
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
14
on a representative sample of
Figure 20. Gonorrhea Rates of Reported Cases by Race/Ethnicity, gonorrhea case reports received
United States, 20122016 from all reporting sources in their
Rate (per 100,000 population) jurisdiction. Enhanced gonorrhea
case report data for 2016 were
600
obtained from Cycle 3 of SSuN,
500 which includes 10 jurisdictions
400
randomly sampling cases reported
AI/AN* NHOPI* in their jurisdictions. In 2016, SSuN
Asians Whites
300 Blacks Multirace collaborators interviewed 5,177
200
Hispanics gonorrhea cases representing 3.6% of
all cases reported from participating
100 jurisdictions. The estimated burden
0 of disease represented by men who
2012 2013 2014 2015 2016 have sex with men only (MSM-only),
Year
men who have sex with both men and
women (MSMW), men who have
sex with women only (MSW), and
compliant formats during 20122016 (see Section A1.5 in the Appendix). women varied substantially across
collaborating sites based on weighted
analysis (Figure 23). San Francisco
Gonorrhea by clinics/facilities (13.9%), STD clinics had the highest proportion of cases
Reporting Source (7.0%), family planning clinics estimated to be MSM-only (81.4%),
(7.0%), and laboratories (5.8%) while Baltimore had the lowest
In 2016, 10.5% of gonorrhea cases (Figure 22). proportion of MSM-only cases at
were reported from STD clinics, 16.2%. Across all jurisdictions, an
75.4% were reported from venues estimated 6.7% of gonorrhea cases
outside of STD clinics, and 14.0% STD Surveillance Network
were attributable to MSMW, which
had an unknown source of report The STD Surveillance Network is an important group representing
(Table A2). (SSuN) is an ongoing collaboration a bridge between MSM-only and
of states and independently funded heterosexual populations. (Figure 23).
During 20072016, the percent of cities collecting enhanced information In total, across all SSuN sites, 44.7%
gonorrhea cases reported by STD
clinics declined 64.8% among males
and 59.3% among females; however, Figure 21. Gonorrhea Percentage of Reported Cases Among Men
the percent of gonorrhea cases with by Reporting Source*, United States, 20072016
missing/unknown reporting source
increased 65.2% among males and Percentage
45.7% among females (Figures 21and 2007 2008 2009 2010 2011
40 2012 2013 2014 2015 2016
22). During 20152016, the percent
of gonorrhea cases reported by STD
30
clinics decreased 13.5% among males
and 9.6% among females.
20
In 2016, among males, private
physicians/health maintenance 10
organizations (HMOs) (22.2%) were
the most common reporting source, 0
followed by STD clinics (13.1%), STD Clinic Other HD Private Emergency Hosp-Other All Other Missing/Unk
other hospital clinics/facilities Clinic Physician/HMO Room
(12.5%), emergency rooms (6.4%), * Includes the top five reporting sources for gonorrhea cases reported among men, plus those with
and other health department clinics reporting sources listed as All Other and Missing/Unknown.
(6.1%) (Figure 21). Among females,
private physicians/HMOs (26.0%) NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Laboratory,
Blood Bank, Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic,
were the most common reporting Mental Health Provider, Indian Health Service, Military, Family Planning, HIV Counseling and Testing
source, followed by other hospital Site, and Other.
15
positive for gonorrhea varied by age
Figure 22. Gonorrhea Percentage of Reported Cases Among group, sex, and sex of sex partner
Women by Reporting Source*, United States, 20072016 (Figure 24). Among those attending
Percentage these clinics, MSM disproportionately
2007 2008 2009 2010 2011
had higher positivity rates when
40 compared to MSW and women in
2012 2013 2014 2015 2016
all age groups. While positivity rates
30 declined with increasing age for
heterosexual males and females, a
20 much slower decline by age was seen
in MSM-only.
10
Additional information about SSuN
0 methodology can be found in Section
STD Clinic Family Private Laboratory Hosp-Other All Other Missing/Unk
A2.2 of the Appendix.
Planning Physician/
Clinic HMO
Gonococcal Isolate
* Includes the top five reporting sources for gonorrhea cases reported among women, plus those
with reporting sources listed as All Other and Missing/Unknown. Surveillance Project

HMO = health maintenance organization.
NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Blood Bank,
Antimicrobial resistance remains
Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic, Mental an important consideration in the
Health Provider, Indian Health Service, Military, Emergency Room, Other Health Department Clinic, treatment of gonorrhea.3,57 In 1986,
HIV Counseling and Testing Site, and Other. the Gonococcal Isolate Surveillance
Project (GISP), a national sentinel
surveillance system, was established
Figure 23. Estimated Proportion* of MSM-Only, MSMW, MSW, and
to monitor trends in antimicrobial
Women Among Gonorrhea Cases by Jurisdiction, STD Surveillance
susceptibilities of urethral N.
Network (SSuN), 2016
gonorrhoeae strains in the United
States.7 Data are collected from
Percentage
selected STD clinic sentinel sites
MSM-Only
100 and from regional laboratories
MSMW
90
MSW
(Figure25).
80
70 Women
60
Antimicrobial susceptibility is
50 measured by the minimum inhibitory
40 concentration (MIC), the lowest
30 antimicrobial concentration that
20 inhibits bacterial growth in the
10 laboratory. Increases in MICs
0
San New York Massachusetts California Philadelphia Baltimore
demonstrate that the bacteria can
Francisco City Multnomah Washington Minnesota Florida survive at higher antimicrobial
County concentrations in the laboratory.
* Estimate based on weighted analysis of data obtained from interviews (n=5,177) conducted Monitoring of MIC trends is useful
among a random sample of reported gonorrhea cases during January to December 2016. because increasing MICs can

MSM-Only = Men who have sex exclusively with men; MSMW = Men who have sex with both oftentimes be an early indicator of the
men and women; MSW = Men who have sex with women only.
emergence of antimicrobial resistance.

California data excludes San Francisco (shown separately).
NOTE: See section A2.2 in the Appendix for SSuN methods.
Information on the antimicrobial
susceptibility criteria used in GISP
of gonorrhea cases were estimated all patients seeking care in selected can be found in Section A2.3 in the
to be among MSM-only or MSMW, STD clinics. Sentinel facility data for Appendix. More information about
22.6% among MSW, and 32.7% this report includes information from GISP and additional data can be found
among women. patients attending STD clinics during at https://www.cdc.gov/std/GISP.
2016 in nine out of the 10 funded
Collaborating SSuN jurisdictions jurisdictions. In 2016, the proportion
also conduct sentinel surveillance on of STD clinic patients who tested
16
and 1993), one from Philadelphia,
Figure 24. Gonorrhea Proportion* of STD Clinic Patients Testing Pennsylvania (1997), and one from
Positive by Age Group, Sex, and Sexual Behavior, STD Surveillance Oklahoma City, Oklahoma (2012).
Network (SSuN), 2016
Percentage Cefixime Susceptibility

40
MSM Susceptibility testing for cefixime
MSW began in 1992, was discontinued in
30 Women 2007, and was restarted in 2009. The
percentage of isolates with elevated
20 cefixime MICs (0.25g/ ml)
declined from 1.4% in 2011 to 0.3%
10 in 2016 (Figure 26).
0 Azithromycin Susceptibility
<=19 20-24 25-29 30-39 >=40
Susceptibility testing for azithromycin
Age Group
began in 1992. Figure 27 displays the
* Proportions represent the overall average of the mean value by jurisdiction. distribution of azithromycin MICs
Results are based on data obtained from patients with known sexual behavior (n=75,347) among GISP isolates collected during

attending SSuN STD clinics in 2016 in all SSuN jurisdictions, excluding Florida.

20122016. Most isolates had MICs
MSW = Men who have sex with women only. of 0.1250.5 g/ml. During 2012
NOTE: See section A2.2 in the Appendix for SSuN methods. 2014, the percentage of isolates with
elevated azithromycin MICs (MICs
2 g/ml) ranged from 0.02% to 1.0%;
during 20142016, the percentage
Figure 25. Location of Participating Sentinel Sites and Regional increased from 2.4% to 3.6%.
Laboratories, Gonococcal Isolate Surveillance Project (GISP), United
States, 2016
Susceptibility to Other
Antimicrobials
Seattle
In 2016, 44.1% of isolates collected
Portland
from GISP sites were resistant to
Minneapolis Buffalo
Boston penicillin, tetracycline, ciprofloxacin,
Pontiac
New York City
or some combination of those
Chicago Cleveland Philadelphia antimicrobials (Figure 28). Although
San Francisco
Kansas City Indianapolis Columbus these antimicrobials are no longer
Las Vegas recommended for treatment of
Los Angeles Greensboro gonorrhea, the resistance phenotypes
Orange Co. Albuquerque Birmingham remain common. Conversely, 55.9%
of isolates were susceptible to all
San Diego Phoenix Atlanta
Sentinel Sites
Austin
Dallas
New Orleans Sites and
three of these antimicrobials.
Regional Labs
Tripler AMC
Honolulu Antimicrobial Treatments
Given for Gonorrhea
NOTE: Austin is a regional laboratory only.
The antimicrobial agents given
to GISP patients for gonorrhea
therapy are shown in Figure 29. The
Ceftriaxone Susceptibility In 2016, 0.3% of isolates had elevated
proportion of patients treated with
ceftriaxone MICs. Five isolates with
Susceptibility testing for ceftriaxone ceftriaxone 250 mg increased from
decreased ceftriaxone susceptibility
began in 1987. During 20062016, 84.0% in 2011 to 96.9% in 2016. In
(MIC = 0.5 g/ml) have been
the percentage of GISP isolates that 2016, 1.5% of patients were treated
previously identified in GISP: one
exhibited elevated ceftriaxone MICs, with gentamicin 240 mg and 0.1%
from San Diego, California (1987),
defined as 0.125 g/ml, fluctuated were treated with cefixime 400mg.
two from Cincinnati, Ohio (1992
between 0.05% and 0.4% (Figure 26).
17
This increase was largely attributable
Figure 26. Neisseria gonorrhoeae Percentage of Isolates with to increases among men. High
Elevated Ceftriaxone Minimum Inhibitory Concentrations (MICs) gonorrhea rates persist in certain
(0.125 g/ml) and Elevated Cefixime MICs (0.25 g/ml), Gonococcal geographic areas, among adolescents
Isolate Surveillance Project (GISP), 20062016 and young adults, and in some racial/
Percentage
ethnic groups.
Elevated Cefixime MICs
1.5
Elevated Ceftriaxone MICs
GISP continues to monitor for the
emergence of decreased susceptibility
1.2 and resistance to cephalosporins and
azithromycin.
0.9
0.6
0.3
0.0
2006 2007* 2008* 2009 2010 2011 2012 2013 2014 2015 2016
Year
* Isolates not tested for cefixime susceptibility in 2007 and 2008.
Figure 27. Neisseria gonorrhoeae Distribution of Azithromycin

Minimum Inhibitory Concentrations (MICs) by Year, Gonococcal
Isolate Surveillance Project (GISP), 20122016
Percentage
50 Year
2012
2013
40
2014
2015
30 2016
20
10
0
<=0.03 0.06 0.125 0.25 0.5 1 2 4 8 >=16
MICs (g/ml)
Gonorrhea Among Special Gonorrhea Summary

Populations The national rate of reported
More information about gonorrhea gonorrhea cases reached a historic
in race/ethnicity groups, females of low in 2009, but increased each year
reproductive age, adolescents, and during 20092012. After a temporary
MSM can be found in the Special decrease in 2013, the gonorrhea rate
Focus Profiles. increased again during 20142016.
18
References
Figure 28. Neisseria gonorrhoeae Distribution of Isolates with
Penicillin, Tetracycline, and/or Ciprofloxacin Resistance, Gonococcal epidemiological synergy to public health policy
Isolate Surveillance Project (GISP), 2016 and practice: the contribution of other sexually
Susceptible
4.3% PenR HIV infection. Sex Transm Infect 1999; 75(1):
11.4% 317.
TetR
QRNG 2. Hogben M, Leichliter JS. Social determinants
PenR/TetR and sexually transmitted disease disparities. Sex
PenR/QRNG
Transm Dis 2008; 35(12 Suppl): S1318.
10.7% TetR/QRNG
PenR/TetR/QRNG 3. Centers for Disease Control and Prevention.
1.5% 64(No. RR-3): 1137.
4. Satterwhite CL, Torrone E, Meites E, et
6.5% al. Sexually transmitted infections among
US women and men: prevalence and
incidence estimates, 2008. Sex Transm
Dis 2013; 40(3): 187193. DOI: 10.1097/
4.1% OLQ.0b013e318286bb53. Review.
55.9%
5.5% Update to CDCs sexually transmitted diseases
treatment guidelines, 2006: fluoroquinolones
no longer recommended for treatment of
gonococcal infections. MMWR Morb Mortal
NOTE: PenR = penicillinase-producing Neisseria gonorrhoeae and chromosomally-mediated
Wkly Rep 2007; 56(14): 332336.
penicillin-resistant N. gonorrhoeae; TetR = chromosomally- and plasmid-mediated tetracycline-
resistant N. gonorrhoeae; and QRNG = quinolone-resistant N. gonorrhoeae. 6. Centers for Disease Control and Prevention.
59(No.RR-12): 1110.
Figure 29. Distribution of Primary Antimicrobial Drugs Used to Treat 7. Schwarcz S, Zenilman J, Schnell D, et al.
Gonorrhea Among Participants, Gonococcal Isolate Surveillance National surveillance of antimicrobial resistance
in Neisseria gonorrhoeae. JAMA 1990;
Project (GISP), 19882016 264(11): 14131417.
Percentage
100 Tetracyclines Other
Penicillins Gentamicin
Ofloxacin
80 Ciprofloxacin
60
Cefixime
40 Ceftriaxone 250 mg
20 Spectinomycin
Ceftriaxone 125 mg
Other Cephalosporins
0
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Year
NOTE: For 2016, Other includes azithromycin 2g (0.7%), no therapy (0.1%), and other less
frequently used drugs (0.8%).
19
20
Syphilis
Background and29). Nationally, P&S syphilis (Figure30, Table 1). This rate
rates increased in every age group represents a 17.6% increase compared
Syphilis, a genital ulcerative
among those aged 15 years or older with 2015 (7.4 cases per 100,000
disease caused by the bacterium
and in every race/ethnicity group population), and a 74.0% increase
Treponema pallidum, is associated
during 20152016 (Figures 39 and compared with 2012 (5.0 cases per
with significant complications if
40, Table34). 100,000 population).
left untreated and can facilitate the
transmission and acquisition of HIV
As in recent years, MSM accounted P&S Syphilis by Region
infection.13 Additionally, historical
for the majority of reported P&S
data demonstrate that untreated In 2016, the West had the highest
syphilis cases in 2016 (Figures 35 and
early syphilis in pregnant women, if rate of reported P&S syphilis cases
36). Nationally, the highest rates of
acquired during the four years before (11.4 cases per 100,000 population),
P&S syphilis in 2016 were observed
delivery, can lead to infection of the followed by the South (8.9 cases per
among men aged 2034 years, among
fetus in up to 80% of cases and may 100,000 population), the Northeast
men in the West, and among Black
result in stillbirth or death of the (8.0 cases per 100,000 population),
men (Figure 37, Tables 29, 34 and
infant in up to 40% of cases.4 and the Midwest (5.7 cases per
35B).
100,000 population) (Table 27).
In 2000 and 2001, the national rate During 20152016, the P&S syphilis
of reported primary and secondary Interpreting Rates of rate increased in every region:
(P&S) syphilis cases was 2.1 cases Reported Cases of Syphilis 21.3% in the Midwest, 21.2% in
per 100,000 population, the lowest the Northeast, 20.0% in the West,
Left untreated, infection with syphilis
rate since reporting began in 1941 and 11.3% in the South (Figure 31,
can span decades. P&S syphilis
(Figure 30, Table 1). However, the Table27).
are the earliest stages of infection,
P&S syphilis rate has increased
reflect symptomatic disease, and
almost every year since 20002001.
are indicators of incident infection.5 P&S Syphilis by State
In 2016, a total of 27,814 P&S
For these reasons, trend analyses
syphilis cases were reported. During In 2016, rates of reported P&S
of syphilis focus on reported cases
20152016, the national P&S syphilis syphilis cases per 100,000 population
and rates of reported cases of P&S
rate increased 17.6% to 8.7 cases per ranged by state from 1.1 in Alaska
syphilis. When referring to P&S
100,000 population, the highest rate to 16.1 in Louisiana (Figure 32,
syphilis, case counts are the sum of
reported since 1993. Table26). The rate of reported P&S
both primary and secondary cases,
and rate of P&S syphilis refers to syphilis cases in the District of
During 20002016, the rise in the Columbia was 24.0 cases per 100,000
this sum per unit population.
rate of reported P&S syphilis was population. During 20152016, P&S
primarily attributable to increased syphilis rates increased in 82.0%
Changes in reporting and
cases among men and, specifically, (41/50) of states and the District of
screening practices can complicate
among gay, bisexual, and other men Columbia, and remained stable or
interpretation of trends over time.
who have sex with men (collectively decreased in 18.0% (9/50) of states
To minimize the effect of changes in
referred to as MSM) (Figures 34 and (Table 27).
reporting over time, trend data in this
35). However, during 20132016,
report are restricted to jurisdictions
the rate increased both among men
that consistently report data of interest P&S Syphilis by Metropolitan
and women (Tables 28 and 29).
(e.g., sex of sex partner) for each year Statistical Area
During 20152016, the rate increased
of a given time period. Details of
14.7% among men and 35.7% among The overall rate of reported P&S
these restrictions are provided in the
women. These increases among syphilis cases in the 50 most populous
text and footnotes of the pertinent text
women are of particular concern metropolitan statistical areas
and figures.
because congenital syphilis cases tend (MSAs) was 11.2 cases per 100,000
to increase as the rate of P&S syphilis population in 2016, which represents
among women increases (Figure 44). P&S Syphilis United States a 14.3% increase since 2015 (9.8
During 20152016, the national, In 2016, a total of 27,814 cases of cases per 100,000 population)
male, and female P&S syphilis rates P&S syphilis were reported in the (Table30). Overall, in 2016, 71.3%
increased in every region of the United States, yielding a rate of of reported P&S syphilis cases
country (Figure 31, Tables 27, 28, 8.7 cases per 100,000 population (73.5% of male cases and 53.0% of
21
syphilis has increased every year
Figure 30. Syphilis Rates of Reported Cases by Stage of Infection, since 2000, and during 20152016,
United States, 19412016 the rate among men increased 14.7%
(Figure 34, Table 29). In contrast,
the P&S syphilis rate among women
400 Primary and Secondary fluctuated between 0.8 and 1.7 cases
Early Latent per 100,000 females during 2000
Total Syphilis
300 2012, but has increased substantially
since 2012 (Figure 34, Table 28).
200 During 20122016, the P&S syphilis
rate among women more than
100 doubled (increased 111.1%). During
20152016, the P&S syphilis rate
0 among women increased 35.7%.
1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011 2016
Year
These increases in male and female
P&S syphilis rates were observed in
NOTE: Data collection for syphilis began in 1941; however, syphilis became nationally notifiable
in 1944. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for more
every region of the country during
information: https://wwwn.cdc.gov/nndss/conditions/syphilis/. 20152016. Among men, the rate
increased 20.5% in the Northeast,
19.8% in the Midwest, 16.1% in the
West, and 9.7% in the South (Table
Figure 31. Primary and Secondary Syphilis Rates of Reported
29). Among women, the largest
Cases by Region, United States, 20072016
increases were observed in the West
Rate (per 100,000 population) (58.8%), followed by the Northeast
14 (28.6%), the South (22.2%) and the
West
Midwest
Midwest (20.0%) (Table 28).
12
Northeast
10 South MSM continued to account for the
8 majority of P&S syphilis cases in
6 2016 (Figures 35 and 36). Of 27,814
4 reported P&S syphilis cases in 2016,
2
16,155 (58.1%) were among MSM,
including 14,553 (52.3%) cases
0
among men who had sex with men
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 only and 1,602 (5.8%) cases among
Year men who had sex with both men
and women (Figure 36). Overall,
female cases) were reported by these rate from 0.2 to 3.3 cases per 100,000 3,880 (13.9%) cases were among
50 MSAs. In 2016, the rate among population, and 1,699 (54.1%) men who had sex with women only
women in these MSAs was 1.8 counties reported no cases of P&S (MSW), 3,049 (11.0%) were among
cases per 100,000 females, while the syphilis in 2016 (Figure 33). women, 4,689 (16.9%) were among
rate among men was 21.0 cases per men without information about sex
100,000 males (Tables 31 and 32). of sex partner, and 41 (0.1%) were
P&S Syphilis by Sex and cases reported with unknown sex.
Sexual Behavior Among the 20,035 male cases with
P&S Syphilis by County information on sex of sex partner,
As has been observed in previous
In 2016, 64.2% of reported P&S years, in 2016 the rate of reported 80.6% occurred among MSM.
syphilis cases occurred in 70 counties P&S syphilis cases among men
or independent cities (Table 33). Of (15.6cases per 100,000 males) was A total of 36 states were able to
3,140 counties in the United States, much higher than the rate among classify at least 70.0% of reported
484 (15.4%) had a P&S syphilis rate women (1.9 cases per 100,000 P&S syphilis cases as MSM, MSW,
greater than 6.7 cases per 100,000 females), and men accounted for or women each year during 2012
population, 480 (15.3%) reported a a large majority (88.9%) of P&S 2016 (Figure 35). In these states,
rate from 3.4 to 6.7 cases per 100,000 syphilis cases (Figure36, Tables 28 during 20152016, the number of
population, 477 (15.2%) reported a and 29). Among men, the rate of P&S cases increased 16.4% among MSM,
22
During 20152016, the overall rate of
Figure 32. Primary and Secondary Syphilis Rates of Reported reported P&S syphilis cases increased
Cases by State, United States and Outlying Areas, 2016 in all age groups among those aged
15 years or older (Table 34). Rates
7.9 increased 13.0% among those aged
1519 years, 8.1% among those aged
1.4 3.2
4.4
8.1
3.0 3.0
5.6
2.3 12.4
VT 3.7 2024 years, 19.6% among those
NH 3.0
1.2
2.8
3.7
MA 7.2 aged 2529 years, 20.1% among
those aged 3034 years, 22.1%
3.5 5.9
15.4 6.2 RI 8.5
3.1 9.8 4.9
15.0 4.6
4.3 6.6 4.9
2.9 5.5
CT
NJ
3.1
5.3
among those aged 3539 years,
Guam 1.2
5.9 10.8 DE 6.1 12.8% among those aged 4044
10.6
9.1
6.7
5.0 6.5 MD 8.5 years, 13.6% among those aged
DC 24.0
10.9 7.7 13.2 4554 years, 25.0% among those
7.1
16.1
Rate per 100,000
aged 5564 years, and 50.0% among
1.1
7.8 11.9 population those aged 65 or older.
<= 3.0 (n= 11)
3.1 - 4.9 (n= 11)
Puerto Rico 14.2 5.0 - 6.7 (n= 11) In 2016, persons aged 1544 years
6.8 - 10.6
>=10.7
(n= 11)
(n= 10)
accounted for 79.6% of reported
Virgin Islands 0.0
P&S syphilis cases with known age.
NOTE: The total rate of reported cases of primary and secondary syphilis for the United States and
Among both men and women, the
outlying areas (Guam, Puerto Rico, and Virgin Islands) was 8.7 per 100,000 population. P&S syphilis rate increased during
20152016 in all age groups among
those aged 1544 years (Figures 38
Figure 33. Primary and Secondary Syphilis Rates of Reported and 39, Table 34).
Cases by County, United States, 2016
P&S Syphilis by
Race/Ethnicity
In 2016, all 50 states and the
District of Columbia submitted
data in the race and ethnicity
categories according to the Office
of Management and Budget (OMB)
standards (see Section A1.5 in the
Appendix). Among these, the rate
of reported P&S syphilis cases was
Rate per 100,000 highest among Blacks (23.1 cases
population per 100,000 population) (Table 35B).
0* (n= 1,699)
The P&S syphilis rate among Blacks
>0-3.3 (n= 477)
was 4.7 times the rate among Whites
3.4-6.7 (n= 480)
>6.7 (n= 484)
(4.9 cases per 100,000 population),
the rate among Native Hawaiians/
* In 2016, 1,699 (54.1%) of 3,140 counties in the United States reported no cases of primary and Other Pacific Islanders (12.9 cases
secondary syphilis. Refer to the NCHHSTP Atlas for further county-level rate information: https:// per 100,000 population) was 2.6
www.cdc.gov/nchhstp/atlas/. times the rate among Whites, the
rate among Hispanics (10.9 cases per
were observed among men aged 100,000 population) was 2.2 times the
22.2% among MSW, and 31.0% rate among Whites, the rate among
among women. 2529 years (48.5 cases per 100,000
males), 2024 years (37.9 cases per American Indians/Alaska Natives (8.0
100,000 males), and 3034 years cases per 100,000 population) was
P&S Syphilis by Age (35.0 cases per 100,000 males). 1.6 times the rate among Whites, and
As in previous years, in 2016, rates The highest rates among women the rate among Asians (3.9 cases per
of reported P&S syphilis cases were were among those aged 2024 years 100,000 population) was 0.8 times the
highest among persons aged 2529 (6.7cases per 100,000 females) and rate among Whites.
years and 2024 years (Figure 37, those aged 2529 years (5.6 cases per
Table 34). In 2016, the highest rates 100,000 females).
23
During 20122016, among the
Figure 34. Primary and Secondary Syphilis Rates of Reported 46 states that submitted race and
Cases by Sex and Male-to-Female Rate Ratios, United States, 1990 ethnicity data according to OMB
2016 standards (see Section A1.5 in the
Rate (per 100,000 population) Rate Ratio (log scale) Appendix) for all five years during
25 Male Rate 16:1 that period, the P&S syphilis rate
Female Rate increased among all race/ethnicity
20 Total Rate
8:1 groups (Figure 40). Among these 46
Male-to-Female Rate Ratio
states, the greatest increases during
15
4:1 20152016 were observed among
10 those who identified as Multiracial
2:1
(34.3%) and Asians (30.0%),
5 followed by Native Hawaiians/Other
0 1:1
Pacific Islanders (26.4%), Hispanics
(24.4%), Whites (17.1%), and Blacks
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
(7.9%).
Year
More information on P&S syphilis
rates among racial/ethnic groups
Figure 35. Primary and Secondary Syphilis Reported Cases by can be found in the Special Focus
Sex and Sexual Behavior, 36 States*, 20122016 Profiles.
Cases
14,000 P&S Syphilis and HIV
12,000 Co-infection
10,000 Reported cases of P&S syphilis
MSM continue to be characterized by a high
8,000
MSW rate of HIV co-infection, particularly
6,000 Women among MSM (Figure 41). Among
4,000 2016 P&S syphilis cases with known
HIV-status, 47.0% of cases among
2,000
MSM were HIV-positive, compared
0 with 10.7% of cases among MSW,
2012 2013 2014 2015 2016 and 4.1% of cases among women.
Year
* 36 states were able to classify 70% of reported cases of primary and secondary syphilis as either P&S Syphilis by
MSM, MSW, or women for each year during 20122016. Reporting Source

MSW = Men who have sex with women only. In 2016, 18.4% of P&S syphilis cases
were reported from STD clinics,
72.1% were reported from venues
Figure 36. Primary and Secondary Syphilis Distribution of Cases outside of STD clinics, and 9.5%
by Sex and Sexual Behavior, United States, 2016 of cases had an unknown source of
14% report (Table A2). During 20152016,
6% Men who have sex with men only the number of P&S syphilis cases
(n = 14553)
reported by STD clinics and by
Men who have sex with men and women
(n = 1602) non-STD clinic settings increased
Men who have sex with women only (Figure 42). However, the proportion
17% (n = 3880) of P&S syphilis cases that were
Men without data on sex of sex partners
(n = 4689)
reported by STD clinics has declined
Women (n = 3049)
over the last decade from 30.3% of
Cases with unknown sex (n = 41)
cases in 2007 to 18.4% of cases in
2016. In 2016, private physicians/
11%
52% health maintenance organizations
0%
(HMOs) and STD clinics were the
most common reporting sources
24
100.0% in the Northeast, 29.9% in
Figure 37. Primary and Secondary Syphilis Rates of Reported the South, and 23.5% in the Midwest
Cases by Age Group and Sex, United States, 2016 (Table 41). During 20152016, the
Men Rate (per 100,000 population) Women
congenital syphilis rate increased
42.1% in the Northeast, 41.4% in the
50 40 30 20 10 0 Age Group 0 10 20 30 40 50 West, and 23.6% in the South, and
0.1 10-14 0.1 did not change in the Midwest. In
8.9 15-19 3.3 2016, the highest congenital syphilis
37.9 20-24 6.7 rates were reported from the West
48.5 25-29 5.6 (25.6 cases per 100,000 live births),
35.0 30-34 4.3 followed by the South (17.8 cases per
26.8 35-39 3.0 100,000 live births), Midwest (8.4
19.4 40-44 1.9 cases per 100,000 live births), and
17.3 45-54 1.2 the Northeast (5.4 cases per 100,000
6.8 55-64 0.4 live births). In addition, rates were
1.3 65+ 0.0
highest among Blacks (43.1 cases
15.6 Total 1.9
per 100,000 live births), followed by
American Indians/Alaska Natives
(31.6 cases per 100,000 live births),
Figure 38. Primary and Secondary Syphilis Rates of Reported Hispanics (20.5 cases per 100,000
Cases Among Women Aged 1544 Years by Age Group, United live births), Asians/Pacific Islanders
States, 20072016 (9.2 cases per 100,000 live births),
and Whites (5.3 cases per 100,000
Rate (per 100,000 population) live births) (Table 42).
10 Age Group
15-19 30-34
8 20-24 35-39 Syphilis All Stages (P&S,
25-29 40-44 Early Latent, Late, Late
6 Latent, and Congenital)
4 In 2016, the total case count
of reported syphilis (all stages
2 combined: P&S, early latent, late,
late latent, and congenital) was the
0
highest recorded since 1993. The
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 total number of cases of syphilis (all
Year stages) reported to CDC increased
17.8% during 20152016 (from
74,707 cases to 88,042 cases)
among MSM (29.5% and 23.6%, rate was 15.7 cases per 100,000 live (Table1). The number of cases of
respectively), MSW (21.4% and births. This rate represents a 27.6% early latent syphilis reported to CDC
21.6%, respectively), and women increase relative to 2015 (12.3 cases increased 19.7% (from 24,173 cases
(24.6% and 15.3%, respectively) per 100,000 live births) and a 86.9% to 28,924 cases), and the number of
(Figure 43). increase relative to 2012 (8.4 cases cases of late and late latent syphilis
per 100,000 live births). As has been increased 17.2% (from 26,170 cases
observed historically, these increases to 30,676 cases) (Tables 1, 36,
Congenital Syphilis
paralleled increases in P&S syphilis and38).
After decreasing from 10.5 to 8.4 among women during 20152016
reported congenital syphilis cases (35.7%) and during 20122016
per 100,000 live births during Syphilis among
(111.1%) (Figure 44, Table 28).
20082012, the rate of reported Special Populations
congenital syphilis has subsequently During 20122016, the increase in More information about syphilis and
increased each year during 2012 reported congenital syphilis cases congenital syphilis in racial/ethnic
2016 (Table1). In 2016, there were was primarily attributable to an groups, women of reproductive age,
a total of 628 reported cases of increase in the West. During this adolescents, and MSM can be found
congenital syphilis, including 41 time period, the congenital syphilis in the Special Focus Profiles.
syphilitic stillbirths, and the national rate increased 365.5% in the West,
25
Syphilis Summary
Figure 39. Primary and Secondary Syphilis Rates of Reported
Cases Among Men Aged 1544 Years by Age Group, United States, The national rate of reported P&S
20072016 syphilis cases reached an historic low
in 2000 and 2001, but has increased
Rate (per 100,000 population) almost every year since then. This
50
Age Group increase was largely attributable
15-19 30-34 to an increase among men, and in
40 20-24 35-39
25-29 40-44 particular among MSM. However,
30 during 20152016, rates increased
among both men and women in
20 every region of the country. Rates
of reported congenital syphilis cases
10 also increased during 20152016.
0
MSM continued to account for the
majority of reported P&S syphilis
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
cases in 2016. Nationally, the highest
Year
rates of P&S syphilis in 2016 were
observed among men aged 2034
years, among men in the West, and
Figure 40. Primary and Secondary Syphilis Rates of Reported among Black men.
Cases by Race/Ethnicity, United States, 20122016

25 AI/AN* NHOPI*
Asians Whites
Blacks Multirace
20 Hispanics
15
10
0
2012 2013 2014 2015 2016
Year
compliant formats during 20122016 (see Section A1.5 in the Appendix).
26
References
Figure 41. Primary and Secondary Syphilis Reported Cases by
1. Jarzebowski W, Caumes E, Dupin N, et al.
Sex, Sexual Behavior, and HIV Status, United States, 2016 Effect of early syphilis infection on plasma
viral load and CD4 cell count in human
Cases immunodeficiency virus- infected men: results
8000 from the FHDH- ANRS CO4 cohort. Arch
Intern Med 2012; 172(16): 12371243.
HIV-
HIV+ 2. Buchacz K, Patel P, Taylor M, et al. Syphilis
6000 Unknown HIV Status increases HIV viral load and decreases CD4
cell counts in HIV-infected patients with
new syphilis infections. AIDS 2004; 18(15):
4000 20752079.
epidemiological synergy to public health policy
2000 and practice: the contribution of other sexually
HIV infection. Sex Trans Infect 1999; 75(1):
0 317.
MSW* Women MSM* 4. Ingraham NR. The value of penicillin alone

in the prevention and treatment of congenital
* MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); syphilis. Acta Derm Venereol 1951; 31(Suppl
MSW = Men who have sex with women only. 24): 6088.
5. Peterman TA, Kahn RH, Ciesielski CA, et
al. Misclassification of the stages of syphilis:
implications for surveillance. Sex Transm Dis
Figure 42. Primary and Secondary Syphilis Reported Cases by 2005; 32(3):144149.
Reporting Source and Sex, United States, 20072016
Cases (in thousands)

20
Non-STD Clinic, Men
Non-STD Clinic, Women
15 STD Clinic, Men
STD Clinic, Women
10
0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
27
Figure 43. Primary and Secondary Syphilis Percentage of
Reported Cases* by Sex, Sexual Behavior, and Selected Reporting
Sources, United States, 2016
Percentage
40
Correctional Facility
HIV Counseling and Testing Site
Private Physician/HMO
30
STD Clinic
20
10
0
MSW Women MSM
* Of all primary and secondary cases, 9.5% had a missing or unknown reporting source. Among all
cases with a known reporting source, the reporting source categories presented represent 57.6%
of cases; 42.4% were reported from sources other than those shown.

HMO = health maintenance organization; MSM = Gay, bisexual, and other men who have sex with
men (collectively referred to as MSM); MSW = Men who have sex with women only.
Figure 44. Congenital Syphilis Reported Cases by Year of Birth

and Rates of Reported Cases of Primary and Secondary Syphilis
Among Women, United States, 20072016
CS* Cases P&S* Rate (per 100,000 women)

800 4
CS Cases
P&S Rate
600 3
400 2
200 1
0 0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
* CS = Congenital syphilis; P&S = Primary and secondary syphilis.
Year
28
Other Sexually Transmitted Diseases
Chancroid Figure 45. Chancroid Reported Cases by Year, United States,
Chancroid is caused by infection with 19412016
the bacterium Haemophilus ducreyi.
Clinical manifestations include genital Cases
ulcers and inguinal lymphadenopathy 10,000
or buboes.1 Reported cases of
chancroid declined steadily between 7,500
1987 and 2001 (Figure 45, Table 1).
Since then, the number of reported 5,000
cases has fluctuated somewhat, while
still appearing to decline overall. In
2,500
2016, a total of 7 cases of chancroid
were reported in the United States.
Six states reported one or more cases 0
of chancroid in 2016 (Table 43). 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011 2016
Year
Although the overall decline in
NOTE: Data collection for chancroid began in 1941; however, chancroid became nationally
reported chancroid cases most likely
notifiable in 1944. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for
reflects a decline in the incidence more information: https://wwwn.cdc.gov/nndss/conditions/chancroid/.
of this disease, these data should
be interpreted with caution because
Haemophilus ducreyi is difficult to States in mid-2006 for females13 and In 2015, a national survey found that
culture; as a result, this condition may in late 2009 for males.14 Although 63% of girls aged 1317 years had
be substantially underdiagnosed.2,3 a bivalent vaccine was also licensed received at least 1 dose of the HPV
for females,15 almost all HPV vaccine vaccine, and 42% had received all
Human Papillomavirus administered in the United States recommended doses in the series.20
Human papillomavirus (HPV) is the through late 2014 was quadrivalent.16 HPV vaccine uptake is lower among
most common sexually transmitted A 9-valent vaccine, which protects boys; 50% of those aged 1317 years
infection in the United States.4 Over against the quadrivalent and 5 received at least 1 dose, but only 28%
40 distinct HPV types can infect additional oncogenic HPV types received all recommended doses.20
the genital tract;5 although most (types 31, 33, 45, 52, and 58), was
infections are asymptomatic and licensed in late 2014 for males and HPV infection is not a nationally
appear to resolve spontaneously females.17 All HPV vaccines have reportable condition. Cervicovaginal
within a few years,6 prevalence of been recommended for routine use prevalence of quadrivalent HPV
genital infection with any HPV type in United States females aged 1112 vaccine types 6, 11, 16, and/or 18 was
was 42.5% among United States years, with catch-up vaccination estimated using data for females aged
adults aged 1859 years during through age 26.13,17 Since late 2011, 1434 years from the National Health
20132014.7 Persistent infection with routine use of the quadrivalent and Nutrition Examination Survey
some HPV types can cause cancer or 9-valent vaccine has been (NHANES; see Section A2.4 in the
and genital warts. HPV types 16 and recommended for males aged 1112, Appendix). Prevalence decreased
18 account for approximately 66% of with catch-up vaccination through significantly from the pre-vaccine
cervical cancers in the United States,8 age 21.18 Vaccination through era (20032006) to the early post-
and approximately 25% of low-grade age 26 is recommended for gay, vaccine era (20092012) in specimens
and 50% of high-grade cervical bisexual, and other men who have from females aged 1419 and 2024
intraepithelial lesions, or dysplasia.9,10 sex with men (collectively referred years, the age groups most likely
HPV types 6 and 11 are responsible to as MSM)18 and persons who are to benefit from HPV vaccination
for approximately 90% of genital immunocompromised (including (Figure46).21 Among those aged
warts.11,12 those infected with HIV).17 2534 years, vaccine-type HPV
prevalence did not differ significantly
Quadrivalent HPV vaccine targets HPV vaccine uptake in the United between the two time periods, and
HPV types 6, 11, 16, and 18.11 This States remains lower than the Healthy no differences were observed in the
vaccine was licensed in the United People 2020 goal of 80% coverage.19 prevalence of non-quadrivalent HPV
29
of population effectiveness of HPV
Figure 46. Human Papillomavirus Cervicovaginal Prevalence of vaccination on clinical sequelae of
Types 6, 11, 16 and 18 Among Females Aged 1434 Years by Age infection among young, privately-
Group and Time Period, National Health and Nutrition Examination insured US women.
Survey (NHANES), 20032006 and 20092012
Prevalence, % Prevalence of genital warts also has
30
Time Period been examined using health-care
2003-2006 claims records (Figures 48A and
2009-2012
25 48B).24 Prevalence among females
20 aged 1519 years was stable during
20032007, but then significantly
15
declined from 2.9 per 1000 person-
10 years in 2006 to 1.8 in 2010. Among
5
females aged 2024 years, genital
wart prevalence significantly
0 increased during 20032007, then was
14-19 20-24 25-29 30-34 essentially unchanged at 5.4 to 5.5 per
Age Group 1000 person-years during 20072009;
NOTE: Error bars indicate 95% confidence interval. although prevalence among women in
SOURCE: Markowitz LE, Liu G, Hariri S, et al. Prevalence of HPV After Introduction of the Vaccination this age group appeared to decrease in
Program in the United States. Pediatrics 2016; 137(3):e20151968. 2010, more years of data are needed
to determine whether this observation
represents a valid inflection in trend.
vaccine types by time period for any interpret this observation. LSIL Prevalence in women aged 2539
age group. An NHANES analysis prevalence in women aged 2024 years significantly increased from 2.5
of 20132014 HPV prevalence years increased during 20072012 per 1000 person-years in 2003 to 3.7
from penile swab specimens found (annual percent change = 3.0%, in 2010, but a potential inflection in
low prevalence of quadrivalent P=0.002), then declined significantly trend was also observed in this age
HPV vaccine types in young males, during 20122014 (annual percent group during 20092010; as with
which the authors attributed to male change = -8.2%, P=0.005). Prevalence women aged 2024, additional years
vaccination and/or herd protection of LSIL increased significantly during of data are needed to appropriately
from female vaccination.22 20072014 for women aged 2539 assess this potential change in trend.
years. In contrast to LSIL, prevalence Genital wart prevalence significantly
Health-care claims data from 9 of HSIL and CIN2+ decreased increased in males aged 1539 years
million females aged 1539 years significantly in females aged 1519 during 20032010, although for
in the United States with employer- and 2024 years during 20072014 men aged 2024 years a potential
provided private health insurance (Figures 47B and 47C). Among those inflection in trend was observed
were used to estimate annual aged 1519 years, annual percent during 20092010.
prevalence of cytologically-detected change in HSIL prevalence during
cervical low-grade and high-grade 20072014 was -8.3% (P<0.001),
squamous intraepithelial lesions while change in CIN2+ prevalence Pelvic Inflammatory Disease
(LSIL and HSIL, respectively) and was -19.8% (P=0.004) during For information on pelvic
high-grade histologically-detected 20072009 and -12.1% (P=0.002) inflammatory disease, see Special
cervical intraepithelial neoplasia during 20092014. For women aged Focus Profiles, STDs in Women and
grades 2 and 3 (CIN2+) during 2024 years, annual percent change Infants.
20072014.23 Analyses were restricted in HSIL was -5.3% (P<0.001) during
to females who received cervical 20072014; annual percent change
cancer screening in a given calendar in CIN2+ was -6.7% (P=0.001)
Herpes Simplex Virus
year. Among females aged 1519 during 20072012 and -12.5% during Herpes simplex virus (HSV) is
years, LSIL prevalence over the entire 20122014 (P=0.020). No decreases among the most prevalent of
period increased (Figure 47A); annual in HSIL or CIN2+ prevalence were sexually transmitted infections.4,25
percent change during 20072014 observed in women aged 2539 Although most infections are
was 2.0% (P=0.041). Although years. Decreases in high-grade lesions subclinical,26 clinical manifestations
prevalence in those aged 1519 years among young women reflected their are characterized by recurrent, painful
appeared to decrease somewhat greater association with HPV types genital and/or anal lesions.27 Most
during 20132014, additional years 16 and 18, compared to low-grade genital HSV infections in the United
of data are needed to appropriately lesions, providing ecologic evidence States are caused by HSV type 2
30
(HSV-2), while HSV type 1 (HSV-1)
Figure 47. Cervical Low- and High-Grade Squamous Intraepithelial infections are typically orolabial and
Lesions and Intraepithelial Neoplasia Grades 2 and 3 Prevalence acquired during childhood.26,28
per 1000 Person-Years Among Female Enrollees in Private Health
Plans Aged 1539 Years, by Age Group and Year, 20072014 HSV infection is not a nationally
A. Low-Grade Squamous Intraepithelial Lesions (LSIL) reportable condition. Most persons
with genital HSV infection have not
Age Group received a diagnosis. The overall
Prevalence 15-19 25-29 percentage of HSV-2 seropositive
20-24 30-34
80 35-39 NHANES participants aged 1449
years who reported never being told
by a doctor or health care professional
60
that they had genital herpes did
not change significantly between
40 19881994 and 20072010, and
remained high (90.7% and 87.4%,
20 respectively).29
0 NHANES data on the gender- and

2007 2008 2009 2010 2011 2012 2013 2014
race/ethnicity-specific seroprevalence
of HSV-2 among those aged 1449
Year
years were compared across survey
B. High-Grade Squamous Intraepithelial Lesions (HSIL) years 19881994, 19992002, 2003
2006, and 20072010 (Figure49).
Prevalence Overall, HSV-2 seroprevalence
10 decreased between 19881994 and
20072010, from 21.2% to 15.5%.29
8 Among non-Hispanic White females,
HSV-2 seroprevalence significantly
6 decreased from 19.5% in 19881994
to 15.3% in 2007 2010; HSV-2
4 seroprevalence remained stable
among non-Hispanic Black females,
2
from 52.5% during 19881994 to
0 49.9% during 20072010. Similar
race/ethnicity differences were
2007 2008 2009 2010 2011 2012 2013 2014
observed for males. These data, along
Year with data from NHANES survey
C. Cervical Intraepithelial Neoplasia Grades 2 and 3 (CIN2+) years 19761980,30 indicate that non-
Hispanic Blacks had higher overall
Prevalence seroprevalence than non-Hispanic
24 Whites in each survey period.
18 NHANES data also show that among

adolescents aged 1419 years, HSV-
1 seroprevalence has significantly
12
decreased by almost 23%, from
39.0% during 19992004 to 30.1%
6 during 20052010, indicating
declining orolabial infection in this
0 age group.28 HSV-2 seroprevalence
2007 2008 2009 2010 2011 2012 2013 2014 in this age group was much
Year lower, less than 2% in both time
SOURCE: Flagg EW, Torrone EA, Weinstock H. Ecological Association of Human Papillomavirus periods.28 Other studies have found
Vaccination with Cervical Dysplasia Prevalence in the United States, 20072014. Am J Public Health that genital HSV-1 infections are
2016; 106(12):22112218. increasing among young adults.31,32
31
Trichomonas Vaginalis
Figure 48. Genital Warts Prevalence per 1000 Person-Years
Trichomonas vaginalis is a common
Among Enrollees in Private Health Plans Aged 1039 Years by Sex,
sexually transmitted protozoal
Age Group, and Year, 20032010
infection associated with adverse
A. Females health outcomes such as preterm
birth and symptomatic vaginitis.4,38,39
Prevalence
Age Group It is not a nationally reportable
10 10-14 25-29 condition, and trend data are limited
15-19 30-34
8 20-24 35-39 to estimates of initial physician office
visits for this condition from the
6 National Disease and Therapeutic
Index (NDTI; see Section A2.5 in
4 the Appendix) (Figure 50, Table 44).
Visits appear to be fairly stable since
2 the 1990s; the number of initial visits
0
for Trichomonas vaginalis infection
in 2015 was 139,000. The 2016 NDTI
2003 2004 2005 2006 2007 2008 2009 2010
data were not obtained in time to
Year include them in this report. NHANES
data from 20012004 indicated
B. Males an overall Trichomonas vaginalis
Prevalence infection prevalence of 3.1%, with the
10 highest prevalence of 13.3% observed
among non-Hispanic Blacks.39
8
0
2003 2004 2005 2006 2007 2008 2009 2010
Year
SOURCE: Flagg EW, Schwartz R, Weinstock H. Prevalence of Anogenital Warts Among Participants
in Private Health Plans in the United States, 20032010: Potential Impact of Human Papillomavirus
Vaccination. Am J Public Health 2013; 103(8):14281435.
This has been attributed, in part, infection during their child-bearing

to the decline in orolabial HSV-1 years,33,36 and first-episode primary
infections, because those who lack HSV infection during pregnancy
HSV-1 antibodies at sexual debut are increases the risk of neonatal HSV
more susceptible to genital HSV-1 transmission.33,37
infection;28,33 increasingly common
oral sex behavior among adolescents For information on neonatal HSV
and young adults also has been infections, see Special Focus Profiles,
suggested as a contributing factor.28,34 STDs in Women and Infants.
The absence of HSV-1 antibodies also
increases the likelihood of developing
symptomatic disease from newly-
acquired (i.e., primary) genital HSV-2
infection.35 Young women may
therefore be increasingly likely to first
acquire HSV-1 infection genitally,
or acquire a primary genital HSV-2
32
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Year 11. Garland SM, Steben M, Sings HL, et al. Natural
History of Genital Warts: Analysis of the
NOTE: The relative standard errors for Trichomonas vaginalis infection estimates range from 23% Placebo Arm of 2 Randomized Phase III Trials
to 17% and for other vaginal infection estimates range from 13% to 8%. See Section A2.5 in the of a Quadrivalent Human Papillomavirus (Types
Appendix and Table 44. 6, 11, 16, and 18) Vaccine. J Infect Dis 2009;
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13. Markowitz LE, Dunne EF, Saraiya M, et al.
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33
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Use in Males and Guidance from the Advisory Pediatrics 2016; 137(3):e20151968. Herpes Simplex Virus Type 1 and Type 2 in
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15. Centers for Disease Control and Prevention. 2017; 215(7):10701079. Proportion of Herpes Simplex Virus Type 1 as
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23. Flagg EW, Torrone EA, Weinstock
Papillomavirus Vaccine (HPV2, Cervarix) for Students. Sex Transm Dis 2003; 30(10):797
H. Ecological Association of Human
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24. Flagg EW, Schwartz R, Weinstock H. and Timing of Oral Sex with Opposite-sex
16. Stokley S, Jeyarajah J, Yankey D, et al. Human
Prevalence of Anogenital Warts Among Partners among Females and Males Aged 1524
Papillomavirus Vaccination Coverage Among
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Adolescents, 20072013, and Postlicensure
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Vaccine Safety Monitoring, 2006-2014
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25. Smith JS, Robinson NJ. Age-Specific 35. Langenberg AGM, Corey L, Ashley RL, et al.
17. Petrosky E, Bocchini Jr. JA, Hariri S, et
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28. Bradley H, Markowitz LE, Gibson T, et al.
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34
Special Focus Profiles
The Special Focus Profiles highlight trends and distribution of STDs in populations of particular interest to STD and
HIV prevention programs in state and local health departments: women and infants, adolescents and young adults, racial
and ethnic minority groups, and gay, bisexual, and other men who have sex with men (collectively referred to as MSM).
STDs in Women and Infants

Public Health Impact affecting her sexual and reproductive concern because it can result in
health, as well as the health of her inflammation and damage to the
Women and their infants are uniquely
unborn baby.6,7 A woman can also be fallopian tubes, elevating the risk
vulnerable to the consequences of
placed at risk for STIs through her of infertility and ectopic pregnancy.
sexually transmitted infections (STI).
partners sexual encounter with an Tubal factor infertility ranks among
While individual-level determinants,
infected partner. Consequently, even a the most common causes of infertility,
including high-risk behaviors,
woman who has only partner may be accounting for 30% of female
contribute to disease transmission and
obliged to practice safer sex, such as infertility in the United States,12 and
acquisition risk, it is widely accepted
using condoms.8 much of this damage results from
that social barriers to STD prevention
previous episodes of PID.13
and control efforts also contribute
Chlamydia and gonorrhea
to infectious disease prevalence. A
disproportionately affect women An important public health measure
womans relationship status with her
because early infection may be for preventing PID, and ultimately
male partner, such as the concurrency
asymptomatic and, if untreated, tubal factor infertility, is through
of the relationship, may be an
infection may ascend to the upper the prevention and control of C.
important predictor of her sexual
reproductive tract resulting in pelvic trachomatis and N. gonorrhoeae.
health.13 In addition to social factors
inflammatory disease (PID). Data Strategies to improve the early
such as poverty and lack of access to
from prospective studies suggest that detection and treatment of chlamydia
quality STD services, homelessness
about 15% of untreated chlamydial and gonorrhea, as demonstrated in
or unstable housing may influence
infections progress to clinically a number of randomized controlled
a womans sexual risk.4 For some
diagnosed PID and the risk with trials,14 has been shown to reduce a
women, maintaining the relationship
untreated gonococcal infection may womans risk for PID and ultimately
with a partner may take a higher
be even higher.911 PID is a major protect the fertility of women.
priority than STD risk reduction,5
35
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles
Human papillomavirus (HPV) Syphilis has long been known to Observations
infections are highly prevalent be an important risk factor for
in the United States, especially adverse pregnancy outcomes. The Pelvic Inflammatory Disease
among young sexually active adults. consequences of untreated maternal Accurate estimates of PID and tubal
Although most HPV infections infection include fetal death, preterm factor infertility resulting from
in women appear to be transient birth, and also congenital infection chlamydial and gonococcal infections
and may not result in clinically in a proportion of surviving infants are difficult to obtain, in part
significant sequelae, high-risk HPV- resulting in both physical and mental because definitive diagnoses of these
type infections can cause abnormal developmental disabilities. Most conditions can be complex. Published
changes in the uterine cervical cases of congenital syphilis are easily data suggest overall declining United
epithelium, which are detected preventable if women are screened States rates of women diagnosed with
by cytological examination of for syphilis and treated early during PID in both hospital and ambulatory
Papanicolaou (Pap) smears. Persistent prenatal care.17 settings.2123 The National Disease and
high-risk HPV-type infections may Therapeutic Index (NDTI; see Section
lead to cervical cancer precursors, Genital infections with herpes A2.5 in the Appendix) provides
which, if undetected can result in simplex virus (HSV) are extremely estimates of initial visits to office-
cancer. Other low-risk HPV-type common, can cause painful outbreaks, based, private physicians for PID.
infections can cause genital warts, and can have serious consequences NDTI estimated that from 20062015
low-grade Pap smear abnormalities, for pregnant women and their the number of initial visits to such
and, rarely, recurrent respiratory infants.18 Neonatal herpes can be physicians for PID among women
papillomatosis in infants born a severe illness presenting with aged 1544 years have decreased by
to infected mothers.15 For more pulmonary disease, seizures, fever, 35.8% from 106,000 to 68,000 visits
information on adolescent and adult and a high case fatality rate following (Figure A). The 2016 NDTI data were
HPV infections, see Other STDs. contact with infected cervical or not obtained in time to include them
vaginal secretions during delivery. in this report. Several factors may be
Impact on Maternal and Fetal Risk of transmission to the infant contributing to declining PID rates,
is greatest when the mother has a including increases in chlamydia and
Outcomes first-episode primary genital infection gonorrhea screening coverage, more
Similar to non-pregnant women, a during pregnancy, especially if she sensitive diagnostic technologies,
high proportion of pregnant women acquires infection towards the end of and availability of single-dose
with chlamydial and gonococcal her pregnancy.19,20 therapies that increase adherence to
infections are asymptomatic.
Documented sequelae of untreated
infections in pregnancy include Figure A. Pelvic Inflammatory Disease Initial Visits to Physicians
stillbirth, premature delivery, Offices Among Women Aged 1544 Years, United States, 20062015
premature rupture of the membranes,
and low birth weight. Maternal Visits (in thousands)
infection can also affect the infant, 200
leading to conjunctivitis infections
160
(termed ophthalmia neonatorum
in the first four weeks of life), 120
and, in the case of C. trachomatis,
pneumonia. Although topical 80
prophylaxis of infants at delivery is
effective for prevention of gonococcal 40
ophthalmia neonatorum, prevention 0
of neonatal pneumonia requires
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
prenatal detection and treatment. The
Year
clinical presentation of conjunctivitis
can be variable and these infections NOTE: The relative standard errors for these estimates are 16%23%. See section A2.5 in the
are especially important to treat Appendix and Table 44.
promptly, as they can lead to visual SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional Services,
IMS Health Report, 19662015. The 2016 data were not obtained in time to include them in this
impairment.16 report.
36
Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016
treatment.2224 While PID is declining
nationally, it still causes an enormous Figure B. Pelvic Inflammatory Disease Lifetime Prevalence*
amount of unnecessary and expensive Among Sexually Experienced Women Aged 1844 Years by Race/
morbidity. Ethnicity and Previous STI Diagnosis, National Health and Nutrition
Examination Survey (NHANES), 20132014
Differences in self-reported lifetime
diagnosis of PID by race/ethnicity Prevalence, %
in reproductive age women have 20
White, Non-Hispanic
been observed in earlier research.25 Black, Non-Hispanic
Data from the 20132014 cycle of 15
the National Health and Nutrition
Examination Survey (NHANES) 10
indicates that non-Hispanic Black
and non-Hispanic White women 5
reporting a previous STI diagnosis
had nearly equal self-reported lifetime
0
PID prevalence (10.0% vs. 10.3%).
However, the lifetime prevalence Yes No
of PID among non-Hispanic Black Previous STD Diagnosis
women was 2.2 times that among
* Prevalence estimates based on response to the question, Have you ever been treated for
non-Hispanic White women if no an infection in your fallopian tubes, uterus or ovaries, also called a pelvic infection, pelvic
previous STI was diagnosed (6.0% inflammatory disease, or PID?. Estimates were weighted to be nationally representative of the U.S.
vs. 2.7%) (Figure B). These findings population, accounting for unequal probabilities of selection and nonresponse.
suggest that PID is associated with
Based on a response of Yes to the question, Have you ever had vaginal, anal, or oral sex?.
previous STI diagnoses and it is STI = sexually transmitted infection. Participants who have been told by a doctor or other

healthcare professional in the last 12 months that they had chlamydia or gonorrhea or have ever
therefore important for physicians been told they have herpes, human papillomavirus, or genital warts.
to screen female patients for NOTE: Error bars indicate 95% confidence intervals. Prevalence estimates among non-Hispanic
chlamydia and gonorrhea to reduce Black women with a previous STI diagnosis have a relative standard error >40% but <50%.
the incidence of PID. The racial SOURCE: Kreisel, K, Torrone, E, Bernstein, K, et al. Prevalence of pelvic inflammatory disease in
disparities observed in PID diagnoses sexually experienced women of reproductive age United States, 20132014. MMWR Morb
Mortal Wkly Rep 2017; 66(3):8083.
are consistent with the marked racial
disparities observed for chlamydia
and gonorrhea. However, because administrative claims,26,27 are needed Chlamydia
of the subjective methods by which to evaluate trends and assess the
PID is diagnosed, racial disparity data Chlamydial infections in women
continued public health burden of
should be interpreted with caution. are usually asymptomatic and
this condition. Data from MarketScan
screening is necessary to identify
Commercial Claims and Encounters
Ectopic Pregnancy most infections. Routine chlamydia
Database, a large administrative
screening of sexually-active young
Ectopic pregnancy is a potentially claims database of United States
women has been recommended by the
life-threatening condition that requires commercial health plans, indicate that
CDC since 1993.28 Rates of reported
prompt evaluation and treatment. Up rates of ectopic pregnancy increased
cases of chlamydia among women
until the early 1990s, a primary data with age and that trends in the rate
increased steadily from the early
source used to estimate the incidence of ectopic pregnancy among women
1990s, likely reflecting expanded
of ectopic pregnancy was the with live births aged 1544 years
screening coverage and use of more
National Hospital Discharge Survey, during the period of 20042014 were
sensitive diagnostic tests (Figure1,
a sample of inpatient discharge relatively stable across all age groups.
Table 1). During 20112013,
records from select hospitals. However, a potential deflection in
chlamydia case rates decreased from
However, the ability to ascertain the trend is observed from 2014
643.4 to 619.0 cases per 100,000
the number of ectopic pregnancies 2015 across all 5-year age groups,
females and then increased 6.2% over
occurring in the United States has for which additional years of data
the next 3 years, resulting in a rate of
been affected by a shift in clinical are needed to appropriately assess
657.3 cases per 100,000 females in
management from an inpatient to an (FigureC). As in previous years, in
2016 (Table 4).
outpatient event, making national 2015, rates of ectopic pregnancy were
surveillance data sources unreliable. highest among women in the 3539
As a result, alternative surveillance and 4044 year age groups.
methods, including data from large
37
gonorrhea among women. Large-scale
Figure C. Ectopic Pregnancy Rates Among Commercially Insured screening programs for gonorrhea
Women with Live Births Aged 1544 Years by Age Group, 20042015 in women began in the 1970s. After
an initial increase in cases detected
Age Group
Rate (per 100,000 live births) through screening, rates of reported
15-19 30-34
3.0 20-24 35-39 gonorrhea cases for both women and
2.4
25-29 40-44 men declined steadily throughout
the 1980s and early 1990s, and then
1.8 declined more gradually in the late
1990s and the 2000s. However, more
1.2 recently, there have been increases in
overall cases. (Figure 12, Table 1).
0.6
0.0 After reaching a 40-year low in

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2009 (104.5 cases per 100,000
Year females), the rate of reported cases
of gonorrhea for women increased
SOURCE: MarketScan Commercial Claims and Encounters Database, Truven Health Analytics, Ann slightly each year during 20092011,
Arbor, MI, 20042015. and then decreased during 20122014
(Figure 13). During 20152016,
the gonorrhea rate among women
Chlamydia rates are highest among aged 1424 years was 8.4%, but for
increased 13.8% to 121.0 cases per
young women, the population women 1419 years of age, chlamydia
100,000 females (Figure 13, Table
targeted for screening (Figure 5, positivity was 9.4%. For women
15).
Table 10). During 20152016, rates between the ages of 1424 years,
of reported chlamydia cases increased chlamydia positivity among non-
The gonorrhea case rate among
2.8% and 0.4% among females aged Hispanic Blacks was almost twice that
women was slightly higher than the
1519 and 2024 years, respectively. of non-Hispanic Whites or Hispanics.
rate among men during 20072012;
Regionally, chlamydia case rates were
however, the rate among men was
highest among women in the South, Gonorrhea higher than the rate among women
with a rate of 718.6 cases per 100,000
Like chlamydia, gonorrhea is often during 20132016 (Figure 13, Tables
females in 2016 (Table 4). Rates of
asymptomatic in women. Therefore, 15 and 16). During 20122016,
reported chlamydia cases exceeded
gonorrhea screening is an important gonorrhea rates among women were
gonorrhea case rates among women in
strategy for the identification of highest among those aged 1524
all regions (Figures D and E, Tables 4
and 15).
Figure D. Chlamydia Rates of Reported Cases Among Women by
Chlamydia Positivity in State, United States and Outlying Areas, 2016
Selected Populations
The STD Surveillance Network
566
577 594 412
(SSuN) is an ongoing collaboration 567 542
VT 369
of state, county, and city health 487
472
720 633
624
664
NH 344
departments from 10 participating 581
564 566
MA 495
RI 602
jurisdictions where demographic, 629
684
405 735 645
705
CT 516
625
clinical, and laboratory data are
357 614
596 670 550 NJ 524
collected from women aged 1544 Guam 820
642 798 DE 754
689 756 MD 651
years attending facilities that provide 885 806
829
786
DC 1136
family planning and reproductive 917 764
735
health services (See Section A2.2 1090
961 Rate per 100,000
population
of the Appendix). Figure F shows 634 612
<= 524 (n= 11)
chlamydia testing and positivity 525 - 602 (n= 11)
reported only among facilities that Puerto Rico 306 603 - 664
665 - 764
(n= 11)
(n= 11)
tested more than 100 women and Virgin Islands 734 >=765 (n= 10)
more than 60% of young women aged
1424 years. In 2016, the overall NOTE: The total rate of reported cases of chlamydia among women in the United States and
positivity of chlamydia among women outlying areas (Guam, Puerto Rico, and Virgin Islands) was 653.6 per 100,000 females.
38
Neonatal Conjunctivitis
Figure E. Gonorrhea Rates of Reported Cases Among Women by
State, United States and Outlying Areas, 2016 During 20102015, 563 chlamydia
or gonorrhea cases among infants
82
aged <1 year with a specimen source
96 140 20 of either eye or conjunctiva
75 80
VT 10
(conjunctivitis infections) were
29
42
178 110
123
86
NH 20 reported to CDC.29 During 2010
111
81 94
MA 40 2014, the overall reported rate of
112 RI 41
106
48
86
136 143
171
CT 63 chlamydial conjunctivitis in infants
decreased by 40.7% (2.7 to 1.6 cases
116 45 119
169 121 NJ 73
per 100,000 live births), followed
Guam 74 185 DE 164
138
126 205
MD 127
by an increase of 31.2% during
147 196 187
163 175 DC 242
135
238
20142015 to 2.1 cases per 100,000
211
230
Rate per 100,000 live births (Figure G). The rate of
population
gonococcal conjunctivitis in infants
78 111
<= 48 (n= 11)
49 - 94 (n= 11) remained relatively constant and low
Puerto Rico 17 95 - 126
127 - 171
(n= 11)
(n= 11)
during 20102015, at 0.2 cases or
Virgin Islands 25 >=172 (n= 10) less per 100,000 live births each year.
The rate of reported cases is heavily
NOTE: The total rate of reported cases of gonorrhea among women in the United States and influenced by the completeness of
outlying areas (Guam, Puerto Rico, and Virgin Islands) was 119.8 per 100,000 females. reported data on specimen source.
Of all cases reported to CDC of
chlamydia or gonorrhea in infants
Figure F. Chlamydia Positivity* Among Women Aged 1439 aged <1 year during 20102015
Years by Race/Ethnicity and Age Group in Clinics Providing Family (n=3,703), nearly 85% did not have
Planning and Reproductive Health Services, STD Surveillance a specimen source of either eye
Network (SSuN), 2016 or conjunctiva; of those, 52% had
a specimen source of unknown
Percentage (40.1%), other-not specified (8.7%),
20 or was missing (3.2%). When
evaluating rates including these cases,
15 the rate of chlamydia and gonorrhea
infections follows similar trends
10 but is higher in all years, indicating
potential missed cases for surveillance
5 (Figure G).
0 Congenital Syphilis
14-19 20-24 25-39 All Non- Non- Hispanics
Hispanic Hispanic Trends in congenital syphilis
Whites Blacks
Age Group
usually follow trends in primary and
Among 14-24 Year Olds
secondary (P&S) syphilis among
* Positivity represents the overall average of the mean value by jurisdiction. women (Figure 44). After plateauing

Only clinics that tested >100 women for chlamydia and those with testing coverage >60% were
included (n = 58).
at a relatively low rate (0.9 cases per
NOTE: See section A2.2 in the Appendix for SSuN methods. 100,000 females) during 20112013,
the rate of reported P&S syphilis
cases has increased each year since
years (Figure 17, Table 21). For then. During 20152016, the rate
women in this age group, rates were among women increased 35.7% to 1.9
highest among 19-year olds in 2016 cases per 100,000 females (Figure 44,
(736.2 cases per 100,000 females) Table 28).
(Table 23).
39
Neonatal Herpes Simplex
Figure G. Chlamydia and Gonorrhea Rates of Reported Cases
Among Infants <1 Year of Age by Year and Specimen Source, United Virus
States, 20102015 Neonatal HSV infections, although
Rate (per 100,000 live births) relatively rare, cause significant
15
CT from Conjunctiva, plus Missing/Unk/Oth morbidity and mortality.18 Most
GC from Conjunctiva, plus Missing/Unk/Oth
CT from Conjunctiva
neonatal HSV infections result
12 GC from Conjunctiva from perinatal transmission
from mother to neonate,20 but
9 postnatal infection can occur.30
Although reporting of neonatal
6
HSV infection is required in a
3
few jurisdictions,31,32 it is not a
nationally reportable disease.
0
2010 2011 2012 2013 2014 2015
An examination of inpatient
Year
records of infants aged 60 days
NOTE: CT = Chlamydia; GC = Gonorrhea.
or younger at admission using the
SOURCE: Kreisel, K, Weston, E, Braxton, et al. Keeping an eye on chlamydia and gonorrhea Healthcare Cost and Utilization
conjunctivitis in infants in the United States, 20102015. Sex Transm Dis 2017; 44(6): 356358. Project Kids Inpatient Database
showed an overall incidence of
Similarly, the rate of reported Although most cases of congenital 9.6 cases per 100,000 live births
congenital syphilis cases has syphilis occur among infants whose in 2006.33 Rates did not vary
increased each year since 2012 mothers have had some prenatal care, significantly by region or race/
(Figure 44, Table 1). In 2016, there late or limited prenatal care has been ethnicity; however prevalence was
were 628 reported cases of congenital associated with congenital syphilis. significantly higher among cases
syphilis and the national congenital Failure of health care providers to for which the expected primary
syphilis rate was 15.7 cases per adhere to maternal syphilis screening payer was Medicaid (15.1 cases
100,000 live births, the highest rate recommendations also contributes per 100,000 live births) compared
reported since 1998. This increase to the occurrence of congenital with private insurance or managed
in 2016 represents a 27.6% increase syphilis.17
relative to 2015 and an 86.9%
increase relative to 2012 (Table 41). Figure H. Primary and Secondary Syphilis Rates of Reported
Cases Among Women by State, United States and Outlying Areas,
In 2016, the highest rates of P&S 2016
syphilis among women and the
highest rates of congenital syphilis 1.4
were observed in the West and in 0.2 0.8

0.4
the South (Figures H and I, Tables 1.7

0.7
1.3
0.2
VT 0.9
28 and 41). The P&S syphilis rates
1.4 1.1
0.3 0.6
NH 0.6
MA 0.7
among women increased in every 3.5 0.5
0.4
1.6
0.9
RI 0.6
region during 20152016. During 3.8
0.4
0.6
0.8
1.5 1.1
1.1 1.1
CT 0.7
NJ 0.5
20152016, the largest increases in
2.1 0.9
Guam 0.0 2.1 DE 0.6
the P&S syphilis rates among women 2.3
2.6
2.1
2.4
1.7
2.1 MD 1.7
were seen in the West (58.8%), 3.8 3.2 2.2
DC 1.4
followed by the Northeast (28.6%), 1.7
8.0
South (22.2%), and Midwest (20.0%). 0.0
1.4 2.6
Rate per 100,000
population
The congenital syphilis rate increased <= 0.5 (n= 11)
42.1% in the Northeast, 41.4% in Puerto Rico 4.7
0.6 - 0.9
1.0 - 1.4
(n= 13)
(n= 9)
the West, and 23.6% in the South, 1.5 - 2.2 (n= 11)
and remained stable in the Midwest Virgin Islands 0.0 >=2.3 (n= 10)
during 20152016 (Table 41).

NOTE: The total rate of reported cases of primary and secondary syphilis among women in the
United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 1.9 per 100,000
females.
40
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Recommendations for the prevention and
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Rep 1993; 42(RR-12):139.
42
STDs in Adolescents and Young Adults
Public Health Impact to improve the underlying social cases of chlamydia was 3,437.5 cases
conditions themselves.5,6 In addition, per 100,000 females. Among men
Incidence and prevalence estimates
in designing STD programs, aged 1524 years, the overall rate
suggest that young people aged
consideration should be given to the of reported cases of chlamydia was
1524 years acquire half of all new
needs of adolescent and young adult 1,209.6 cases per 100,000 males.
STDs1 and that one in four sexually
populations including extended hours, Rates varied by state for both males
active adolescent females has an
optimizing privacy in waiting rooms, and females, with the majority of
STD, such as chlamydia or human
and urine based specimen collection.3 states having the highest reported case
papillomavirus (HPV).2 Compared
rates in the South (Figures J and K).
with older adults, sexually active
adolescents aged 1519 years and Observations
1519 Year Old Females In 2016,
young adults aged 2024 years are
at higher risk of acquiring STDs
Chlamydia the rate of reported chlamydia cases
In 2016, there were 1,008,403 among women aged 1519 years was
for a combination of behavioral,
reported cases of chlamydial infection 3,070.9 cases per 100,000 females,
biological, and cultural reasons.
among persons aged 1524 years, a 2.8% increase from the 2015
For some STDs, such as chlamydia,
representing 63.1% of all reported rate of 2,986.5 cases per 100,000
adolescent females may have
chlamydia cases. Among those aged females (Table 10). Increases in
increased susceptibility to infection
1519 years, the rate of reported cases rates of reported cases of chlamydia
because of increased cervical ectopy.
of chlamydia increased 4.0% during during 20152016 were largest
Cervical ectopy refers to columnar
20152016 (1,854.2 to 1,929.2 cases among 16year old and 18year old
cells, which are typically found
per 100,000 population) (Table 10). women (3.4% and 4.1% increases,
within the cervical canal, located
Among those aged 2024 years, the respectively) (Table 12). During
on the outer surface of the cervix.
rate increased 1.9% during 2015 20122016, the overall rate of
Although this is a normal finding in
2016 (2,594.5 to 2,643.8 cases per reported cases for women aged 1519
adolescent and young women, these
100,000 population) (Table 10). years decreased 7.8% (Table 10).
cells are more susceptible to infection.
The higher prevalence of STDs
Among women aged 1524 years, 2024 Year Old Females In 2016,
among adolescents may also reflect
the population targeted for chlamydia women aged 2024 years had the
multiple barriers to accessing quality
screening, the overall rate of reported highest rate of reported chlamydia
STD prevention and management
services, including inability to pay,
lack of transportation, long waiting
times, conflict between clinic hours Figure J. Chlamydia Rates of Reported Cases Among Women
and work and school schedules, Aged 1524 Years by State, United States and Outlying Areas, 2016
embarrassment attached to seeking
STD services, method of specimen 2958
collection, and concerns about 3285 2663 2618
confidentiality (e.g., Explanation of 3126 2967

VT 1674
Benefits for services received mailed
2554 3129 3286 3293
2579 3460
NH 2736
to parents or guardians).3 3600 2931
2762 3195
MA
RI
2491
2201
4016
1742 3873 3354
2908 3189 2248
2516
CT 2690
Traditionally, intervention efforts
3166 3661 3052 NJ 2557
Guam 2371 DE 4335
have targeted individual level 3382
4248
2628
4241
3637
4330
4346
MD 3660
factors associated with STD risk 3712 DC 5215
5056 3702
which do not address higher-level 3625
factors (e.g., peer norms and media 4832

3297
5264
Rate per 100,000
population
influences) that may also influence 3438
<= 2579 (n= 11)
behaviors.4 Interventions for at- 2580 - 3052 (n= 11)
3053 - 3382 (n= 11)
risk adolescents and young adults Puerto Rico 1424
3383 - 4016 (n= 11)
that address underlying aspects of Virgin Islands 5093 >=4017 (n= 10)
the social and cultural conditions

affecting sexual risk-taking behaviors NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population
are needed, as are strategies designed estimates (see Section A1.2 in the Appendix).
43
the rate was 455.3 cases per 100,000
Figure K. Chlamydia Rates of Reported Cases Among Men Aged males. For both women and men,
1524 Years by State, United States and Outlying Areas, 2016 rates varied by state. The majority of
states with the highest reported case
987
rates were in the South (Figures L and
1177 1067 909 M).
1040 1070
VT 504
1519 Year Old Females In
868 1021 1173 1349
989 1243
NH 1063
1207 1049
966 1326
MA
RI
973
887
2016, women aged 1519 years had
the second highest rate of reported
1413
622 1394 1096
1044 1079 737
CT 903
965
966 1384 1069 NJ 837 gonorrhea cases (482.1 cases per
Guam 582 DE 1619
1204
1289
974
1263
1379
1391
1369
MD 1487 100,000 females) compared with
1316 DC 2881 other age groups among women
1818 1236
1092 (Figure 17, Table 21). During 2015
1513
1649
Rate per 100,000 2016, the rate of reported gonorrhea
1117 population
1239
<= 965 (n= 11) cases for women in this age group
966 - 1063 (n= 11) increased 9.3% and decreased 8.6%
1064 - 1207 (n= 11)
Puerto Rico 307
1208 - 1384 (n= 11) during 20122016 (Table 21).
Virgin Islands 2003 >=1385 (n= 10)
2024 Year Old Females In 2016,

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population women aged 2024 years had the
estimates (see Section A1.2 in the Appendix). highest rate of reported gonorrhea
cases (595.5 cases per 100,000
females) compared with other age
cases (3,779.0 cases per 100,000 Gonorrhea groups among women (Figure 17,
females) compared with any other Table 21). During 20152016, the
During 20152016, the rate of
age group for either sex (Figure 5, rate of reported gonorrhea for women
reported gonorrhea cases increased
Table 10). During 20152016, the in this age group increased 7.9% and
11.3% for persons aged 1519 years
overall rate of reported chlamydia 4.8% during 20122016 (Table 21).
and 10.9% for persons aged 2024
cases among women in this age group
years (Table 21). In 2016, among
remained relatively stable; however, 1519 Year Old Males In 2016,
women aged 1524 years, the rate
this rate increased 4.1% during the rate of reported gonorrhea cases
was 540.8 cases per 100,000 females
20122016 (Table 10). among men aged 1519 years was
and among men aged 1524 years,
1519 Year Old Males In 2016,
the rate of reported chlamydia cases Figure L. Gonorrhea Rates of Reported Cases Among Women
among men aged 1519 years was Aged 1524 Years by State, United States and Outlying Areas, 2016
832.6 cases per 100,000 males, an
8.6% increase from 2015. During
20122016, the rate of reported 301
330 79
chlamydia cases for men aged 1519
477
249 370
VT 32
years increased 6.0% (Table 10). 84 538 513 384
NH 84
161 570
310 446
MA 149
2024 Year Old Males In 2016, as
434
478 815 RI 116
128 693 624
CT 249
in previous years, men aged 2024
376 358 218 415
443 773 530 NJ 310
years had the highest rate of reported Guam 249
614
682
856 DE 736
490 MD 632
chlamydia cases among all men 481 879 902
DC 1106
(1,558.6 cases per 100,000 males). 721 685
1194
609
The rate for men in this age group 601
1196
Rate per 100,000
increased 5.5% during 20152016 297 530 population
<= 218 (n= 11)
(Table 10). Similarly, during 2012 219 - 376 (n= 11)
2016, the rate for men aged 2024 Puerto Rico 77 377 - 530 (n= 12)
531 - 693 (n= 10)
years increased 17.8% (Table 10). Virgin Islands 161 >=694 (n= 10)
NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population
estimates (see Section A1.2 in the Appendix).
44
compared with any other age group
Figure M. Gonorrhea Rates of Reported Cases Among Men Aged for either sex (Figure 37, Table 34).
1524 Years by State, United States and Outlying Areas, 2016 The P&S syphilis rate among men
in this age group has increased each
291 year since 2006 (Figure 39, Table 34).
194 295
125 During 20152016, the rate increased
262
122
289
382
VT 45 5.6%.
250 447
155 388
NH 133
MA 227
National Job Training
229 402
312
469 543 RI 163
152 564 436
420 322
310 648 356
153 319
CT 201
NJ 276 Program
DE 512
The National Job Training Program
Guam 126 617
557
469
431
377
604 MD 543
(NJTP) is an educational program
589
553 557 DC 1546
522
906
for socioeconomically disadvantaged
296
810
Rate per 100,000 youth aged 1624 years and is
population
administered at more than 100 sites
278 491
<= 163 (n= 11)
164 - 295 (n= 11) throughout the country. The NJTP
296 - 420 (n= 11)
Puerto Rico 81
421 - 553 (n= 11) screens participants for chlamydia
Virgin Islands 108 >=554 (n= 10) and gonorrhea within two days of
entry to the program. All of NJTPs
NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population chlamydia screening tests and the
estimates (see Section A1.2 in the Appendix). majority of gonorrhea screening tests
are conducted by a single national
contract laboratory*.
280.8 cases per 100,000 males 3.3 to 1.9 cases per 100,000 females)
(Figure 17, Table 21). During 2015 (Figure 38, Table 34). However, the To increase the stability of the
2016, the rate of reported gonorrhea rate has subsequently increased each estimates, chlamydia or gonorrhea
cases for men in this age group year since then. During 20152016, prevalence data are presented when
increased 14.8% and 15.8% during the rate increased 22.2%, from 2.7 valid test results for 100 or more
20122016 (Table 21). to 3.3 cases per 100,000 females students per year are available for
(Figure38, Table 34). the population subgroup and state.
2024 Year Old Males In 2016, Additional information about NJTP
as in previous years, men aged 2024 Year Old Females In 2016, can be found in Section A2.1 in the
2024 years had the highest rate of women aged 2024 years had the Appendix.
reported gonorrhea cases (616.8 cases highest rate of P&S syphilis (6.7
per 100,000 males) compared with cases per 100,000 females) compared Among women entering the program
any other age group for either sex with other age groups among women in 45 states, the District of Columbia,
(Figure17, Table 21). During 2015 (Figure 37, Table 34). The P&S and Puerto Rico, the median state-
2016, the rate of reported gonorrhea syphilis rate among women in this age specific chlamydia prevalence in 2016
for men in this age group increased group has increased each year since was 11.4% (range: 6.0% to 25.3%)
13.7% and 36.1% during 20122016 2011 (Figure 38, Table 34). During (Figure N). Among men entering
(Table 21). 20152016, the rate increased 28.8%. the program in 49 states, the District
of Columbia, and Puerto Rico, the
Primary and Secondary 1519 Year Old Males In 2016, median state-specific chlamydia
Syphilis the rate of reported P&S syphilis prevalence was 7.1% (range: 2.4% to
cases among men aged 1519 years 12.9%) (Figure O).
During 20152016, the rate of was 8.9 cases per 100,000 males
reported primary and secondary (Figure37, Table 34). The P&S Among women entering the program
(P&S) syphilis cases increased 13.0% syphilis rate among men in this age in 45 states, the District of Columbia,
among persons aged 1519 years group has increased each year since and Puerto Rico, the median state-
and 8.1% among persons aged 2024 2011 (Figure 39, Table 34). During specific gonorrhea prevalence in 2016
years (Table 34). 20152016, the rate increased 11.3%. was 2.0% (range: 0.0% to 6.7%)
(Figure P). Among men entering the
1519 Year Old Females The rate 2024 Year Old Males In 2016,
of reported P&S syphilis cases among men aged 2024 years had the second
women aged 1519 years decreased highest rate of reported P&S syphilis * Laboratory tests are conducted by the Center for
each year during 20092013 (from (37.9 cases per 100,000 males) Disease Detection, LLC San Antonio, Texas.
45
program in 44 states and Puerto Rico,
Figure N. Chlamydia Prevalence Among Women Aged 1624 the median state-specific gonorrhea
Years Entering the National Job Training Program (NJTP) by State of prevalence was 0.5% (range: 0.0% to
Residence, United States and Outlying Areas, 2016 2.7%) (Figure Q).
9.2 Adolescents and Young

6.8
12.3 9.6
8.0
6.0
Adults Summary
VT *
*
9.9
*
8.9
15.8
10.1
NH 6.0 The rate of reported cases of
6.0 10.2
MA 7.0 chlamydia, gonorrhea, and P&S
9.4 RI *
syphilis increased for both sexes in
* 15.6
11.2 15.8 16.4
8.6 9.3 CT 9.3
both the adolescent (1519 years)
14.4 8.8 11.6
14.0 10.9 NJ 11.4
9.1 14.1
22.5 13.4 DE
MD
18.3
10.6
and young adult (2024 years) age
groups during 20122016. For
12.9 25.3 11.7
18.5
DC 10.2
14.5
14.8
20.1
chlamydia, rates of reported cases
11.4
15.3 Prevalence (%) are consistently highest among
women aged 1524 years, likely
22.1 13.7 * (n= 6)
<= 9.1 (n= 10)
9.2 - 10.2 (n= 9) reflecting targeted screening of
10.3 - 13.4 (n= 10)
Puerto Rico 14.7
13.5 - 15.6 (n= 9) young women; however, the rate
Virgin Islands *
>=15.7 (n= 9) of reported chlamydia in males
increased 14.0% during 20122016,
* Fewer than 100 women who resided in these states/areas and entered the NJTP were screened while the rate in females decreased
for chlamydia in 2016. 1.4%. Similarly, in 2016, the rate
NOTE: See Section A2.1 in the Appendix for more information regarding NJTP methods.
of reported cases of gonorrhea in
females aged 1524 years was higher
than in men of the same age group;
Figure O. Chlamydia Prevalence Among Men Aged 1624 Years however, during 20122016, the rate
Entering the National Job Training Program (NJTP) by State of of reported gonorrhea in males aged
Residence, United States and Outlying Areas, 2016 1524 years increased 29.9%, while
the rate in females decreased 1.4%.
3.0
Increases in chlamydia and gonorrhea
6.1 3.8
5.0 diagnoses among men likely reflect a
4.0 4.3
VT 2.9
combination of increased screening
2.4
5.8
7.1 5.7
12.9
6.4
NH 4.1 among young men, including extra-
2.9
5.1 9.5 MA 6.1 genital screening, and increased
RI *
incidence. Conversely, rates of
5.6 9.1
3.4 12.2 7.1
4.8 6.7 9.6 CT 7.5
8.8 8.0 9.6
7.3
NJ 10.9 reported cases of P&S syphilis have
4.2 5.2
10.3
8.7 DE
MD
10.6
6.4
been consistently higher among
adolescent and young adult men
6.0 11.6 9.4
10.3
DC 10.5
8.9
9.3
11.1
compared to women, and during
4.9
11.7 Prevalence (%) 20122016, rates of reported P&S
8.9 7.9
* (n= 2) syphilis cases increased substantially
<= 4.3 (n= 11)
4.4 - 6.1 (n= 11) in both adolescent and young adult
Puerto Rico 3.6 6.2 - 8.0
8.1 - 9.6
(n= 9)
(n= 10)
males and females, with 54.2% and
Virgin Islands * >=9.7 (n= 10) 64.5% increases, respectively.
* Fewer than 100 men who resided in these states/areas and entered the NJTP were screened for
chlamydia in 2016.
46
References
Figure P. Gonorrhea Prevalence Among Women Aged 1624 1. Satterwhite CL, Torrone E, Meites E, et al.
Years Entering the National Job Training Program (NJTP) by State of Sexually transmitted infections among US
Residence, United States and Outlying Areas, 2016 women and men: prevalence and incidence
estimates, 2008. Sex Trans Dis 2013; 40(3)187
193.
0.0
2. Forhan SE, Gottlieb SL, Sternberg MR, et al.
1.3 5.2 0.5
0.3
Prevalence of sexually transmitted infections
1.2 VT *
3.7 among female adolescents aged 14 to 19 in the
1.6
* * NH 0.0 United States. Pediatrics 2009; 124(6):1505
2.0 3.6
0.4 1.0
MA 1.2 1512.
0.9 * 3.2 RI *
0.0 3.7
0.7 0.8
4.1
0.7 1.8
CT 2.0 3. Tilson EC, Sanchez V, Ford CL, et al. Barriers
2.1 NJ 2.4
3.9 2.4 to asymptomatic screening and other STD
2.6 DE 1.7 services for adolescents and young adults: focus
6.7
1.3
1.8
4.4
6.6 3.9 MD 3.2 group discussions. BMC Public Health 2004;
DC 2.0
3.3 3.3 5.9 4(1):21.
3.1
4.0 4. DiClemente RJ, Salazar LF, Crosby RA. A
1.6 Prevalence (%)
4.5 review of STD/HIV preventive interventions
3.0 * (n= 6)
<= 0.8 (n= 10)
for adolescents: sustaining effects using an
0.9 - 1.7 (n= 9) ecological approach. J Pediatr Psychol 2007;
Puerto Rico 0.4 1.8 - 3.0 (n= 10) 32(8):888906.
3.1 - 3.9 (n= 10)
Virgin Islands *
>=4.0 (n= 8) 5. Sieving RE, Bernat DH, Resnick MD, et al.
A clinic-based youth development program to
reduce sexual risk behaviors among adolescent
* Fewer than 100 women who resided in these states/areas and entered the NJTP were screened
girls: prime time pilot study. Health Promot
for gonorrhea in 2016. Pract 2012; 13(4):462471.
6. Upchurch DM, Mason WM, Kusunoki Y, et
al. Social and behavioral determinants of self-
reported STD among adolescents. Perspect Sex
Reprod Health 2004; 36(6):276287.
Figure Q. Gonorrhea Prevalence Among Men Aged 1624 Years
Entering the National Job Training Program (NJTP) by State of
Residence, United States and Outlying Areas, 2016
0.2
0.9 1.6 0.2
0.2 0.4
VT 0.0
* 0.0 * 0.5
0.0 0.9
NH 0.5
0.4 1.7
MA 0.0
1.0
0.8 2.2 RI *
0.0 2.4 0.8
0.4 1.5 0.3
CT 0.0
* 1.0
* 1.1 NJ 0.7
0.9
0.9 DE *
0.0 0.5 MD
0.2 2.7 0.5 0.5
1.3 1.6 DC *
1.0
0.2
1.8
0.7 Prevalence (%)
0.4
* * (n= 9)
<= 0.2 (n= 13)
0.3 - 0.4 (n= 5)
Puerto Rico 0.0 0.5 - 0.8 (n= 9)
0.9 - 1.3 (n= 9)
Virgin Islands * >=1.4 (n= 8)
* Fewer than 100 men who resided in these states/areas and entered the NJTP were screened for
gonorrhea in 2016.
47
48
STDs in Racial and Ethnic Minorities
Public Health Impact Even when health care is available, Survey (NHANES) and the National
Surveillance data show higher rates fear and distrust of health care Longitudinal Study of Adolescent
of reported STDs among some racial institutions can negatively affect the Health, confirm the existence of
or ethnic minority groups when health care-seeking experience for marked STD disparities in some
compared with rates among Whites.1,2 many racial/ethnic minorities when minority populations.12,13
Race and Hispanic ethnicity in there is social discrimination, provider
the United States are population bias, or the perception that these may Method of Classifying Race
characteristics that are correlated exist.9,10 Moreover, the quality of care
with other factors affecting health can differ substantially for minority and Hispanic Ethnicity
status such as unemployment and patients.11 Inequities in social and Interpretation of racial and ethnic
low educational attainment.3-5 In economic conditions are reflected in disparities among persons with STDs
2015, the overall proportion of the the profound disparities observed in is influenced by data collection
United States population living in the incidence of STDs among some methods and by the categories by
poverty was 14.7% (or 48.2 million) racial and ethnic minorities. which these data are displayed.
and decreased slightly from 2014. Race/ethnicity data are presented in
Although the overall poverty rate is In communities where STD Office of Management and Budget
currently stable, many Americans face prevalence is higher because of (OMB) race and ethnicity categories
challenges overcoming inequalities these factors, persons can experience according to the 1997 revised
in economic opportunity. The poverty difficulties reducing their risk for OMB standards.14 However, the
rate in 2015 for Whites was 9.1% sexually transmitted infections. With National Center for Health Statistics
(17.7 million), for Blacks it was each sexual encounter, they can face (NCHS) bridged-race categories
24.1% (or 10.0 million), and for a greater chance of encountering an are used where OMB categories
Hispanics it was 21.4% (or 13.1 infected partner than those in lower are not available (i.e., congenital
million).3 Those who cannot afford prevalence settings.2 Acknowledging syphilis). As of 2016, all reporting
basic life necessities often have inequities in STD rates by race or jurisdictions collect and report data
trouble accessing and affording ethnicity is one of the first steps in in OMB-compliant formats for
quality sexual health services.6 People empowering affected communities to syphilis, chlamydia, and gonorrhea.
who struggle financially are often organize and focus on this problem. Historical trend and rate data by race
experiencing life circumstances that and Hispanic ethnicity displayed in
potentially increase their risk for STD Reporting Practices figures and interpreted in this report
STDs.6 for 20122016 include only those
Surveillance data are based on cases states and/or reporting jurisdictions
Access to quality STD prevention and of STDs reported to state and local (46 jurisdictions for chlamydia,
treatment services is key to reducing health departments (see Section gonorrhea, and syphilis) reporting
STD disparities in the United States. A.1 in the Appendix). In many in the current standard consistently
Of the estimated 19 million new cases state and local health departments, for all years from 2012 through 2016
of sexually transmitted infections electronic laboratory reporting is (See Section A1.5 of the Appendix for
that occur each year, approximately increasingly a primary source of additional information on reporting of
half of the cases occur among people initial case notification. The reports race and Hispanic ethnicity).
aged 1524 years.7 Although the are often missing race and ethnicity
overall proportion of adults without of the patient; ascertainment of
information on race and Hispanic Completeness of Race/
health insurance decreased from
ethnicity is therefore a function Ethnicity Data in 2016
13.3% in 2013 to 9.1% (or 29.0
million) in 2015, many people in of active follow-up or dependent Chlamydia 28.8% of chlamydia
the United States continue to lack on previous information available case reports were missing race or
access to health care.8 Among all about the patient in existing health ethnicity data, ranging by jurisdiction
races and ethnicities in the United department surveillance databases. from 0.1% to 76.6% (Table A1).
States, Hispanics had the lowest rate Prevalence data from population-
of health insurance coverage in 2015 based surveys, such as the National
at 83.8%.8 Health and Nutrition Examination
49
Gonorrhea 19.0% of gonorrhea
case reports were missing information Figure R. Chlamydia Rates of Reported Cases by Race/Ethnicity
on race or ethnicity, ranging by and Sex, United States, 2016
jurisdiction from 0.1% to 69.9% Men Rate (per 100,000 population) Women
(Table A1).
2250 1800 1350 900 450 0 Race/ 0 450 900 1350 1800 2250
Ethnicity
Syphilis 3.8% of all primary and 376.7 AI/AN* 1112.1
secondary (P&S) syphilis case reports
were missing information on race or 84.0 Asians 151.0
ethnicity, ranging from no missing 839.0 Blacks 1387.2
cases to 30.4% missing information 219.8 Hispanics 532.4

on race or ethnicity among 333.4 978.1
NHOPI*
jurisdictions with 10 or more cases of
P&S syphilis (Table A1). 126.4 Whites 271.1
101.7 Multirace 197.0
Observations 330.5 Total 657.3
Chlamydia
Among the 46 states that submitted NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of
data on race and ethnicity for Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix).
chlamydia cases each year during
20122016 according to the OMB (Table 11B). The rate of reported reported chlamydia cases among AI/
standards, rates of reported chlamydia chlamydia cases among Black women AN in the United States was 3.8 times
cases increased during that time aged 1519 years (6,485.2 cases per the rate among Whites.
frame among Whites (12.7%), Asians 100,000 females) was 4.5 times the
(10.2%), Native Hawaiians/Other rate among White women in the same Native Hawaiians/Other Pacific
Pacific Islanders (NHOPI) (8.3%), age group (1,433.3 cases per 100,000 Islanders In 2016, the rate of
and Multirace (60.6%), and decreased females). The rate of reported reported chlamydia cases among
in American Indians/Alaska Natives chlamydia cases among Black women NHOPI was 653.4 cases per 100,000
(AI/AN) (-6.4%) and Blacks (-3.5%) aged 2024 years was 3.7 times the population (Table 11B). The overall
(Figure 6). Rates were stable among rate among White women in the same rate of reported chlamydia cases
Hispanics during 20122016. age group (6,747.6 and 1,836.2 cases among NHOPI was 3.3 times the rate
per 100,000 females, respectively) among Whites and 5.5 times the rate
In 2016, 50 states and the District (Table 11B). among Asians.
of Columbia submitted data on race
and ethnicity for chlamydia cases Similar racial disparities in reported Hispanics In 2016, the rate of
according to the OMB standards. chlamydia rates exist among men. reported chlamydia cases among
Among men aged 1519 years, the Hispanics was 374.6 cases per
Blacks In 2016, the overall rate rate of reported chlamydia cases 100,000 population, which was 1.9
of reported chlamydia cases among among Blacks was 8.8 times the rate times the rate among Whites (Table
Blacks in the United States was among Whites (2,337.7 and 266.9 11B).
1,125.9 cases per 100,000 population cases per 100,000 males, respectively)
(Table 11B). The rate of reported (Table 11B). The rate of reported Asians In 2016, the rate of
chlamydia cases among Black women chlamydia cases among Black men reported chlamydia cases among
was 5.1 times the rate among White aged 2024 years was 4.9 times the Asians was 119.3 cases per 100,000
women (1,387.2 and 271.1 cases rate among White men of the same population (Table 11B). The overall
per 100,000 females, respectively) age group (3,316.9 and 682.5 cases rate of reported chlamydia cases
(Figure R and Table 11B). The per 100,000 males, respectively). among Whites was 1.7 times the rate
rate of reported chlamydia cases
among Asians.
among Black men was 6.6 times American Indians/Alaska Natives
the rate among White men (839.0 In 2016, the rate of reported
and 126.4 cases per 100,000 males, chlamydia cases among AI/AN was
respectively). Rates of reported cases 749.8 cases per 100,000 population
of chlamydia were highest for Blacks (Table 11B). Overall, the rate of
aged 1519 and 2024 years in 2016
50
Gonorrhea
Figure S. Gonorrhea Rate Ratios* by Race/Ethnicity, United States,
Among 46 states submitting race
20122016
and ethnicity data for gonorrhea
cases consistently according to Rate Ratio AI/AN Hispanics
OMB standards each year during 32:1 Asians NHOPI
Blacks
20122016, rates of reported 16:1
gonorrhea cases increased 120.4%
among Multirace persons (25.0 to 8:1
55.1 cases per 100,000 population), 4:1
91.4% among NHOPI (84.4 to 161.5 2:1
cases per 100,000 population), 82.5%
1:1
among Whites (31.4 to 57.3 cases per
100,00 population), 81.3% among AI/ 1:2
AN (125.8 to 228.1 cases per 100,000 1:4
population), 76.7% among Asians 2012 2013 2014 2015 2016
(16.3 to 28.8 cases per 100,000 Year
population), 61.8% among Hispanics
* Rate ratios are calculated as the rate of reported gonorrhea cases per 100,000 population for a
(59.4 to 96.1 cases per 100,000 given racial or ethnic minority population divided by the rate of reported gonorrhea cases per
population), and 10.5% among Blacks 100,000 population for Whites. Any population with a lower rate of reported cases of gonorrhea
(455.3 to 503.2 cases per 100,000 than the White population will have a rate ratio of less than 1:1.
population) (Figure 20).
Y-axis is log scale.

AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.
In 2016, 50 states and the District compliant formats during 20122016 (see Section A1.5 in the Appendix).
of Columbia submitted data on race
and ethnicity for gonorrhea cases
according to the OMB standards.
Figure T. Gonorrhea Rates of Reported Cases by Race/Ethnicity
Blacks In 2016, 51.0% of reported and Sex, United States, 2016
gonorrhea cases with known race
and ethnicity occurred among Blacks Men Rate (per 100,000 population) Women
(excluding cases with missing 750 600 450 300 150 0 Race/ 0 150 300 450 600 750
information on race or ethnicity, and Ethnicity
cases whose reported race or ethnicity 196.8 AI/AN* 287.7
was Other) (Table 22A). The rate 43.4 Asians 14.5

of reported gonorrhea cases among 568.4 Blacks 400.7
Blacks in 2016 (481.2 cases per
100,000 population) was 8.6 times 117.0 Hispanics 74.2
the rate among Whites (55.7 cases 171.1 NHOPI* 160.0
per 100,000 population) (Table 22B). 64.1 Whites 47.5

Although the calculated rate ratio for 75.1 Multirace 49.7
2016 differs when considering only
the 46 jurisdictions that submitted 170.7 Total 121.0
data in race and ethnicity categories

according to the OMB standards for * AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.
each year during 20122016, this NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of
Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix).
disparity has decreased slightly in
recent years (Figure S). In 2016, this
disparity was similar for Black men Considering all race, ethnicity, and women in the same age group (232.0
(8.9 times the rate among White men) age categories, rates of reported cases per 100,000 females). The rate
and Black women (8.4 times the rate gonorrhea cases were highest for of reported gonorrhea cases among
among White women) (Figure T, Blacks aged 2024, 1519, and 2529 Black women aged 1519 years
Table 22B). As in previous years, the years in 2016 (Table 22B). The rate (1,663.1 cases per 100,000 females)
disparity in gonorrhea rates for Blacks of reported gonorrhea cases among was 10.3 times the rate among White
in 2016 was larger in the Midwest and Black women aged 2024 years women in the same age group (161.9
Northeast than in the South and West (1,856.5 cases per 100,000 females) cases per 100,000 females). Among
(Figure U). was 8.0 times the rate among White Black men aged 2024 years, the rate
51
2016 was higher in the Northeast
Figure U. Gonorrhea Rate Ratios* by Race/Ethnicity and Region, than in the Midwest, South, or West
United States, 2016 (Figure U).
Rate Ratio Asians In 2016, the rate of

West
16:1 Midwest
reported gonorrhea cases among
Northeast Asians (28.3 cases per 100,000
8:1 South population) was 0.5 times the rate
among Whites (Table 22B). This
4:1
difference is larger for Asian women
2:1 than for Asian men (Figure T, Table
22B). In 2016, rates among Asians
1:1 were lower than rates among Whites
in all four regions of the United States
1:2
(Figure U).
1:4
AI/AN Asians Blacks Hispanics NHOPI Primary and Secondary
Syphilis
* Rate ratios are calculated as the rate of reported gonorrhea cases per 100,000 population for a
given racial or ethnic minority population divided by the rate of reported gonorrhea cases per During 20122016, 46 states
100,000 population for Whites. Any population with a lower rate of reported cases of gonorrhea submitted race and ethnicity data
than the White population will have a rate ratio of less than 1:1. for syphilis each year according to

Y-axis is log scale.

AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.
the OMB standards. In these states,
NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of rates of reported P&S syphilis
Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix). cases increased 186.2% among AI/
AN (2.9 to 8.3 cases per 100,000
population), 147.4% among those
of reported gonorrhea cases (1,892.7 Native Hawaiians/Other Pacific who identified as Multirace (1.9 to
cases per 100,000 males) was 9.1 Islanders In 2016, the rate of 4.7 cases per 100,000 population),
times the rate among White men in reported gonorrhea cases among 105.3% among Asians (1.9 to 3.9
the same age group (207.0 cases per NHOPI (165.8 cases per 100,000 cases per 100,000 population), 91.1%
100,000 males). The rate of reported population) was 3.0 times the rate among Hispanics (5.6 to 10.7 cases
gonorrhea cases among Black men among Whites (Table 22B). The per 100,000 population), 77.8%
aged 2529 years (1,641.0 cases per disparity between gonorrhea rates for among Whites (2.7 to 4.8 cases per
100,000 males) was 7.4 times the NHOPI and Whites was larger for 100,000 population), 61.6% among
rate among White men in the same NHOPI women (3.4 times the rate NHOPI (8.6 to 13.9 cases per 100,000
age group (222.3 cases per 100,000 among White women) than NHOPI population), and 43.8% among Blacks
males). men (2.7 times the rate among (16.2 to 23.3 cases per 100,000
White men) (Figure T, Table 22B). population) (Figure 40).
American Indians/Alaska Natives The disparity in gonorrhea rates for
In 2016, the rate of reported NHOPI in 2016 was lower in the West In 2016, all 50 states and the District
gonorrhea cases among AI/AN (242.9 than in the Midwest, Northeast, or of Columbia submitted syphilis data
cases per 100,000 population) was South (Figure U). by race and ethnicity according to the
4.4 times the rate among Whites OMB standards.
(Table 22B). The disparity between Hispanics In 2016, the rate of
gonorrhea rates for AI/AN and reported gonorrhea cases among Blacks In 2016, 36.6% of reported
Whites was larger for AI/AN women Hispanics was 95.9 cases per 100,000 P&S syphilis cases with known
(6.1 times the rate among White population, which was 1.7 times the race and ethnicity occurred among
women) than for AI/AN men (3.1 rate among Whites (Table 22B). This Blacks (excluding cases with missing
times the rate among White men) disparity was similar for Hispanic information on race or ethnicity,
(Figure T, Table 22B). The disparity women (1.6 times the rate among and cases whose reported race or
in gonorrhea rates for AI/AN in White women) and Hispanic men ethnicity was Other) (Table 35A). The
2016 was larger in the Midwest than (1.8 times the rate among White men) rate of reported P&S syphilis cases
in the West, Northeast, and South (Figure T, Table 22B). The disparity among Blacks in 2016 (23.1 cases per
(FigureU). in gonorrhea rates for Hispanics in 100,000 population) was 4.7 times
52
the rate among Whites (4.9 cases per
100,000 population) (Table 35B). Figure V. Primary and Secondary Syphilis Rates of Reported
The disparity was higher for Black Cases by Race/Ethnicity and Sex, United States, 2016
women (7.0 times the rate among
Men Rate (per 100,000 population) Women
White women) than for Black men
(4.6 times the rate among White men) 50 40 30 20 10 0 Race/ 0 10 20 30 40 50
Ethnicity
(Figure V, Table 35B).
12.4 AI/AN* 3.7
Considering all race, ethnicity, sex, 7.6 Asians 0.4
and age categories, rates of reported 41.3 Blacks 6.3

P&S syphilis cases were highest 19.7 Hispanics 1.9
among Black men aged 2024 years
and 2529 years in 2016 (Table 35B). 23.0 NHOPI* 2.5
The rate of reported P&S syphilis 9.0 Whites 0.9
cases among Black men aged 2024 11.2 Multirace 1.2

years (105.0 cases per 100,000 males) 15.6 1.9
Total
was 6.4 times the rate among White
men in the same age group (16.4
cases per 100,000 males). The rate of * AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.
NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of
reported P&S syphilis cases among Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix).
Black men aged 2529 years (144.6
cases per 100,000 males) was 6.2
times the rate among White men in
(2.2 times the rate among White Other) (Table 42). The rate of
the same age group (23.5 cases per
men). reported cases of congenital syphilis
100,000 males).
among Blacks in 2016 (43.1 cases
Asians In 2016, the rate of per 100,000 live births) was 8.1 times
reported P&S syphilis cases among the rate among Whites (5.3 cases
Islanders In 2016, the rate of
Asians was 3.9 cases per 100,000 per 100,000 live births). The rate of
reported P&S syphilis cases among
population, which was 0.8 times reported cases of congenital syphilis
NHOPI was 12.9 cases per 100,000
the rate among Whites (Table 35B). was 31.6 cases per 100,000 live
population, which was 2.6 times the
This difference was larger for Asian births among AI/AN (6.0 times the
rate among Whites (Table 35B). This
women (0.4 times the rate among rate among Whites), 20.5 cases per
disparity was similar for NHOPI
White women) than for Asian men 100,000 live births among Hispanics
women (2.8 times the rate among
(0.8 times the rate among White (3.9 times the rate among Whites),
White women) and NHOPI men (2.6
men). and 9.2 cases per 100,000 live births
times the rate among White men).
among Asians/Pacific Islanders (1.7
Congenital Syphilis times the rate among Whites).
American Indians/Alaska Natives
In 2016, the rate of reported P&S Race and ethnicity for cases of
syphilis cases among AI/AN (8.0 congenital syphilis is based on
cases per 100,000 population) was 1.6 the mothers race and ethnicity.
times the rate among Whites (Table During 20152016, rates of reported
35B). This disparity was larger for congenital syphilis cases increased in
AI/AN women (4.1 times the rate all race and ethnicity groups. Rates
among White women) than for AI/AN increased 201% among AI/AN, 67.3%
men (1.4 times the rate among White among Asians/Pacific Islanders,
men). 31.4% among Hispanics, 23.5%
among Blacks, and 17.8% among
Hispanics In 2016, the rate of Whites (Figure W, Table 42).
reported P&S syphilis cases among
Hispanics (10.9 cases per 100,000 In 2016, 43.0% of congenital syphilis
population) was 2.2 times the rate cases with known race and ethnicity
among Whites (Table 35B). This occurred among Blacks (excluding
disparity was similar for Hispanic cases with missing information on
women (2.1 times the rate among race or ethnicity, and cases whose
White women) and Hispanic men reported race or ethnicity was
53
References
Figure W. Congenital Syphilis Rates of Reported Cases by Year of 1. Newman LM, Berman SM. Epidemiology
Birth and Race/Ethnicity of Mother, United States, 20072016 of STD Disparities in African American
Communities. Sex Transm Dis 2008;
Rate (per 100,000 live births) AI/AN* 35(12):S4S12.
Asians/Pacific Islanders
50 Blacks 2. Hogben M, Leichliter JS. Social determinants
Hispanics and sexually transmitted disease disparities. Sex
40 Whites Transm Dis 2008; 35(12 Suppl):S1318.
3. U.S. Census Bureau, Current Population Survey,
30 2016 Annual Social and Economic Supplement.
Available at: https://www.census.gov/data/
20 tables/time-series/demo/income-poverty/
cps-pov/pov-01.2015.html#par_textimage_10
10 Accessed July 31, 2017.
4. Harling G, Subramanian SV, Barnighausen T,
0 et al. Socioeconomic disparities in sexually
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 transmitted infections among young adults in
Year the United States: Examining the interaction
* AI/AN = American Indians/Alaska Natives. between Income and race/ethnicity. Sex Transm
NOTE: National Center for Health Statistics bridged race categories are presented to allow the Dis 2013; 40(7):575581.
display of data across several years. 5. Centers for Disease Control and Prevention.
CDC Health Disparities and Inequalities Report
United States 2013. MMWR Morb Mortal
Wkly Rep 2013; 62(Suppl 3).
6. Institute of Medicine. The Hidden Epidemic:
Confronting Sexually Transmitted Diseases.
Washington, DC: National Academy Press;
1997.
7. Satterwhite CL, Torrone E, Meites E, et al.
Sexually transmitted infections among US
women and men: prevalence and incidence
estimates, 2008. Sex Transm Dis 2013;
40(3):187193.
8. Barnett JC, Vornovitsky MS. Current
Population Reports, P60-257(RV), Health
Insurance Coverage in the United States: 2015.
Washington, DC: U.S. Government Printing
Office; 2016.
9. Prez-Escamilla R. Health care access among
Latinos: Implications for social and health care
reform. J Hispanic High Educ 2010: 9(1):4360.
10. Berk ML, Schur CL. The effect of fear on
access to care among undocumented Latino
immigrants. J Immigr Health 2001; 3(3):151
156.
11. Institute of Medicine. Unequal Treatment:
Confronting Racial and Ethnic Disparities
in Health Care. Washington, DC: National
Academies Press; 2002.
12. Datta SD, Sternberg M, Johnson RE, 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):8996.
13. Miller WC, Ford CA, Morris M, et al.
Prevalence of chlamydial and gonococcal
infections among young adults in the United
States. JAMA 2004; 291(18):22292236.
14. Office of Management and Budget. Provisional
guidance on the implementation of the 1997
standards for federal data on race and ethnicity.
Available at: https://www.whitehouse.gov/omb/
fedreg_1997standards Accessed July 29, 2013.
54
STDs in Men Who Have Sex with Men
Public Health Impact population of MSM, may suggest a sentinel and enhanced surveillance
distinct mixing patterns in their project established in 2005 to provide
The incidence of many STDs in gay,
sexual networks, reduced access supplemental information on STDs.
bisexual, and other men who have
to screening and treatment, and
sex with men (collectively referred
differential experiences of stigma Nationally Notifiable Syphilis
to as MSM) including primary
and discrimination, rather than
and secondary (P&S) syphilis and Surveillance Data
greater numbers of sexual partners
antimicrobial-resistant gonorrhea is
or frequency of condomless sex.15, MSM accounted for 80.6% of male
greater than that reported in women 21-22, 24-26
Disparities may also be P&S syphilis cases with information
and men who have sex with women
more pronounced for racial and about sex of sex partners in 2016
only (MSW).1-6 In addition to the
ethnic minority MSM who are also (Figure 36). Of MSM P&S syphilis
negative effects of untreated STDs,
unemployed, young, and/or of lower cases, 36.8% were White, 29.1%
elevated STD burden is of concern
socioeconomic status.26-27 were Black, and 24.0% were Hispanic
because it may indicate high risk for
(Figure X). Relative to the percentage
subsequent HIV infection. Annual
With the exception of reported of the US population that is White
increases in reported STD cases
syphilis cases, nationally notifiable (62.3%), Black (12.3%), and Hispanic
could reflect increased frequency of
STD surveillance data do not (17.1%), this represents a significant
behaviors that transmit both STDs and
routinely include information on inequality in the burden of disease
HIV (e.g., condomless anal sex), and
sexual behaviors and these data are for non-White MSM, which was also
having an STD increases the risk of
missing for the majority of gonorrhea evident among MSW and women.30
acquisition or transmission of HIV.7-14
and chlamydia cases reported to In addition, among MSM P&S
CDC. Therefore, trends in STDs syphilis cases with known HIV status
The relatively high incidence of
among MSM in the United States in 2016, 47.0% were also reported to
STD infection among MSM may be
are based on findings from sentinel be HIV-positive (Figure 41).
related to multiple factors, including
and enhanced surveillance systems.
individual behaviors and sexual
Testing strategies are also evolving In 2016, 44 areas (43 states and the
network characteristics.15-17 The
to include more extragenital STD District of Columbia) provided data
number of lifetime or recent sex
screening, which may increase to classify at least 70% of cases as
partners, rate of partner exchange, and
detection of asymptomatic infections. MSM, MSW, or women. Among
frequency of condomless sex each
Until recently, testing for gonorrhea these areas, estimated rates of P&S
influence an individuals probability
and chlamydia in MSM largely syphilis cases in MSM ranged from 0
of exposure to STDs.15 However,
focused on detecting urethral cases per 100,000 MSM in Wyoming
MSM network characteristics
infections, which are more likely to to 861 cases per 100,000 MSM in
such as high prevalence of STDs,
be symptomatic than pharyngeal or Mississippi, with 26 states (59%)
interconnectedness and concurrency
rectal infections.28 estimated to have rates between 200
of sex partners, and possibly limited
and 400 cases per 100,000 MSM
access to health care also affect
For data reported in this chapter, (Figure Y).
the risk of acquiring an STD.15, 18
MSM were defined as men who either
Furthermore, experiences of stigma
reported having one or more male sex When examining reported P&S
verbal harassment, discrimination, or
partners or who self-reported as gay/ syphilis cases over time, 36 states
physical assault based on attraction to
homosexual or bisexual. MSW were were able to classify at least 70%
men are associated with increased
defined as men who reported having of reported P&S syphilis cases as
sexual risk behavior among MSM.19
sex with women only or who did not MSM, MSW, or women each year
report the sex of their sex partner, during 20122016. In these states,
Disparities among MSM reflect those
but reported that they considered cases among MSM increased 16.4%
observed in the general population,
themselves straight/heterosexual. during 20152016 and 63.7% during
with disproportionate incidence of
Data presented in this chapter are 20122016 (Figure 35). However,
STDs reported among racial and
derived from the National Notifiable the percentage of P&S syphilis cases
ethnic minority MSM, MSM of
Diseases Surveillance System that were attributed to MSM in those
lower socioeconomic status, and
(NNDSS), the Gonococcal Isolate states fell slightly from 73.2% in 2012
young MSM.20-24 The higher burden
Surveillance Project (GISP), and the to 68.6% in 2016.
of STDs among MSM with these
STD Surveillance Network (SSuN),
characteristics, relative to the general
55
Gonococcal Isolate
Figure X. Primary and Secondary Syphilis Reported Cases* by Surveillance Project
Sex, Sexual Behavior, and Race/Ethnicity, United States, 2016
GISP is a national sentinel
Cases
surveillance system designed to
6500 monitor trends in antimicrobial
Whites
Blacks susceptibilities of Neisseria
4875 Hispanics gonorrhoeae strains in the United
Other States.31 Overall, the proportion of
isolates collected in selected STD
3250 clinics participating in GISP that
were from MSM increased steadily,
1625
from 3.9% in 1989 to 38.1% in
2015 and decreased to 37.8% in
2016 (Figure Z). The reason for
0 this increase over time is unclear,
MSW Women MSM but might reflect changes in the
epidemiology of gonorrhea or in
* Of all reported cases of primary and secondary syphilis, 16.9% were among men without data health care seeking behavior of men
on sex of sex partner, and <1% were cases with unknown sex; 4.6% of all cases had missing or
unknown race/ethnicity. Cases with missing or unknown race/ethnicity are included in the Other
infected with gonorrhea. GISP has
category. demonstrated that gonococcal isolates

MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); from MSM are more likely to exhibit
MSW = Men who have sex with women only. antimicrobial resistance than isolates
from MSW.3, 4 During 20072016, the
proportion of isolates with elevated
Figure Y. Primary and Secondary Syphilis Estimated Rates of ceftriaxone minimum inhibitory
Reported Cases Among MSM by State, United States, 2016 concentrations (MICs) (0.125 g/
ml) was higher in isolates from MSM
than from MSW (Figure AA).
299.9
Information on the antimicrobial
susceptibility criteria used in GISP
79.5 547.8 190.2
274.2 230.7
136.2 320.5 *
* VT
NH
188.3
261.1
can be found in Section A2.3 of the
0.0
358.2
226.7
384.3 MA 496.8 Appendix. More information about
682.2
213.2
*
341.4 312.8
274.0 RI * GISP and additional data can be
CT 219.6
450.7 154.7
381.4 309.7 251.7
169.4 224.2
NJ 307.4
found at https://www.cdc.gov/std/
*
589.1 DE * GISP.
440.8 388.0 498.9 MD 329.7
455.9 349.1
* DC 209.5
861.4 329.2
268.0 STD Surveillance Network
714.5 Rate per 100,000
79.8
328.0 352.2 population SSuN is an ongoing collaboration
*
<= 209.5
(n=
(n=
7)
9)
of state, county and city health
209.6 - 274.0 (n= 9) departments collecting enhanced
274.1 - 329.7 (n= 9)
329.8 - 450.7 (n= 9) provider- and patient-based
>=450.8 (n= 8)
information among a random sample
* States reporting less than 70% of cases identified as MSM, MSW, or women in 2016 are of reported gonorrhea cases, as well
suppressed. as clinical and behavioral information

among all patients attending STD
NOTE: Estimates based on reported P&S syphilis cases among MSM in 2016 (numerator) and a clinics in collaborating jurisdictions.29
published method of estimating the population size of MSM (denominator) by state. See Section Data for 2016 were obtained from 29
A1.2 in the Appendix for information on estimating MSM population sizes for rate denominators. STD clinics in SSuN jurisdictions.
Additional information about SSuN

A description of the methods for information about syphilis can be can be found in Section A2.2 of the
estimating MSM population sizes for found in the Syphilis section of the Appendix.
rate denominators can be found in National Profile.
Section A1.2 of the Appendix. More
56
time period, estimated gonorrhea
Figure Z. Neisseria gonorrhoeae Percentage of Urethral Isolates rates among women and MSW also
Obtained from MSM* Attending STD Clinics, Gonococcal Isolate increased, but by a significantly
Surveillance Project (GISP), 19892016 smaller proportion (39.8% and 31.7%,
Percentage respectively).33
40
Gonorrhea and Chlamydia in
32
STD Clinics, 2016
24 In 2016, 25,880 unique MSM
presented for care in the 29 STD
16
clinics in nine SSuN jurisdictions.
8 In total, 22,418 unique MSM were
tested for urogenital gonorrhea and/
0 or chlamydia (22,404 for gonorrhea,
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 22,152 for chlamydia). The proportion
Year of men tested for urogenital infections
was similar across SSuN jurisdictions,
* MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM).
though the proportion who tested
positive (positivity) varied by SSuN
Figure AA. Neisseria gonorrhoeae Percentage of Urethral Isolates jurisdiction (Figure CC). In general,
with Elevated Ceftriaxone Minimum Inhibitory Concentrations (MICs) urogenital gonorrhea positivity was
(0.125 g/ml) by Reported Sex of Sex Partner, Gonococcal Isolate higher than urogenital chlamydia
Surveillance Project (GISP), 20062016 positivity (except in Massachusetts
and Multnomah County); median
Percentage site-specific positivity for gonorrhea
2.0 was 8.8% (range by jurisdiction:
MSM* 2.8%15.3%) and for chlamydia was
MSW* 6.3% (range: 4.8%10.3%).
1.5
A total of 17,489 unique MSM were
tested for rectal gonorrhea and/
1.0 or chlamydia in 2016 (17,467 for
gonorrhea, 17,445 for chlamydia)
0.5
(Figure DD). In most jurisdictions,
similar proportions of MSM were
tested for rectal gonorrhea and
0.0 chlamydia, likely reflecting use of
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 dual diagnostic tests. Compared to
urogenital testing, a lower proportion
Year
of MSM were tested for rectal
* MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); infection. The median site-specific
positivity for rectal gonorrhea was
15.9% (range: 9.9%30.3%) and for
Gonorrhea, 20102015 size of the MSM population in rectal chlamydia was 17.2% (range:
each county were obtained from 12.3%20.0%).
The number of diagnosed and
published estimates and used to
reported gonorrhea cases among
estimate the incidence of reported During 2016, 15,680 MSM were
MSM was estimated at the county
gonorrhea by year among MSM in tested at the oropharyngeal site
level based on patient interviews
the six collaborating SSuN sites.32, for gonorrhea (Figure EE). The
conducted among a random 33
Estimated gonorrhea incidence median site-specific positivity for
sample of all cases reported to six
among MSM increased 151.0% oropharyngeal gonorrhea was 8.8%
health departments continuously
across the study period from 1,368.6 (range by jurisdiction: 1.0%16.1%).
collaborating in the STD Surveillance
cases per 100,000 MSM in 2010 to Oropharyngeal chlamydia data are
Network between January 2010 and
3,434.7 cases per 100,000 MSM in not shown as some of the SSuN
June 2013, and again July through
2015 (Figure BB). Over the same jurisdictions do not offer routine
December 2015. Estimates of the
57
testing for oropharyngeal chlamydia
Figure BB. Gonorrhea Estimated* Rates of Reported Gonorrhea infections.
Cases by MSM, MSW, and Women, STD Surveillance Network
(SSuN), 20102015
HIV Status and STDs in STD
Clinics, 2016
4,000 Among HIV-positive MSM visiting
MSM
MSW SSuN STD clinics in 2016, urogenital
3,000
Women chlamydia positivity was 8.6% and
urogenital gonorrhea positivity was
14.0% (compared to 6.7% and 9.0%,
2,000
respectively, among HIV-negative
MSM) (Figure FF). Among HIV-
1,000
positive MSM, 7.4% were diagnosed
with P&S syphilis compared to 3.1%
0 of HIV-negative MSM. Percentages
2010 2011 2012 2013 2014 2015 represent the overall average of the
Year mean value by jurisdiction.
* Estimates based on interviews among a random sample of reported cases of gonorrhea
(N=14,080); cases weighted for analysis.

Summary
MSW = Men who have sex with women only. The number of reported P&S syphilis

Sites include Baltimore, Philadelphia, New York City, Washington State, San Francisco, and cases among MSM continued to
California (excluding San Francisco).
NOTE: Data not available for 2014; 20132015 trend interpolated shown in dashed line; trends
rise in 2016 and the majority of
lines overlap for MSW and Women in this figure. See section A2.2 in the Appendix for SSuN P&S syphilis cases remained among
methods. MSM. Estimated rates of reported
SOURCE: Stenger M, Pathela P, Anschuetz G, et al. Increases in the rate of Neisseria gonorrhoeae gonorrhea incidence increased among
among gay, bisexual and other men who have sex with men (MSM) findings from the STD MSM in SSuN jurisdictions in recent
Surveillance Network 20102015. Sex Transm Dis 2017; 44(7):393397.
years. Furthermore, the proportion of
GISP isolates with elevated MICs to
antimicrobials currently used to treat
Figure CC. Gonorrhea and Chlamydia Proportion* of MSM gonorrhea was higher among MSM
Attending STD Clinics Testing Positive for Urogenital Gonorrhea than among MSW.
and Chlamydia by Jurisdiction, STD Surveillance Network (SSuN),
2016 Beyond STD burden in the general
MSM population, the data indicated
Percentage
% of MSM who tested positive for gonorrhea
% of MSM tested for gonorrhea
% of MSM who tested positive for chlamydia
% of MSM tested for chlamydia
heterogeneity of STD prevalence
100 among MSM according to geography,
race and ethnicity, and HIV status.
80 State-specific P&S syphilis rate
60
estimates among MSM varied from 0
to over 800 cases per 100,000 MSM
40 and the prevalence of diagnosed
STDs among MSM differed by SSuN
20 jurisdiction. Reported P&S syphilis
15.3
6.2 9.1 6.2 2.8 4.8 6.4 6.4 7.2 6.0 8.6 6.1
14.4
7.9 9.0 6.7 was disproportionately prevalent
0
Baltimore Los Angeles Massachusetts Multnomah Minnesota New York City Philadelphia San Francisco
among Black and Hispanic MSM, and
County data from MSM who attended SSuN
Jurisdiction clinics suggested that P&S syphilis,
* Results based on data obtained from 22,404 patients tested for urogenital gonorrhea and 22,152 urogenital gonorrhea, and urogenital
patients tested for urogenital chlamydia attending SSuN STD clinics in 2016; data from Florida and chlamydia may be more prevalent
Seattle were not available. among MSM living with diagnosed
MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM). HIV infection than among HIV-

Urogenital includes results from both urethral and urine specimens.
NOTE: See section A2.2 in the Appendix for SSuN methods.
negative MSM.
58
References
Figure DD. Gonorrhea and Chlamydia Proportion* of MSM 1. An Q, Wejnert C, Bernstein K, et al. Syphilis
Attending STD Clinics Testing Positive for Rectal Gonorrhea and screening and diagnosis among men who have
Chlamydia by Jurisdiction, STD Surveillance Network (SSuN), 2016 sex with men, 20082014, 20 US cities. JAIDS
2017; 75(Suppl 3):S363S369.
Percentage % of MSM who tested positive for gonorrhea % of MSM who tested positive for chlamydia
2. de Voux A, Kidd S, Grey JA, et al. State-specific
100 % of MSM tested for gonorrhea % of MSM tested for chlamydia rates of primary and secondary syphilis among
men who have sex with men United States,
80 2015. MMWR Morb Mortal Wkly Rep 2017;
66(13):349354.
60 3. Kirkcaldy RD, Harvey A, Papp JR, et
al. Neisseria gonorrhoeae antimicrobial
40 susceptibility surveillance the Gonococcal
Isolate Surveillance Project, 27 sites, United
20 States, 2014. MMWR Surveill Summ 2016;
30.3
19.1 18.2 65(SS-7):119.
17.1 16.0 15.9 15.2 17.1 15.9 20.0 12.1 12.7 14.5 16.8 16.2 18.3
9.9 12.3
0 4. Kirkcaldy RD, Zaidi A, Hook EW 3rd, et al.
Baltimore Massachusetts Minnesota Philadelphia Seattle Neisseria gonorrhoeae antimicrobial resistance
Los Angeles Multnomah New York City San Francisco
County among men who have sex with men and men
Jurisdiction
who have sex exclusively with women: The
Gonococcal Isolate Surveillance Project,
20052010. Ann Intern Med 2013; 158(5 Pt
* Results based on data obtained from 17,467 patients tested for rectal gonorrhea and 17,445 1):321328.
patients tested for rectal chlamydia attending SSuN STD clinics in 2016; data from Florida were not
5. Patton ME, Su JR, Nelson R, et al. Primary and
available.
secondary syphilis United States, 2005

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MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM). HIV incidence among men who have sex with
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* Proportions represent the overall average of the mean value by jurisdiction. black men who have sex with men in 6 US

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Tables
Table 1. Sexually Transmitted Diseases Reported Cases and Rates of Reported Cases per 100,000 Population,
United States, 19412016
Syphilis
Primary and Early Late and
All Stages Secondary Latent Late Latent Congenital Chlamydia Gonorrhea Chancroid
Year* 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 130,697 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 19,779 8.5 259 7.0 NR 960,633 414.7 1,392 0.6
Continued on next page.
62
Tables Centers for Disease Control and Prevention: STD Surveillance 2016
Table 1. Sexually Transmitted Diseases Reported Cases and Rates of Reported Cases per 100,000 Population,
United States, 19412016 (continued)
Syphilis
Primary and Early Late and
All Stages Secondary Latent Late Latent Congenital Chlamydia Gonorrhea Chancroid
Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate
Cases Rate Cases Rate Cases Rate
1983 74,637 31.9 32,698 14.0 23,738 10.2 17,896 7.7 239 6.6 NR 900,435 385.1 847 0.4
1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 305 8.3 7,594 6.5 878,556 372.5 665 0.3
1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 329 8.7 25,848 17.4 911,419 383.0 2,067 0.9
1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 410 10.9 58,001 35.2 892,229 371.5 3,045 1.3
1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 480 12.6 91,913 50.8 787,532 325.0 4,986 2.1
1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 741 19.0 157,854 87.1 738,160 301.9 4,891 2.0
1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 1,837 45.5 200,904 102.5 733,294 297.1 4,697 1.9
1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7
1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4
1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7
1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5
1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3
1995 69,359 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,863 47.8 478,577 187.8 392,651 147.5 607 0.2
1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1
1997 46,716 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,082 27.9 537,904 205.5 327,665 120.2 246 0.1
1998 38,289 13.9 7,007 2.5 12,696 4.6 17,743 6.4 843 21.4 614,250 231.8 356,492 129.2 189 0.1
1999 35,386 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 44,832 14.6 13,997 4.6 13,066 4.3 17,338 5.6 431 10.4 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 9.7 1,307,893 423.6 309,341 100.2 24 0.0
2011 46,040 14.8 13,970 4.5 13,136 4.2 18,576 6.0 358 9.1 1,412,791 453.4 321,849 103.3 8 0.0
2012 49,915 15.9 15,667 5.0 14,503 4.6 19,411 6.2 334 8.4 1,422,976 453.3 334,826 106.7 15 0.0
2013 56,484 17.9 17,375 5.5 16,929 5.4 21,819 6.9 361 9.2 1,401,906 443.5 333,004 105.3 10 0.0
2014 63,453 19.9 19,999 6.3 19,452 6.1 23,541 7.4 461 11.6 1,441,789 452.2 350,062 109.8 6 0.0
2015 74,707 23.2 23,872 7.4 24,173 7.5 26,170 8.1 492 12.3 1,526,658 475.0 395,216 123.0 11 0.0
2016 88,042 27.4 27,814 8.7 28,924 9.0 30,676 9.5 628 15.7 1,598,354 497.3 468,514 145.8 7 0.0
* For 19411946, 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 19411958, 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, late syphilis with clinical manifestations other than
neurosyphilis, and late syphilis with clinical manifestations (including late benign syphilis and cardiovascular syphilis).
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, 2017. The number of cases and the rates shown here supersede those published in previous reports. See Section A1.1 in the Appendix for more information.
Cases and rates shown in this table exclude the outlying areas of Guam, Puerto Rico, and Virgin Islands. Case definitions have changed over time. See Section
Appendix C.1 in the Appendix for more information.
63
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables
Table 2. Chlamydia Reported Cases and Rates of Reported Cases by State, Ranked by Rates, United States,
2016
Rank* State Cases Rate per 100,000 Population
1 Alaska 5,698 771.6
2 Louisiana 31,727 679.3
3 Mississippi 20,112 672.1
4 New Mexico 13,108 628.6
5 Georgia 62,776 614.6
6 North Carolina 58,006 577.6
7 South Carolina 28,179 575.5
8 Delaware 5,365 567.2
9 Arkansas 16,737 562.0
10 Illinois 72,201 561.4
11 Alabama 26,901 553.6
12 New York 109,433 552.8
13 Oklahoma 21,449 548.4
14 Ohio 60,496 520.9
15 Texas 142,952 520.4
16 Arizona 34,923 511.5
17 Maryland 30,658 510.4
18 Missouri 30,843 507.0
19 Nevada 14,649 506.7
20 California 198,155 506.2
21 South Dakota 4,331 504.5
U.S. TOTAL 1,598,354 497.3
22 Tennessee 32,304 489.4
23 Hawaii 6,902 482.1
24 Virginia 39,666 473.2
25 Colorado 25,569 468.6
26 Florida 94,742 467.4
27 Rhode Island 4,936 467.3
28 Wisconsin 26,894 466.0
29 Indiana 30,847 466.0
30 Michigan 45,936 462.9
31 North Dakota 3,455 456.5
32 Pennsylvania 56,930 444.7
33 Washington 31,254 435.9
34 Oregon 17,425 432.5
35 Nebraska 8,197 432.3
36 Montana 4,416 427.5
37 Kansas 12,160 417.6
38 Iowa 12,983 415.6
39 Minnesota 22,685 413.2
40 Kentucky 18,286 413.2
41 Massachusetts 26,807 394.5
42 Connecticut 13,911 387.4
43 New Jersey 34,519 385.3
44 Idaho 5,897 356.3
45 Wyoming 2,060 351.5
46 Utah 9,457 315.7
47 Maine 4,156 312.6
48 Vermont 1,690 269.9
49 West Virginia 4,821 261.4
50 New Hampshire 3,467 260.6
* States were ranked by rate, then by case count, then in alphabetical order, with rates shown rounded to the nearest tenth.
Total includes cases reported by the District of Columbia with 7,283 cases and a rate of 1,083.4, but excludes outlying areas (Guam with 934 cases and rate of
577.3, Puerto Rico with 7,198 cases and rate of 207.2, and Virgin Islands with 571 cases and rate of 554.6).
64
Table 3. Chlamydia Reported Cases and Rates of Reported Cases by State/Area and Region in Alphabetical
Order, United States and Outlying Areas, 20122016
Cases Rates per 100,000 Population
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 30,621 29,464 29,010 26,359 26,901 635.0 609.6 598.2 542.5 553.6
Alaska 5,462 5,774 5,789 5,660 5,698 746.7 785.4 785.8 766.5 771.6
Arizona 30,444 30,564 32,397 32,387 34,923 464.6 461.2 481.3 474.3 511.5
Arkansas 16,611 15,447 15,605 16,166 16,737 563.3 522.0 526.1 542.8 562.0
California 167,695 167,346 176,308 189,170 198,155 440.8 436.6 454.4 483.3 506.2
Colorado 21,631 20,386 21,863 23,857 25,569 417.0 387.0 408.2 437.2 468.6
Connecticut 13,065 12,775 13,382 13,126 13,911 363.9 355.2 372.1 365.5 387.4
Delaware 4,438 5,213 4,473 4,605 5,365 483.9 563.1 478.1 486.8 567.2
District of Columbia 6,808 6,414 5,293 7,894 7,283 1,076.7 992.2 803.3 1,174.3 1,083.4
Florida 77,644 80,182 84,194 90,468 94,742 401.9 410.1 423.2 446.3 467.4
Georgia 52,418 51,070 51,945 57,639 62,776 528.4 511.1 514.4 564.3 614.6
Hawaii 6,340 6,640 6,419 7,074 6,902 455.4 472.9 452.2 494.1 482.1
Idaho 4,550 5,428 5,442 5,631 5,897 285.1 336.7 333.0 340.3 356.3
Illinois 67,701 63,797 66,536 69,610 72,201 525.8 495.2 516.6 541.3 561.4
Indiana 29,505 28,023 28,519 28,886 30,847 451.3 426.5 432.3 436.4 466.0
Iowa 11,377 10,953 11,804 12,085 12,983 370.1 354.4 379.9 386.9 415.6
Kansas 11,135 11,012 11,116 11,464 12,160 385.8 380.5 382.8 393.7 417.6
Kentucky 17,273 17,134 17,664 17,444 18,286 394.3 389.8 400.2 394.2 413.2
Louisiana 27,353 28,739 28,955 32,325 31,727 594.4 621.3 622.7 692.1 679.3
Maine 3,413 3,438 3,530 3,965 4,156 256.8 258.8 265.4 298.3 312.6
Maryland 26,534 26,723 27,424 27,450 30,658 450.9 450.7 458.9 457.0 510.4
Massachusetts 23,550 23,210 21,271 24,100 26,807 354.3 346.8 315.3 354.7 394.5
Michigan 47,566 44,835 44,256 46,486 45,936 481.3 453.1 446.6 468.5 462.9
Minnesota 18,056 18,742 19,907 21,243 22,685 335.7 345.8 364.8 387.0 413.2
Mississippi 23,054 17,464 19,605 17,371 20,112 772.3 583.8 654.8 580.5 672.1
Missouri 27,835 27,328 27,981 28,948 30,843 462.2 452.1 461.5 475.8 507.0
Montana 3,827 3,818 4,193 4,184 4,416 380.7 376.1 409.6 405.1 427.5
Nebraska 6,748 7,301 7,499 7,956 8,197 363.7 390.7 398.6 419.6 432.3
Nevada 11,137 11,781 11,841 12,925 14,649 403.7 422.2 417.1 447.1 506.7
New Hampshire 3,072 3,119 3,586 3,095 3,467 232.6 235.7 270.3 232.6 260.6
New Jersey 27,271 28,327 29,904 31,337 34,519 307.6 318.3 334.6 349.8 385.3
New Mexico 11,898 12,249 11,558 12,632 13,108 570.5 587.4 554.2 605.8 628.6
New York 100,546 95,803 98,814 103,615 109,433 513.8 487.5 500.4 523.4 552.8
North Carolina 50,596 48,416 47,147 64,376 58,006 518.8 491.6 474.1 641.0 577.6
North Dakota 2,908 2,932 3,451 3,159 3,455 415.6 405.3 466.7 417.3 456.5
Ohio 53,141 53,121 54,858 56,726 60,496 460.3 459.1 473.2 488.5 520.9
Oklahoma 16,843 18,278 20,662 21,025 21,449 441.5 474.7 532.8 537.5 548.4
Oregon 13,454 14,181 15,508 16,305 17,425 345.0 360.8 390.6 404.7 432.5
Pennsylvania 54,993 52,056 50,536 53,460 56,930 430.9 407.5 395.2 417.6 444.7
Rhode Island 4,313 4,312 4,349 4,575 4,936 410.6 410.1 412.2 433.1 467.3
South Carolina 27,149 25,594 28,087 27,538 28,179 574.7 536.0 581.2 562.4 575.5
South Dakota 3,924 3,927 4,166 3,949 4,331 470.9 464.8 488.3 460.0 504.5
Tennessee 32,525 30,370 30,793 31,272 32,304 503.8 467.5 470.2 473.8 489.4
Texas 127,036 129,861 131,219 141,158 142,952 487.5 491.0 486.8 513.9 520.4
Utah 7,615 7,535 8,223 8,633 9,457 266.7 259.7 279.4 288.2 315.7
Vermont 1,724 1,842 2,237 1,901 1,690 275.4 294.0 357.0 303.7 269.9
Virginia 34,963 33,316 36,048 35,349 39,666 427.1 403.3 432.9 421.7 473.2
Washington 24,596 24,950 26,577 28,699 31,254 356.6 357.9 376.4 400.2 435.9
West Virginia 4,790 5,139 4,719 4,958 4,821 258.2 277.1 255.0 268.9 261.4
Wisconsin 23,726 23,572 23,154 24,381 26,894 414.3 410.5 402.1 422.4 466.0
Wyoming 2,102 2,005 1,972 2,037 2,060 364.7 344.1 337.6 347.5 351.5
U.S. TOTAL 1,422,976 1,401,906 1,441,789 1,526,658 1,598,354 453.3 443.5 452.2 475.0 497.3
Northeast 231,947 224,882 227,609 239,174 255,849 416.0 402.0 405.3 424.9 454.6
Midwest 303,622 295,543 303,247 314,893 331,028 451.0 437.5 447.6 463.7 487.5
South 576,656 568,824 582,843 623,397 641,964 491.8 480.5 486.6 514.4 529.7
West 310,751 312,657 328,090 349,194 369,513 422.3 421.1 436.4 459.2 485.9
Guam 1,031 937 839 881 934 644.7 584.2 521.1 544.5 577.3
Puerto Rico 6,227 5,969 4,899 5,295 7,198 169.8 165.1 138.1 152.4 207.2
Virgin Islands 802 775 791 743 571 761.8 739.9 759.3 721.7 554.6
OUTLYING AREAS 8,060 7,681 6,529 6,919 8,703 205.0 198.0 171.2 185.1 232.8
TOTAL 1,431,036 1,409,587 1,448,318 1,533,577 1,607,057 450.2 440.5 448.9 471.6 494.2
65
Table 4. Chlamydia Among Women Reported Cases and Rates of Reported Cases by State/Area and Region in
Alphabetical Order, United States and Outlying Areas, 20122016
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 22,099 21,096 20,619 18,674 19,131 889.8 847.8 825.0 745.2 763.5
Alaska 3,670 3,899 3,940 3,786 3,807 1,047.9 1,115.4 1,127.5 1,083.6 1,089.6
Arizona 22,087 21,950 22,747 22,299 23,693 670.4 658.9 671.5 648.9 689.4
Arkansas 12,247 11,334 11,625 12,088 12,216 816.1 752.7 770.4 797.7 806.2
California 114,396 112,460 115,339 121,387 123,906 598.2 583.7 590.5 616.1 628.9
Colorado 15,476 14,336 14,906 16,151 16,945 598.9 546.8 559.4 595.4 624.6
Connecticut 9,464 9,210 9,512 9,089 9,495 514.2 500.0 516.4 494.2 516.3
Delaware 3,181 3,714 3,084 3,118 3,678 672.9 777.3 638.6 638.8 753.5
District of Columbia 4,426 3,992 3,709 4,632 4,018 1,328.0 1,173.4 1,071.1 1,309.9 1,136.2
Florida 55,628 56,688 58,800 62,048 63,415 563.6 567.4 578.2 598.4 611.6
Georgia 37,456 36,559 36,871 40,302 43,377 738.9 715.3 713.1 769.9 828.6
Hawaii 4,452 4,646 4,469 4,720 4,480 644.9 669.0 637.1 668.3 634.4
Idaho 3,206 3,885 3,895 3,963 4,022 402.2 482.6 477.3 479.7 486.8
Illinois 48,575 45,764 46,516 47,268 48,128 740.9 698.1 709.1 722.1 735.3
Indiana 21,633 20,307 20,586 20,385 21,664 651.8 609.0 615.0 607.1 645.2
Iowa 8,194 7,895 8,385 8,372 8,872 528.7 507.1 536.1 532.6 564.4
Kansas 8,440 8,323 8,276 8,325 8,688 581.8 573.2 568.1 571.0 595.9
Kentucky 12,366 12,086 12,404 12,140 12,345 556.3 541.5 553.7 540.5 549.6
Louisiana 20,507 21,258 21,297 23,351 22,942 872.7 900.2 896.4 978.3 961.2
Maine 2,420 2,404 2,478 2,735 2,795 356.5 354.5 365.0 403.4 412.2
Maryland 19,295 19,049 19,162 18,612 20,145 635.9 623.7 622.1 601.3 650.8
Massachusetts 16,319 15,851 14,000 15,588 17,299 476.4 459.7 402.9 445.6 494.5
Michigan 34,510 32,056 31,470 32,425 31,497 685.7 636.5 624.2 642.8 624.4
Minnesota 12,568 12,950 13,484 14,112 14,967 464.3 474.9 491.2 511.4 542.3
Mississippi 16,771 12,676 14,008 12,335 14,123 1,092.1 824.9 909.9 800.7 916.8
Missouri 19,745 19,303 19,549 19,926 20,757 643.0 626.7 632.8 643.1 669.9
Montana 2,655 2,701 2,878 2,846 2,962 530.8 534.5 564.9 554.1 576.7
Nebraska 4,628 4,945 5,110 5,409 5,527 495.9 526.8 540.9 568.8 581.2
Nevada 7,628 8,183 8,039 8,743 9,849 557.7 591.0 569.2 607.0 683.8
New Hampshire 2,150 2,187 2,452 2,089 2,316 321.6 326.5 365.2 310.4 344.2
New Jersey 20,231 20,771 21,556 22,274 24,021 445.5 456.0 471.0 485.7 523.8
New Mexico 8,724 9,033 8,395 9,227 9,306 828.6 858.9 797.5 877.4 884.9
New York 68,337 64,454 65,114 66,164 67,602 677.9 637.2 640.6 649.7 663.8
North Carolina 39,140 37,146 35,494 47,178 41,085 782.9 735.9 696.0 915.9 797.6
North Dakota 1,898 1,923 2,202 2,028 2,187 551.9 544.2 610.9 551.0 594.2
Ohio 38,879 38,293 39,033 39,825 41,797 658.8 647.8 659.4 671.9 705.2
Oklahoma 12,341 13,065 14,855 14,904 14,933 641.1 672.3 758.7 754.9 756.4
Oregon 9,425 9,932 10,545 11,075 11,542 478.8 500.2 525.6 544.0 566.9
Pennsylvania 37,569 35,657 34,170 35,201 37,030 575.0 545.9 523.0 538.4 566.4
Rhode Island 3,091 3,044 3,037 3,064 3,278 570.3 561.5 558.5 562.9 602.2
South Carolina 20,497 19,103 20,581 19,743 19,783 844.7 779.2 828.8 784.3 785.9
South Dakota 2,801 2,793 2,942 2,831 3,072 674.9 664.2 694.1 663.8 720.3
Tennessee 22,732 21,057 21,203 21,112 21,714 687.3 632.6 631.6 624.1 641.9
Texas 96,405 96,923 96,959 102,141 101,618 735.3 728.7 714.3 738.5 734.7
Utah 5,149 5,050 5,414 5,704 6,031 362.8 350.2 370.0 383.1 405.1
Vermont 1,296 1,319 1,613 1,352 1,171 408.5 415.5 507.7 425.8 368.8
Virginia 24,670 23,167 24,754 23,859 26,146 592.4 551.8 585.1 560.3 614.0
Washington 17,271 17,452 18,193 19,047 20,276 499.8 500.2 515.1 531.2 565.5
West Virginia 3,405 3,624 3,356 3,449 3,330 362.2 386.1 358.4 369.6 356.9
Wisconsin 16,727 16,448 16,063 16,660 18,382 580.1 569.0 554.3 573.7 633.0
Wyoming 1,492 1,387 1,352 1,387 1,356 528.8 486.0 472.5 482.9 472.1
U.S. TOTAL 1,018,272 993,348 1,006,441 1,045,143 1,072,719 638.7 619.0 621.6 640.4 657.3
Northeast 160,877 154,897 153,932 157,556 165,007 562.0 539.7 534.4 546.0 571.8
Midwest 218,598 211,000 213,616 217,566 225,538 639.9 615.9 621.9 632.2 655.4
South 423,166 412,537 418,781 439,686 443,999 708.3 684.1 685.9 711.7 718.6
West 215,631 214,914 220,112 230,335 238,175 584.6 577.5 583.6 604.0 624.5
Guam 726 700 595 618 654 921.9 885.8 749.6 774.4 819.5
Puerto Rico 5,102 4,766 3,770 3,950 5,551 267.1 252.7 204.4 217.4 305.5
Virgin Islands 592 579 590 563 405 1,056.8 1,037.1 1,060.7 1,020.6 734.1
OUTLYING AREAS 6,420 6,045 4,955 5,131 6,610 314.0 299.1 250.4 262.9 338.6
TOTAL 1,024,692 999,393 1,011,396 1,050,274 1,079,329 634.6 615.0 617.1 636.0 653.6
NOTE: Cases reported with unknown sex are not included in this table.
66
Table 5. Chlamydia Among Men Reported Cases and Rates of Reported Cases by State/Area and Region in
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 8,295 8,201 8,318 7,549 7,585 354.7 349.7 354.0 320.8 322.3
Alaska 1,792 1,875 1,849 1,871 1,891 470.0 486.3 477.4 480.9 486.1
Arizona 8,354 8,610 9,650 10,028 11,217 256.4 261.3 288.6 295.7 330.7
Arkansas 4,360 4,104 3,964 4,078 4,521 301.0 282.3 272.0 278.8 309.1
California 52,983 54,679 60,687 67,475 73,625 280.1 286.8 314.9 347.0 378.7
Colorado 6,155 6,050 6,957 7,706 8,624 236.4 228.6 258.5 280.9 314.3
Connecticut 3,524 3,481 3,757 3,926 4,268 201.4 198.4 214.1 224.1 243.6
Delaware 1,257 1,499 1,389 1,487 1,687 282.9 334.6 306.8 324.8 368.5
District of Columbia 2,345 2,400 1,555 3,108 3,112 784.2 783.7 497.4 975.5 976.8
Florida 22,009 23,300 25,239 28,332 31,275 233.0 243.7 259.6 286.1 315.8
Georgia 14,521 14,063 14,736 17,212 19,338 299.3 288.1 299.1 345.6 388.3
Hawaii 1,888 1,994 1,950 2,352 2,421 269.0 281.0 271.6 324.2 333.8
Idaho 1,344 1,528 1,547 1,663 1,869 168.3 189.3 189.0 200.7 225.5
Illinois 18,977 17,943 19,908 21,966 24,008 300.3 283.6 315.0 347.9 380.2
Indiana 7,850 7,708 7,921 8,492 9,174 243.9 238.2 243.8 260.3 281.3
Iowa 3,183 3,058 3,419 3,712 4,111 208.8 199.4 221.6 239.2 264.9
Kansas 2,695 2,689 2,840 3,139 3,472 187.8 186.5 196.2 215.9 238.8
Kentucky 4,851 4,989 5,194 5,273 5,590 224.8 230.6 239.0 242.0 256.5
Louisiana 6,846 7,481 7,655 8,974 8,784 304.0 330.4 336.6 392.9 384.6
Maine 990 1,031 1,050 1,230 1,356 152.2 158.6 161.2 188.9 208.2
Maryland 7,193 7,654 8,237 8,780 10,479 252.4 266.2 284.4 301.6 360.0
Massachusetts 7,193 7,341 7,197 8,406 9,433 223.4 226.2 220.0 255.0 286.2
Michigan 12,962 12,683 12,723 14,015 14,417 267.2 261.0 261.3 287.3 295.5
Minnesota 5,430 5,791 6,414 7,122 7,703 203.2 215.0 236.5 260.9 282.2
Mississippi 6,281 4,788 5,588 5,018 5,955 433.4 329.2 384.2 345.6 410.2
Missouri 8,090 8,025 8,432 9,022 10,086 274.1 270.8 283.5 302.2 337.9
Montana 1,172 1,116 1,314 1,338 1,454 232.1 218.9 255.6 257.6 280.0
Nebraska 2,093 2,196 2,357 2,531 2,649 226.9 236.2 251.6 267.8 280.3
Nevada 3,508 3,590 3,786 4,152 4,777 252.2 255.4 265.4 286.2 329.3
New Hampshire 922 932 1,130 1,006 1,150 141.4 142.6 172.4 153.0 174.9
New Jersey 6,958 7,476 8,272 9,025 10,435 160.9 172.1 189.6 206.4 238.7
New Mexico 3,170 3,209 3,148 3,400 3,794 307.0 310.5 304.8 329.0 367.1
New York 32,147 31,273 33,634 37,346 41,722 338.8 327.9 351.0 388.6 434.1
North Carolina 11,354 11,254 11,638 17,195 16,918 238.9 234.4 240.2 351.5 345.8
North Dakota 1,010 1,009 1,249 1,131 1,268 283.9 272.7 329.5 290.9 326.1
Ohio 14,262 14,828 15,825 16,901 18,699 252.8 262.0 278.9 297.2 328.8
Oklahoma 4,498 5,213 5,802 6,121 6,516 238.0 273.3 302.2 316.0 336.4
Oregon 4,028 4,243 4,953 5,223 5,876 208.6 218.2 252.2 262.0 294.8
Pennsylvania 17,388 16,360 16,315 18,201 19,840 279.1 262.1 260.9 290.5 316.7
Rhode Island 1,222 1,268 1,312 1,511 1,656 240.4 248.9 256.6 295.1 323.5
South Carolina 6,588 6,432 7,376 7,705 8,286 286.8 276.9 314.0 323.9 348.3
South Dakota 1,123 1,134 1,224 1,118 1,259 268.5 267.2 285.1 258.8 291.5
Tennessee 9,754 9,311 9,587 10,158 10,584 309.8 294.0 300.3 315.7 329.0
Texas 30,532 31,980 34,110 38,539 40,992 235.8 243.2 254.9 282.6 300.6
Utah 2,466 2,485 2,808 2,929 3,424 171.7 170.3 189.8 194.3 227.2
Vermont 428 523 622 549 518 138.6 169.2 201.4 177.9 167.9
Virginia 10,247 10,112 11,244 11,460 13,395 254.8 248.9 274.6 277.8 324.7
Washington 7,325 7,498 8,384 9,651 10,975 212.8 215.3 237.5 269.2 306.1
West Virginia 1,385 1,514 1,363 1,509 1,491 151.3 165.4 149.1 165.6 163.7
Wisconsin 6,999 7,114 7,077 7,703 8,487 246.2 249.4 247.5 268.6 296.0
Wyoming 610 617 619 643 704 207.3 207.5 207.7 215.1 235.5
U.S. TOTAL 402,557 405,652 433,325 478,981 522,870 260.6 260.6 276.1 302.7 330.5
Northeast 70,772 69,685 73,289 81,200 90,378 260.8 255.8 268.0 296.1 329.5
Midwest 84,674 84,178 89,389 96,852 105,333 255.4 252.9 267.7 289.2 314.5
South 152,316 154,295 162,995 182,498 196,508 264.8 265.7 277.6 307.2 330.8
West 94,795 97,494 107,652 118,431 130,651 258.3 263.2 287.3 312.4 344.6
Guam 305 234 244 263 280 375.8 287.6 298.9 320.8 341.6
Puerto Rico 1,125 1,203 1,126 1,319 1,647 64.0 69.6 66.1 79.6 99.4
Virgin Islands 210 196 201 180 166 426.3 400.7 414.0 376.7 347.4
OUTLYING AREAS 1,640 1,633 1,571 1,762 2,093 86.9 87.8 85.6 98.6 117.1
TOTAL 404,197 407,285 434,896 480,743 524,963 258.5 258.6 273.9 300.4 328.1
67
Table 6. Chlamydia Reported Cases and Rates of Reported Cases in Selected Metropolitan Statistical Areas
(MSAs)* in Alphabetical Order, United States, 20122016
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Atlanta-Sandy Springs-Roswell, GA 26,470 16,429 25,744 19,106 33,273 485.0 297.5 458.5 334.6 582.6
Austin-Round Rock, TX 9,810 10,138 10,920 11,679 12,299 534.8 538.4 561.9 583.7 614.7
Baltimore-Columbia-Towson, MD 13,578 13,749 14,095 14,016 15,829 493.2 496.2 505.9 501.0 565.8
Birmingham-Hoover, AL 6,868 6,552 6,309 5,839 1,179 604.2 574.6 551.6 509.7 102.9
Boston-Cambridge-Newton, MA-NH 16,339 16,127 14,264 14,378 15,880 352.1 344.3 301.4 301.2 332.6
Buffalo-Cheektowaga-Niagara Falls, NY 6,010 5,724 5,841 5,900 6,252 529.9 504.7 514.0 519.7 550.7
Charlotte-Concord-Gastonia, NC-SC 11,548 11,418 11,766 16,284 14,314 502.8 488.9 494.3 671.1 589.9
Chicago-Naperville-Elgin, IL-IN-WI 51,329 47,837 51,457 54,248 56,478 539.0 501.6 538.6 568.0 591.3
Cincinnati, OH-KY-IN 10,234 10,207 10,516 11,219 11,392 480.8 477.5 489.2 519.9 528.0
Cleveland-Elyria, OH 12,339 12,126 11,363 11,312 12,475 598.0 587.3 550.6 548.9 605.3
Columbus, OH 8,946 9,734 10,258 11,327 12,113 460.2 494.8 514.3 560.3 599.2
Dallas-Fort Worth-Arlington, TX 31,697 30,684 30,549 35,900 32,771 473.0 450.5 439.3 505.4 461.4
Denver-Aurora-Lakewood, CO 12,764 12,131 13,346 13,942 14,282 482.5 449.7 484.6 495.4 507.5
Detroit-Warren-Dearborn, MI 24,229 22,567 21,012 22,238 21,966 564.5 525.4 489.0 516.9 510.6
Hartford-West Hartford-East Hartford, CT 4,562 4,311 4,713 4,689 4,898 375.7 354.8 388.1 387.1 404.4
Houston-The Woodlands-Sugar Land, TX 26,807 29,120 30,554 32,823 35,594 434.0 461.3 470.8 493.1 534.7
Indianapolis-Carmel-Anderson, IN 12,714 11,835 11,952 11,544 12,794 659.1 605.7 606.3 580.4 643.3
Jacksonville, FL 6,813 7,138 7,391 8,012 8,434 494.5 511.8 520.8 552.7 581.9
Kansas City, MO-KS 10,152 9,513 9,866 10,240 11,043 498.0 463.0 476.4 490.5 529.0
Las Vegas-Henderson-Paradise, NV 8,587 9,286 9,485 10,049 11,362 429.2 457.9 458.3 475.2 537.3
Los Angeles-Long Beach-Anaheim, CA 60,231 59,386 64,263 68,285 71,943 461.4 452.2 484.6 511.9 539.3
Louisville-Jefferson County, KY-IN 6,658 6,384 6,751 6,735 6,881 532.1 505.8 531.7 526.8 538.2
Memphis, TN-MS-AR 12,744 10,763 10,554 10,342 10,365 949.8 802.2 785.7 769.4 771.1
Miami-Fort Lauderdale-West Palm Beach, FL 20,933 22,821 24,599 26,746 28,070 363.2 391.6 414.8 444.9 466.9
Milwaukee-Waukesha-West Allis, WI 10,929 10,754 10,303 10,645 11,891 697.5 685.1 655.3 675.6 754.6
Minneapolis-St. Paul-Bloomington, MN-WI 12,144 12,227 13,589 14,709 15,584 354.9 353.5 388.8 417.3 442.2
Nashville-Davidson-Murfreesboro-Franklin, TN 7,151 7,356 7,878 8,066 8,196 414.1 418.5 439.5 440.7 447.8
New Orleans-Metairie, LA 7,118 8,134 8,595 9,291 9,626 580.1 655.5 686.6 735.7 762.2
New York-Newark-Jersey City, NY-NJ-PA 92,763 89,211 93,515 97,835 105,463 467.7 447.2 465.4 484.8 522.6
Oklahoma City, OK 5,640 6,190 7,293 7,633 7,693 435.0 469.1 545.6 561.9 566.3
Orlando-Kissimmee-Sanford, FL 9,928 10,230 11,001 12,026 12,492 446.5 451.1 473.9 503.8 523.3
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 35,513 34,741 33,376 34,910 38,182 590.0 575.7 551.6 575.1 629.0
Phoenix-Mesa-Scottsdale, AZ 20,358 20,164 21,576 21,795 23,567 470.2 458.4 480.6 476.4 515.2
Pittsburgh, PA 8,994 8,605 8,059 8,604 8,623 381.0 364.5 342.1 365.7 366.5
Portland-Vancouver-Hillsboro, OR-WA 7,797 8,536 9,283 9,982 11,052 340.5 368.8 395.3 417.8 462.6
Providence-Warwick, RI-MA 5,941 5,828 5,695 5,907 6,668 371.0 363.3 353.9 366.2 413.4
Raleigh, NC 5,373 4,966 5,126 6,911 6,493 452.1 408.9 412.4 542.6 509.8
Richmond, VA 7,224 6,817 7,817 7,878 8,592 586.4 547.2 620.4 619.7 675.8
Riverside-San Bernardino-Ontario, CA 20,994 19,819 19,560 20,778 20,081 482.6 452.4 440.4 462.8 447.3
Sacramento-Roseville-Arden-Arcade, CA 9,852 9,771 9,674 10,621 10,892 448.5 441.0 431.0 467.0 478.9
Salt Lake City, UT 4,041 3,947 4,423 4,751 5,264 359.6 346.1 383.5 406.0 449.8
San Antonio-New Braunfels, TX 13,023 13,335 11,573 14,465 15,149 582.9 585.5 497.0 606.7 635.4
San Diego-Carlsbad, CA 16,524 14,706 15,754 17,378 18,937 520.1 458.0 482.7 526.7 573.9
San Francisco-Oakland-Hayward, CA 17,171 18,254 20,377 23,519 24,894 385.4 404.2 443.6 505.1 534.6
San Jose-Sunnyvale-Santa Clara, CA 4,676 6,717 6,278 6,898 7,166 246.8 349.9 321.5 348.9 362.5
Seattle-Tacoma-Bellevue, WA 12,965 12,971 13,861 15,257 16,886 365.0 359.3 377.5 408.6 452.3
St. Louis, MO-IL 14,843 14,783 14,711 14,961 15,512 530.9 527.8 524.2 532.1 551.7
Tampa-St. Petersburg-Clearwater, FL 12,274 12,752 12,952 13,472 13,996 431.7 444.2 444.2 452.8 470.4
Virginia Beach-Norfolk-Newport News, VA-NC 12,409 11,852 12,192 11,281 13,223 730.0 694.2 710.2 654.0 766.6
Washington-Arlington-Alexandria, DC-VA-MD-WV 23,872 23,531 18,342 18,890 21,269 407.3 395.5 304.0 309.8 348.8
SELECTED MSAs TOTAL 811,879 792,177 820,371 865,316 919,278 474.2 458.3 469.1 489.6 520.1
* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
The variable used to identify county, which is used to classify cases into MSAs, was complete for 95% of cases in a state contributing data to this MSA.
See Appendix A1.4 for more information.
68
Table 7. Chlamydia Among Women Reported Cases and Rates of Reported Cases in Selected Metropolitan
Statistical Areas (MSAs)* in Alphabetical Order, United States, 20122016
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Birmingham-Hoover, AL 4,866 4,486 4,300 3,940 861 826.1 759.2 724.5 662.3 144.7
Columbus, OH 6,280 6,749 6,895 7,704 8,027 635.3 674.7 680.3 750.2 781.6
Jacksonville, FL 4,812 5,131 5,238 5,637 5,757 680.7 717.4 719.3 758.6 774.8
Kansas City, MO-KS 7,295 6,795 6,991 7,108 7,544 701.5 649.2 662.4 668.8 709.9
Memphis, TN-MS-AR 9,367 7,717 7,758 7,238 7,324 1,342.7 1,105.5 1,109.2 1,033.5 1,045.8
New Orleans-Metairie, LA 5,326 6,062 6,301 6,710 6,843 843.9 948.7 975.3 1,028.6 1,049.0
Oklahoma City, OK 3,951 4,430 5,255 5,420 5,308 601.6 662.5 775.0 786.4 770.2
Pittsburgh, PA 6,325 6,046 5,509 5,681 5,551 519.7 497.4 454.6 469.9 459.2
Raleigh, NC 3,691 3,490 3,502 4,685 4,244 606.8 561.5 550.1 718.3 650.7
Richmond, VA 5,083 4,792 5,311 5,330 5,725 798.4 744.7 815.9 811.1 871.2
Salt Lake City, UT 2,679 2,541 2,873 3,067 3,275 479.6 448.0 500.3 526.4 562.1
St. Louis, MO-IL 10,351 10,364 10,271 10,158 10,417 717.8 717.6 709.9 701.1 719.0
Virginia Beach-Norfolk-Newport News, VA-NC 8,771 8,259 8,425 7,677 8,791 1,015.2 952.5 966.9 877.4 1,004.8
The variable used to identify county, which is used to classify cases into MSAs, was complete for 95% of cases in a state contributing data to this MSA. See
Appendix A1.4 for more information.
69
Table 8. Chlamydia Among Men Reported Cases and Rates of Reported Cases in Selected Metropolitan
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Columbus, OH 2,666 2,985 3,363 3,623 4,086 279.0 308.7 342.8 364.2 410.8
Jacksonville, FL 2,001 1,989 2,138 2,367 2,672 298.2 292.7 309.4 335.1 378.2
Kansas City, MO-KS 2,857 2,718 2,875 3,132 3,499 286.1 269.7 283.1 305.6 341.5
Memphis, TN-MS-AR 3,377 3,046 2,795 3,104 3,035 524.3 473.2 434.1 482.2 471.4
Oklahoma City, OK 1,688 1,760 2,036 2,213 2,385 263.8 270.4 309.1 330.7 356.4
Pittsburgh, PA 2,668 2,550 2,541 2,909 3,062 233.3 222.6 222.1 254.3 267.6
Raleigh, NC 1,673 1,474 1,622 2,226 2,248 288.3 248.6 267.5 358.3 361.8
Richmond, VA 2,129 2,011 2,503 2,540 2,827 357.6 333.9 410.9 413.5 460.3
Salt Lake City, UT 1,362 1,406 1,550 1,684 1,989 241.0 245.2 267.7 286.6 338.5
St. Louis, MO-IL 4,474 4,411 4,429 4,762 5,091 330.5 325.1 325.8 349.4 373.6
70
Table 9. Chlamydia Reported Cases and Rates of Reported Cases in Counties and Independent Cities* Ranked
by Number of Reported Cases, United States, 2016
Rank* County/Independent City Cases Rate per 100,000 Population Cumulative Percentage
1 Los Angeles County, CA 59,116 581.3 3
2 Cook County, IL 41,056 783.8 6
3 Harris County, TX 27,847 613.6 8
4 Maricopa County, AZ 22,134 531.1 9
5 Philadelphia County, PA 19,992 1,275.5 10
6 Kings County, NY 19,900 754.7 11
7 San Diego County, CA 18,937 573.9 13
8 Bronx County, NY 17,043 1,171.0 14
9 New York County, NY 15,216 925.3 15
10 Wayne County, MI 14,082 800.4 15
11 Bexar County, TX 13,724 723.2 16
12 Queens County, NY 12,904 551.7 17
13 Orange County, CA 12,827 404.7 18
14 Miami-Dade County, FL 12,687 471.1 19
15 Dallas County, TX 12,216 478.4 20
16 San Bernardino County, CA 11,495 540.1 20
17 Clark County, NV 11,362 537.3 21
18 Milwaukee County, WI 10,751 1,122.5 22
19 Cuyahoga County, OH 10,090 803.4 22
20 Broward County, FL 9,928 523.5 23
21 Marion County, IN 9,815 1,045.2 23
22 Franklin County, OH 9,712 775.9 24
23 King County, WA 9,422 445.0 25
24 Tarrant County, TX 9,230 465.6 25
25 Travis County, TX 8,618 732.5 26
26 Riverside County, CA 8,586 363.7 26
27 Sacramento County, CA 8,525 567.8 27
28 Orange County, FL 8,354 648.5 27
29 Fulton County, GA 8,292 820.5 28
30 San Francisco County, CA 8,175 945.3 28
31 Alameda County, CA 8,166 498.5 29
32 Hillsborough County, FL 8,066 597.9 29
33 Mecklenburg County, NC 7,969 770.6 30
34 Shelby County, TN 7,838 835.5 30
35 Hennepin County, MN 7,575 619.3 31
36 Baltimore (City), MD 7,394 1,189.0 31
37 Santa Clara County, CA 6,979 363.9 32
38 Hamilton County, OH 6,915 856.2 32
39 Prince George's County, MD 6,753 742.5 33
40 Duval County, FL 6,634 726.6 33
41 Fresno County, CA 6,473 664.0 33
42 Collin County, TX 6,364 696.2 34
43 Kern County, CA 6,307 714.9 34
44 Denver County, CO 6,300 923.0 35
45 Allegheny County, PA 6,020 489.2 35
46 Pima County, AZ 5,819 576.1 35
47 DeKalb County, GA 5,799 789.1 36
48 Essex County, NJ 5,726 718.1 36
49 St. Louis County, MO 5,698 567.9 36
50 Jackson County, MO 5,585 812.2 37
51 Wake County, NC 5,502 537.2 37
52 Palm Beach County, FL 5,455 383.4 37
53 Honolulu County, HI 5,399 540.6 38
54 Oklahoma County, OK 5,273 678.8 38
55 Jefferson County, KY 5,221 683.7 38
56 Contra Costa County, CA 5,205 462.0 39
57 Erie County, NY 5,201 563.7 39
58 Salt Lake County, UT 5,106 461.1 39
59 Multnomah County, OR 5,065 640.9 40
60 Pierce County, WA 4,965 588.3 40
61 Bernalillo County, NM 4,759 703.3 40
62 Middlesex County, MA 4,729 298.3 41
63 Monroe County, NY 4,706 627.8 41
64 Orleans Parish, LA 4,632 1,188.9 41
65 Guilford County, NC 4,594 887.6 42
66 Suffolk County, NY 4,506 300.1 42
67 Davidson County, TN 4,476 659.3 42
68 Etowah County, AL 4,348 4,219.0 42
69 Hartford County, CT 4,219 471.0 43
70 Baltimore County, MD 4,190 504.1 43
* The top 70 counties and independent cities ranked in descending order by number of cases reported in 2016 then by rate are displayed.
NOTE: Relative rankings of counties may be impacted by completeness of the variable used to identify county. In 2016, the variable used to identify county was
complete for 95% of cases in Alabama and Massachusetts. See Appendix A1.4 for more information.
71
Table 10. Chlamydia Reported Cases and Rates of Reported Cases by Age Group and Sex, United States,
20122016
Age Cases Rates per 100,000 Population*
Group Total Male Female Unknown Sex Total Male Female
04 774 272 495 7 3.9 2.7 5.1
59 151 17 134 0 0.7 0.2 1.3
1014 14,355 1,655 12,673 27 69.5 15.7 125.5
1519 433,239 86,150 346,430 659 2,028.2 785.8 3,331.7
2024 554,173 152,772 400,629 772 2,453.9 1,322.8 3,630.9
2529 224,014 77,666 146,037 311 1,046.9 716.2 1,383.8
2012
3034 97,736 38,011 59,594 131 467.4 362.2 572.1
3539 43,660 18,274 25,313 73 224.0 188.1 259.0
4044 23,882 11,596 12,245 41 113.6 110.9 115.9
4554 20,321 11,332 8,961 28 45.9 52.0 39.9
5564 4,950 2,783 2,161 6 12.8 15.0 10.8
65+ 1,134 602 525 7 2.6 3.2 2.2
Unknown Age 4,587 1,427 3,075 85
TOTAL 1,422,976 402,557 1,018,272 2,147 453.3 260.6 638.7
04 681 266 402 13 3.4 2.6 4.1
59 145 20 123 2 0.7 0.2 1.2
1014 12,585 1,554 11,001 30 60.9 14.7 108.9
1519 395,612 78,404 316,438 770 1,869.7 722.9 3,068.4
2024 553,658 153,102 399,545 1,011 2,428.8 1,310.9 3,594.2
2529 233,429 82,190 150,733 506 1,081.7 749.9 1,419.3
2013
3034 103,675 41,017 62,414 244 487.6 384.0 589.8
3539 46,991 20,157 26,720 114 239.7 206.0 272.1
4044 24,774 12,200 12,501 73 118.8 117.8 119.2
4554 21,511 12,180 9,299 32 49.1 56.5 41.9
5564 5,424 3,154 2,259 11 13.8 16.6 11.1
65+ 1,377 750 616 11 3.1 3.8 2.5
Unknown Age 2,044 658 1,297 89
TOTAL 1,401,906 405,652 993,348 2,906 443.5 260.6 619.0
04 603 200 388 15 3.0 2.0 4.0
59 181 26 152 3 0.9 0.2 1.5
1014 11,406 1,342 10,041 23 55.2 12.7 99.2
1519 381,717 77,908 303,294 515 1,811.9 722.4 2,949.3
2024 566,385 159,804 405,876 705 2,472.0 1,361.3 3,632.7
2529 253,825 91,729 161,793 303 1,154.4 821.8 1,494.4
2014
3034 113,208 45,990 67,060 158 525.9 425.5 625.6
3539 52,536 22,894 29,545 97 263.7 230.3 296.0
4044 27,426 13,711 13,662 53 133.2 134.2 131.7
4554 24,773 14,318 10,424 31 57.0 66.8 47.3
5564 6,527 3,911 2,603 13 16.3 20.2 12.5
65+ 1,449 871 570 8 3.1 4.3 2.2
Unknown Age 1,753 621 1,033 99
TOTAL 1,441,789 433,325 1,006,441 2,023 452.2 276.1 621.6
04 518 196 322 0 2.6 1.9 3.3
59 148 18 130 0 0.7 0.2 1.3
1014 10,642 1,216 9,394 32 51.6 11.6 93.0
1519 391,396 82,775 307,937 684 1,854.2 766.6 2,986.5
2024 589,963 172,313 416,772 878 2,594.5 1,476.8 3,764.4
2529 280,429 104,679 175,291 459 1,248.5 917.5 1,586.0
2015
3034 123,866 52,019 71,653 194 571.5 477.7 664.3
3539 59,905 27,180 32,621 104 294.0 267.2 319.8
4044 30,379 15,210 15,118 51 150.3 151.6 148.4
4554 28,833 17,011 11,764 58 66.8 79.9 53.7
5564 7,756 4,901 2,840 15 19.0 24.9 13.4
65+ 1,596 1,043 546 7 3.3 4.9 2.0
Unknown Age 1,227 420 755 52
TOTAL 1,526,658 478,981 1,045,143 2,534 475.0 302.7 640.4
04 597 225 368 4 3.0 2.2 3.8
59 188 25 161 2 0.9 0.2 1.6
1014 10,571 1,341 9,206 24 51.3 12.7 91.1
1519 407,230 89,899 316,639 692 1,929.2 832.6 3,070.9
2024 601,173 181,857 418,388 928 2,643.8 1,558.6 3,779.0
2529 298,176 114,484 183,222 470 1,327.5 1,003.4 1,657.8
2016
3034 133,062 58,583 74,226 253 613.9 538.0 688.2

3539 66,669 31,671 34,872 126 327.2 311.3 341.8
4044 32,548 16,784 15,705 59 161.0 167.3 154.2
4554 32,316 19,569 12,683 64 74.8 91.9 57.9
5564 9,321 5,942 3,354 25 22.8 30.1 15.8
65+ 1,772 1,161 597 14 3.7 5.5 2.2
Unknown Age 4,731 1,329 3,298 104
TOTAL 1,598,354 522,870 1,072,719 2,765 497.3 330.5 657.3
* 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 04 age group may include cases due to perinatal transmission.
72
Table 11A. Chlamydia Reported Cases by Race/Ethnicity, Age Group, and Sex, United States*, 2016
American Indians/ Native Hawaiians/

Asians Blacks
Age Alaska Natives Other Pacific Islanders
Group Total Male Female Total Male Female Total Male Female Total Male Female
04 3 1 2 1 0 1 134 53 81 5 3 2
59 7 0 7 3 0 3 50 8 42 2 0 2
1014 177 13 164 37 4 33 4,113 683 3,426 9 2 7
1519 4,332 862 3,470 2,823 442 2,375 131,081 35,461 95,551 789 127 662
2024 5,887 1,411 4,475 7,339 1,917 5,416 170,169 57,223 112,858 1,356 299 1,055
2529 3,714 977 2,737 4,696 1,806 2,883 81,647 33,340 48,261 773 237 536
3034 1,907 553 1,354 2,567 1,119 1,444 32,095 15,546 16,530 371 128 243
3539 902 269 633 1,381 625 754 14,804 8,080 6,713 198 75 123
4044 408 129 279 821 418 401 6,580 4,017 2,560 72 28 44
4554 335 142 192 813 456 352 6,120 4,040 2,075 65 33 32
5564 80 34 46 237 132 105 1,906 1,253 651 13 9 4
65+ 10 5 5 38 22 16 261 179 81 1 0 1
Unknown Age 6 4 2 25 10 15 550 174 371 3 0 3
TOTAL 17,768 4,400 13,366 20,781 6,951 13,798 449,510 160,057 289,200 3,657 941 2,714
Other/
Whites Multirace Hispanics
Age Unknown
04 105 33 72 5 4 1 67 26 41 277 105 168
59 29 6 23 0 0 0 27 4 23 70 7 61
1014 1,881 105 1,775 86 3 83 1,411 173 1,238 2,857 358 2,480
1519 95,731 15,715 79,975 2,830 485 2,344 50,984 9,993 40,968 118,660 26,814 91,294
2024 154,572 43,536 110,984 3,552 958 2,591 77,237 20,639 56,552 181,061 55,874 124,457
2529 73,929 28,222 45,677 1,731 778 952 41,273 14,517 26,724 90,413 34,607 55,452
3034 33,089 14,843 18,240 834 487 347 19,960 8,024 11,918 42,239 17,883 24,150
3539 16,352 8,113 8,236 380 230 150 10,529 4,319 6,198 22,123 9,960 12,065
4044 7,825 4,254 3,570 179 113 65 5,130 2,279 2,837 11,533 5,546 5,949
4554 8,685 6,019 2,661 229 188 41 4,244 2,307 1,932 11,825 6,384 5,398
5564 2,625 2,012 612 55 44 11 851 446 404 3,554 2,012 1,521
65+ 531 393 138 4 4 0 119 79 40 808 479 316
Unknown Age 255 85 163 2 0 2 190 54 134 3,700 1,002 2,608
TOTAL 395,609 123,336 272,126 9,887 3,294 6,587 212,022 62,860 149,009 489,120 161,031 325,919
* Includes 50 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2016.
Total includes cases reported with unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 35 for total and sex-specific cases
and rates. Cases in the 04 age group may include cases due to perinatal transmission.
73
Table 11B. Chlamydia Rates of Reported Cases per 100,000 Population by Race/Ethnicity, Age Group, and Sex,
United States*, 2016
Asians Blacks
04 1.8 1.2 2.4 0.1 0.0 0.2 4.9 3.8 6.0 12.4 14.3 10.3
59 4.0 0.0 8.1 0.3 0.0 0.6 1.8 0.6 3.0 4.9 0.0 9.9
1014 100.4 14.5 189.1 3.6 0.8 6.5 146.3 47.9 247.0 22.3 9.8 35.1
1519 2,378.1 930.0 3,878.3 274.9 85.3 466.8 4,383.6 2,337.7 6,485.2 1,943.2 606.5 3,366.6
2024 2,956.3 1,382.0 4,611.6 583.1 300.1 873.9 5,008.3 3,316.9 6,747.6 2,890.0 1,243.3 4,612.8
2529 2,026.3 1,047.6 3,040.3 316.4 249.6 379.1 2,621.1 2,164.0 3,065.4 1,485.7 879.1 2,138.1
3034 1,171.7 682.1 1,657.6 170.6 157.4 181.9 1,159.1 1,167.8 1,149.8 761.0 512.2 1,022.8
3539 609.0 365.2 850.1 97.7 95.1 99.8 567.7 653.8 489.3 466.8 347.7 590.0
4044 284.6 182.7 383.5 58.1 63.3 53.3 257.9 335.1 189.2 193.2 148.7 238.6
4554 108.4 94.8 120.5 34.0 40.9 27.6 115.5 162.4 73.8 93.3 95.3 91.4
5564 28.9 26.1 31.4 12.3 15.1 9.9 41.3 59.5 25.9 24.0 34.0 14.4
65+ 4.1 4.5 3.7 1.9 2.5 1.4 6.2 10.6 3.2 2.2 0.0 4.1
Unknown Age
TOTAL 749.8 376.7 1,112.1 119.3 84.0 151.0 1,125.9 839.0 1,387.2 653.4 333.4 978.1
Age Whites Multirace Hispanics

Group Total Male Female Total Male Female Total Male Female
04 1.1 0.7 1.5 0.5 0.8 0.2 1.3 1.0 1.6
59 0.3 0.1 0.5 0.0 0.0 0.0 0.5 0.2 0.9
1014 17.3 1.9 33.5 11.1 0.8 21.8 28.6 6.9 51.1
1519 834.7 266.9 1,433.3 413.2 139.8 693.6 1,081.1 414.0 1,779.8
2024 1,244.2 682.5 1,836.2 591.5 318.9 863.4 1,604.7 826.1 2,443.1
2529 585.2 439.7 734.9 374.8 351.1 396.2 910.8 608.7 1,244.9
3034 267.8 238.1 298.0 217.6 269.4 171.4 448.4 345.0 560.5
3539 141.0 138.8 143.2 116.9 150.7 87.0 248.1 197.5 301.4
4044 66.0 71.4 60.5 64.0 85.9 43.9 130.4 114.4 146.2
4554 30.9 43.1 18.9 46.7 81.0 15.9 64.9 69.9 59.7
5564 9.0 14.1 4.1 14.1 23.7 5.4 19.8 21.5 18.2
65+ 1.4 2.4 0.7 1.2 2.6 0.0 3.2 4.8 1.9
Unknown Age
TOTAL 199.8 126.4 271.1 150.2 101.7 197.0 374.6 219.8 532.4

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 35 for total and sex-specific cases
and rates. Cases in the 04 age group may include cases due to perinatal transmission. No population data exist for unknown sex, unknown age, or unknown race;
therefore rates are not calculated.
74
Table 12. Chlamydia Among Women Aged 1524 Years Reported Cases and Rates of Reported Cases by Age,
Age Cases Rate per 100,000 Population
15 24,453 1,207.2
16 45,041 2,212.8
17 69,465 3,346.4
18 99,459 4,699.5
2012
19 108,012 5,036.6
20 104,425 4,727.7
21 96,456 4,266.0
22 81,292 3,593.9
23 65,473 3,011.7
24 52,983 2,489.8
15 21,680 1,070.3
16 40,528 1,994.3
17 61,666 3,018.5
18 90,330 4,332.6
2013
19 102,234 4,806.0
20 99,556 4,617.4
21 93,713 4,219.8
22 81,884 3,600.6
23 68,600 3,013.5
24 55,792 2,548.7
15 20,096 987.4
16 38,507 1,891.0
17 58,940 2,880.9
18 87,040 4,224.2
2014
19 98,711 4,688.0
20 98,480 4,581.9
21 94,204 4,323.2
22 82,581 3,679.3
23 71,535 3,112.0
24 59,076 2,567.1
15 19,643 945.9
16 37,786 1,847.7
17 60,149 2,935.4
18 89,481 4,339.6
2015
19 100,878 4,854.1
20 99,861 4,703.6
21 95,927 4,427.2
22 84,740 3,855.7
23 73,686 3,254.1
24 62,558 2,697.2
15 19,704 948.8
16 39,066 1,910.3
17 61,406 2,996.7
18 93,174 4,518.7
2016
19 103,289 4,970.1
20 100,524 4,734.8
21 96,723 4,463.9
22 84,813 3,859.0
23 73,054 3,226.2
24 63,274 2,728.0
NOTE: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
75
Table 13. Gonorrhea Reported Cases and Rates of Reported Cases by State, Ranked by Rates,
United States, 2016
1 Mississippi 7,157 239.2
2 Louisiana 10,782 230.8
3 Georgia 20,553 201.2
4 Alaska 1,454 196.9
6 Oklahoma 7,574 193.6
7 Arkansas 5,732 192.5
8 Missouri 11,479 188.7
9 South Carolina 9,194 187.8
10 Delaware 1,702 179.9
11 Ohio 20,487 176.4
12 Alabama 8,408 173.0
13 New Mexico 3,516 168.6
14 California 64,551 164.9
15 Illinois 21,199 164.8
16 Maryland 9,523 158.5
17 Texas 42,472 154.6
18 Tennessee 10,179 154.2
19 Nevada 4,380 151.5
20 Arizona 10,330 151.3
21 South Dakota 1,269 147.8
22 New York 29,000 146.5
U.S. TOTAL 468,514 145.8
23 Indiana 9,451 142.8
24 Florida 28,162 138.9
25 Virginia 11,084 132.2
26 North Dakota 1,000 132.1
27 Kentucky 5,812 131.3
28 Michigan 12,450 125.5
29 Kansas 3,353 115.2
30 Pennsylvania 14,603 114.1
31 Washington 8,174 114.0
32 Nebraska 2,156 113.7
33 Wisconsin 6,498 112.6
34 Colorado 5,975 109.5
35 Oregon 4,353 108.0
36 Hawaii 1,467 102.5
37 Minnesota 5,104 93.0
38 New Jersey 8,162 91.1
39 Montana 867 83.9
40 Iowa 2,600 83.2
41 Connecticut 2,731 76.1
42 Massachusetts 4,980 73.3
43 Utah 2,100 70.1
44 Rhode Island 716 67.8
45 West Virginia 919 49.8
46 Wyoming 275 46.9
47 Idaho 635 38.4
48 New Hampshire 456 34.3
49 Maine 451 33.9
50 Vermont 126 20.1
Total includes cases reported by the District of Columbia with 3,226 cases and a rate of 479.9, but excludes outlying areas (Guam with 133 cases and rate of 82.2,
Puerto Rico with 744 cases and rate of 21.4, and Virgin Islands with 35 cases and rate of 34.0).
76
Table 14. Gonorrhea Reported Cases and Rates of Reported Cases by State/Area and Region in Alphabetical
Order, United States and Outlying Areas, 20122016
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 9,270 8,377 7,677 7,196 8,408 192.2 173.3 158.3 148.1 173.0
Alaska 726 1,128 1,341 1,113 1,454 99.3 153.4 182.0 150.7 196.9
Arizona 5,809 6,412 7,750 8,245 10,330 88.6 96.8 115.1 120.8 151.3
Arkansas 4,307 4,007 4,539 4,780 5,732 146.0 135.4 153.0 160.5 192.5
California 33,579 38,166 45,408 54,135 64,551 88.3 99.6 117.0 138.3 164.9
Colorado 2,822 2,820 3,170 4,387 5,975 54.4 53.5 59.2 80.4 109.5
Connecticut 2,133 2,860 2,333 2,088 2,731 59.4 79.5 64.9 58.1 76.1
Delaware 899 1,390 1,279 1,310 1,702 98.0 150.1 136.7 138.5 179.9
Florida 19,462 20,818 20,944 24,125 28,162 100.7 106.5 105.3 119.0 138.9
Georgia 15,326 14,252 13,770 15,982 20,553 154.5 142.6 136.4 156.5 201.2
Hawaii 815 718 1,020 1,239 1,467 58.5 51.1 71.9 86.5 102.5
Idaho 167 211 443 472 635 10.5 13.1 27.1 28.5 38.4
Illinois 18,149 16,464 15,970 17,130 21,199 141.0 127.8 124.0 133.2 164.8
Indiana 7,338 7,144 7,289 7,843 9,451 112.2 108.7 110.5 118.5 142.8
Iowa 2,006 1,472 1,641 2,247 2,600 65.3 47.6 52.8 71.9 83.2
Kansas 2,228 2,161 2,568 2,536 3,353 77.2 74.7 88.4 87.1 115.2
Kentucky 4,283 4,315 4,353 4,678 5,812 97.8 98.2 98.6 105.7 131.3
Louisiana 8,873 8,669 9,002 10,282 10,782 192.8 187.4 193.6 220.1 230.8
Maine 456 245 237 417 451 34.3 18.4 17.8 31.4 33.9
Maryland 5,686 5,989 6,108 6,858 9,523 96.6 101.0 102.2 114.2 158.5
Massachusetts 2,628 3,106 3,817 3,817 4,980 39.5 46.4 56.6 56.2 73.3
Michigan 12,584 10,569 9,688 10,330 12,450 127.3 106.8 97.8 104.1 125.5
Minnesota 3,082 3,873 4,073 4,097 5,104 57.3 71.5 74.6 74.6 93.0
Mississippi 6,875 5,096 5,625 5,775 7,157 230.3 170.4 187.9 193.0 239.2
Missouri 7,889 7,546 7,387 8,942 11,479 131.0 124.8 121.8 147.0 188.7
Montana 108 224 434 844 867 10.7 22.1 42.4 81.7 83.9
Nebraska 1,429 1,385 1,459 1,703 2,156 77.0 74.1 77.5 89.8 113.7
Nevada 2,264 2,714 3,188 3,630 4,380 82.1 97.3 112.3 125.6 151.5
New Hampshire 147 121 226 245 456 11.1 9.1 17.0 18.4 34.3
New Jersey 7,486 7,014 6,636 7,228 8,162 84.4 78.8 74.2 80.7 91.1
New Mexico 1,883 1,918 2,246 2,489 3,516 90.3 92.0 107.7 119.4 168.6
New York 22,571 19,919 20,758 25,561 29,000 115.3 101.4 105.1 129.1 146.5
North Carolina 14,318 13,666 14,415 19,809 19,687 146.8 138.8 145.0 197.2 196.0
North Dakota 335 492 694 684 1,000 47.9 68.0 93.8 90.4 132.1
Ohio 16,493 16,619 16,237 16,564 20,487 142.9 143.6 140.0 142.6 176.4
Oklahoma 4,441 5,303 6,137 6,542 7,574 116.4 137.7 158.2 167.3 193.6
Oregon 1,464 1,729 2,320 3,232 4,353 37.5 44.0 58.4 80.2 108.0
Pennsylvania 15,390 13,874 12,710 12,791 14,603 120.6 108.6 99.4 99.9 114.1
Rhode Island 507 454 590 580 716 48.3 43.2 55.9 54.9 67.8
South Carolina 7,638 7,194 8,253 8,206 9,194 161.7 150.7 170.8 167.6 187.8
South Dakota 707 784 892 1,048 1,269 84.8 92.8 104.6 122.1 147.8
Tennessee 9,098 7,376 7,199 8,386 10,179 140.9 113.5 109.9 127.1 154.2
Texas 32,473 33,835 35,322 39,717 42,472 124.6 127.9 131.0 144.6 154.6
Utah 479 951 1,441 1,562 2,100 16.8 32.8 49.0 52.1 70.1
Vermont 99 97 84 155 126 15.8 15.5 13.4 24.8 20.1
Virginia 6,885 6,952 8,250 8,099 11,084 84.1 84.2 99.1 96.6 132.2
Washington 3,238 4,369 6,221 7,171 8,174 46.9 62.7 88.1 100.0 114.0
West Virginia 831 1,063 841 769 919 44.8 57.3 45.5 41.7 49.8
Wisconsin 4,704 4,599 4,078 5,260 6,498 82.1 80.1 70.8 91.1 112.6
Wyoming 44 66 116 175 275 7.6 11.3 19.9 29.9 46.9
U.S. TOTAL 334,826 333,004 350,062 395,216 468,514 106.7 105.3 109.8 123.0 145.8
Northeast 51,417 47,690 47,391 52,882 61,225 92.2 85.2 84.4 94.0 108.8
Midwest 76,944 73,108 71,976 78,384 97,046 114.3 108.2 106.2 115.4 142.9
South 153,067 150,780 155,597 175,256 202,166 130.5 127.4 129.9 144.6 166.8
West 53,398 61,426 75,098 88,694 108,077 72.6 82.7 99.9 116.6 142.1
Guam 92 92 99 147 133 57.5 57.4 61.5 90.9 82.2
Puerto Rico 345 356 454 620 744 9.4 9.8 12.8 17.8 21.4
Virgin Islands 136 58 84 52 35 129.2 55.4 80.6 50.5 34.0
OUTLYING AREAS 573 506 637 819 912 14.6 13.0 16.7 21.9 24.4
TOTAL 335,399 333,510 350,699 396,035 469,426 105.5 104.2 108.7 121.8 144.4
77
Table 15. Gonorrhea Among Women Reported Cases and Rates of Reported Cases by State/Area and Region
in Alphabetical Order, United States and Outlying Areas, 20122016
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 5,187 4,668 4,090 3,629 4,088 208.9 187.6 163.6 144.8 163.1
Alaska 385 589 665 567 738 109.9 168.5 190.3 162.3 211.2
Arizona 2,827 3,102 3,564 3,505 4,315 85.8 93.1 105.2 102.0 125.6
Arkansas 2,432 2,160 2,527 2,510 2,964 162.1 143.4 167.5 165.6 195.6
California 13,045 14,258 16,009 18,404 20,914 68.2 74.0 82.0 93.4 106.2
Colorado 1,362 1,243 1,318 1,832 2,323 52.7 47.4 49.5 67.5 85.6
Connecticut 1,153 1,419 1,108 851 1,165 62.6 77.0 60.1 46.3 63.3
Delaware 496 763 693 641 799 104.9 159.7 143.5 131.3 163.7
District of Columbia 1,006 953 858 874 857 301.8 280.1 247.8 247.2 242.3
Florida 9,570 9,718 9,228 10,078 11,488 97.0 97.3 90.7 97.2 110.8
Georgia 7,921 7,060 6,552 7,322 9,156 156.3 138.1 126.7 139.9 174.9
Hawaii 299 264 350 446 551 43.3 38.0 49.9 63.2 78.0
Idaho 63 87 196 197 237 7.9 10.8 24.0 23.8 28.7
Illinois 9,837 8,574 7,559 7,698 8,920 150.1 130.8 115.2 117.6 136.3
Indiana 4,139 3,796 3,819 3,984 4,811 124.7 113.8 114.1 118.6 143.3
Iowa 1,170 812 862 1,122 1,267 75.5 52.2 55.1 71.4 80.6
Kansas 1,339 1,222 1,464 1,262 1,695 92.3 84.2 100.5 86.6 116.3
Kentucky 2,328 2,331 2,270 2,242 2,716 104.7 104.4 101.3 99.8 120.9
Louisiana 5,080 4,927 5,049 5,535 5,493 216.2 208.6 212.5 231.9 230.1
Maine 240 119 98 143 134 35.4 17.5 14.4 21.1 19.8
Maryland 2,878 2,841 2,793 3,090 3,944 94.9 93.0 90.7 99.8 127.4
Massachusetts 1,076 1,168 1,215 1,027 1,390 31.4 33.9 35.0 29.4 39.7
Michigan 7,194 5,865 5,129 5,191 6,201 142.9 116.5 101.7 102.9 122.9
Minnesota 1,676 2,037 1,802 1,675 2,214 61.9 74.7 65.6 60.7 80.2
Mississippi 3,834 2,726 2,987 3,131 3,665 249.7 177.4 194.0 203.2 237.9
Missouri 4,209 3,944 3,620 4,187 5,228 137.1 128.0 117.2 135.1 168.7
Montana 58 127 221 462 493 11.6 25.1 43.4 89.9 96.0
Nebraska 784 694 770 870 1,055 84.0 73.9 81.5 91.5 110.9
Nevada 982 1,203 1,294 1,402 1,611 71.8 86.9 91.6 97.3 111.9
New Hampshire 61 52 91 65 132 9.1 7.8 13.6 9.7 19.6
New Jersey 3,798 3,484 3,082 3,110 3,338 83.6 76.5 67.3 67.8 72.8
New Mexico 857 823 961 1,087 1,542 81.4 78.3 91.3 103.4 146.6
New York 10,021 8,020 7,077 8,593 8,709 99.4 79.3 69.6 84.4 85.5
North Carolina 8,093 7,547 7,759 10,064 9,527 161.9 149.5 152.2 195.4 185.0
North Dakota 207 301 385 375 516 60.2 85.2 106.8 101.9 140.2
Ohio 9,706 9,176 8,735 8,466 10,130 164.5 155.2 147.6 142.8 170.9
Oklahoma 2,652 3,000 3,451 3,580 4,052 137.8 154.4 176.3 181.3 205.2
Oregon 528 566 786 1,158 1,519 26.8 28.5 39.2 56.9 74.6
Pennsylvania 8,360 7,206 6,164 5,889 6,135 128.0 110.3 94.3 90.1 93.8
Rhode Island 232 192 218 172 221 42.8 35.4 40.1 31.6 40.6
South Carolina 4,416 4,050 4,527 4,401 4,709 182.0 165.2 182.3 174.8 187.1
South Dakota 446 464 557 621 757 107.5 110.3 131.4 145.6 177.5
Tennessee 4,721 3,617 3,419 3,809 4,681 142.7 108.7 101.8 112.6 138.4
Texas 17,151 17,206 17,253 17,843 18,620 130.8 129.4 127.1 129.0 134.6
Utah 132 373 565 507 717 9.3 25.9 38.6 34.1 48.2
Vermont 54 46 35 85 32 17.0 14.5 11.0 26.8 10.1
Virginia 3,734 3,678 4,361 4,007 5,056 89.7 87.6 103.1 94.1 118.7
Washington 1,230 1,704 2,504 2,797 2,943 35.6 48.8 70.9 78.0 82.1
West Virginia 438 539 461 365 422 46.6 57.4 49.2 39.1 45.2
Wisconsin 2,640 2,455 2,046 2,557 3,189 91.6 84.9 70.6 88.1 109.8
Wyoming 19 39 61 86 120 6.7 13.7 21.3 29.9 41.8
U.S. TOTAL 172,066 163,208 162,608 173,514 197,499 107.9 101.7 100.4 106.3 121.0
Northeast 24,995 21,706 19,088 19,935 21,256 87.3 75.6 66.3 69.1 73.7
Midwest 43,347 39,340 36,748 38,008 45,983 126.9 114.8 107.0 110.4 133.6
South 81,937 77,784 78,278 83,121 92,237 137.1 129.0 128.2 134.5 149.3
West 21,787 24,378 28,494 32,450 38,023 59.1 65.5 75.6 85.1 99.7
Guam 46 43 47 67 59 58.4 54.4 59.2 84.0 73.9
Puerto Rico 157 120 161 259 313 8.2 6.4 8.7 14.3 17.2
Virgin Islands 92 41 54 28 14 164.2 73.4 97.1 50.8 25.4
OUTLYING AREAS 295 204 262 354 386 14.4 10.1 13.2 18.1 19.8
TOTAL 172,361 163,412 162,870 173,868 197,885 106.7 100.6 99.4 105.3 119.8
78
Table 16. Gonorrhea Among Men Reported Cases and Rates of Reported Cases by State/Area and Region in
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 4,034 3,680 3,563 3,519 4,265 172.5 156.9 151.6 149.5 181.2
Alaska 341 539 676 546 716 89.4 139.8 174.5 140.4 184.0
Arizona 2,981 3,310 4,186 4,724 6,011 91.5 100.5 125.2 139.3 177.2
Arkansas 1,873 1,843 2,007 2,270 2,768 129.3 126.8 137.7 155.2 189.2
California 20,431 23,849 29,310 35,644 43,259 108.0 125.1 152.1 183.3 222.5
Colorado 1,460 1,577 1,852 2,555 3,652 56.1 59.6 68.8 93.1 133.1
Connecticut 978 1,440 1,219 1,237 1,564 55.9 82.1 69.5 70.6 89.3
Delaware 403 627 586 669 903 90.7 140.0 129.4 146.1 197.2
Florida 9,892 11,049 11,686 14,039 16,661 104.7 115.5 120.2 141.8 168.2
Georgia 7,301 7,075 7,137 8,631 11,378 150.5 144.9 144.9 173.3 228.5
Hawaii 516 454 669 793 914 73.5 64.0 93.2 109.3 126.0
Idaho 104 124 247 275 396 13.0 15.4 30.2 33.2 47.8
Illinois 8,283 7,872 8,386 9,335 12,255 131.1 124.4 132.7 147.8 194.1
Indiana 3,188 3,347 3,465 3,854 4,636 99.1 103.4 106.6 118.2 142.1
Iowa 836 660 779 1,122 1,332 54.8 43.0 50.5 72.3 85.8
Kansas 889 939 1,104 1,274 1,658 61.9 65.1 76.3 87.6 114.1
Kentucky 1,948 1,966 2,068 2,430 3,006 90.3 90.9 95.2 111.5 137.9
Louisiana 3,793 3,742 3,953 4,747 5,289 168.4 165.3 173.8 207.9 231.6
Maine 216 126 137 274 316 33.2 19.4 21.0 42.1 48.5
Maryland 2,806 3,145 3,304 3,755 5,573 98.4 109.4 114.1 129.0 191.4
Massachusetts 1,551 1,932 2,590 2,768 3,575 48.2 59.5 79.2 84.0 108.5
Michigan 5,372 4,694 4,551 5,129 6,245 110.8 96.6 93.5 105.1 128.0
Minnesota 1,395 1,835 2,260 2,420 2,881 52.2 68.1 83.3 88.6 105.5
Mississippi 3,039 2,370 2,637 2,638 3,486 209.7 162.9 181.3 181.7 240.1
Missouri 3,680 3,602 3,767 4,755 6,251 124.7 121.5 126.7 159.3 209.4
Montana 50 97 213 381 374 9.9 19.0 41.4 73.4 72.0
Nebraska 641 674 686 833 1,097 69.5 72.5 73.2 88.1 116.1
Nevada 1,280 1,509 1,892 2,218 2,763 92.0 107.4 132.6 152.9 190.5
New Hampshire 86 69 135 180 324 13.2 10.6 20.6 27.4 49.3
New Jersey 3,673 3,514 3,544 4,108 4,810 85.0 80.9 81.2 94.0 110.0
New Mexico 1,025 1,095 1,284 1,401 1,971 99.3 105.9 124.3 135.6 190.7
New York 12,529 11,844 13,624 16,893 20,224 132.0 124.2 142.2 175.8 210.4
North Carolina 6,180 6,113 6,652 9,744 10,160 130.0 127.3 137.3 199.2 207.7
North Dakota 127 191 309 309 484 35.7 51.6 81.5 79.5 124.5
Ohio 6,787 7,443 7,502 8,098 10,357 120.3 131.5 132.2 142.4 182.1
Oklahoma 1,789 2,303 2,685 2,962 3,521 94.7 120.7 139.8 152.9 181.8
Oregon 936 1,163 1,532 2,073 2,834 48.5 59.8 78.0 104.0 142.2
Pennsylvania 7,025 6,659 6,543 6,892 8,449 112.8 106.7 104.6 110.0 134.9
Rhode Island 275 262 372 408 495 54.1 51.4 72.7 79.7 96.7
South Carolina 3,196 3,133 3,689 3,781 4,436 139.1 134.9 157.0 158.9 186.5
South Dakota 259 320 335 427 512 61.9 75.4 78.0 98.8 118.5
Tennessee 4,368 3,758 3,778 4,577 5,497 138.7 118.7 118.4 142.3 170.8
Texas 15,286 16,410 18,035 21,792 23,779 118.1 124.8 134.8 159.8 174.4
Utah 347 578 876 1,055 1,383 24.2 39.6 59.2 70.0 91.8
Vermont 45 51 49 70 94 14.6 16.5 15.9 22.7 30.5
Virginia 3,145 3,272 3,879 4,085 5,996 78.2 80.5 94.7 99.0 145.4
Washington 2,008 2,665 3,717 4,374 5,231 58.3 76.5 105.3 122.0 145.9
West Virginia 393 524 380 404 497 42.9 57.2 41.6 44.3 54.6
Wisconsin 2,064 2,140 2,027 2,697 3,302 72.6 75.0 70.9 94.1 115.1
Wyoming 25 27 55 88 155 8.5 9.1 18.5 29.4 51.9
U.S. TOTAL 162,235 169,130 186,943 221,070 270,033 105.0 108.7 119.1 139.7 170.7
Northeast 26,378 25,897 28,213 32,830 39,851 97.2 95.1 103.2 119.7 145.3
Midwest 33,521 33,717 35,171 40,253 51,010 101.1 101.3 105.3 120.2 152.3
South 70,832 72,529 77,050 91,860 109,513 123.2 124.9 131.2 154.6 184.4
West 31,504 36,987 46,509 56,127 69,659 85.9 99.9 124.1 148.1 183.8
Guam 46 49 52 80 74 56.7 60.2 63.7 97.6 90.3
Puerto Rico 188 236 293 359 431 10.7 13.6 17.2 21.7 26.0
Virgin Islands 44 17 30 24 21 89.3 34.8 61.8 50.2 43.9
OUTLYING AREAS 278 302 375 463 526 14.7 16.2 20.4 25.9 29.4
TOTAL 162,513 169,432 187,318 221,533 270,559 103.9 107.6 118.0 138.4 169.1
79
Table 17. Gonorrhea Reported Cases and Rates of Reported Cases in Selected Metropolitan Statistical Areas
(MSAs)* in Alphabetical Order, United States, 20122016
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Boston-Cambridge-Newton, MA-NH 1,995 2,372 2,716
2,487
3,002 43.0 50.6 57.4 52.1 62.9
Columbus, OH 2,859 3,220 3,260 3,676 4,821 147.1 163.7 163.4 181.8 238.5
Hartford-West Hartford-East Hartford, CT 744 1,065 894 726 963 61.3 87.6 73.6 59.9 79.5
Jacksonville, FL 1,948 2,321 2,608 2,740 3,168 141.4 166.4 183.8 189.0 218.6
Kansas City, MO-KS 2,919 2,696 2,642 2,943 4,009 143.2 131.2 127.6 141.0 192.1
Memphis, TN-MS-AR 4,498 3,086 2,625 3,143 3,746 335.2 230.0 195.4 233.8 278.7
Oklahoma City, OK 1,947 2,352 2,366 2,403 2,953 150.2 178.2 177.0 176.9 217.4
Pittsburgh, PA 3,048 2,827 2,602 2,422 2,601 129.1 119.7 110.4 102.9 110.5
Providence-Warwick, RI-MA 643 593 913 834 1,108 40.2 37.0 56.7 51.7 68.7
Raleigh, NC 1,532 1,384 1,408 2,018 1,915 128.9 114.0 113.3 158.5 150.4
Richmond, VA 1,671 1,658 2,173 2,200 3,198 135.6 133.1 172.5 173.0 251.5
Salt Lake City, UT 342 690 1,026 1,078 1,462 30.4 60.5 89.0 92.1 124.9
St. Louis, MO-IL 4,810 4,492 4,346 5,257 6,558 172.0 160.4 154.9 187.0 233.2
80
Table 18. Gonorrhea Among Women Reported Cases and Rates of Reported Cases in Selected Metropolitan
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Austin-Round Rock, TX 993 1,078 1,213 1,039 1,162 108.5 114.8 124.9 103.9 116.2
Birmingham-Hoover, AL 1,280 1,099 970 999 160 217.3 186.0 163.4 167.9 26.9
Boston-Cambridge-Newton, MA-NH 738 828 844 601 720 30.9 34.3 34.7 24.5 29.3
Buffalo-Cheektowaga-Niagara Falls, NY 1,173 594 664 959 985 200.4 101.6 113.4 164.0 168.5
Columbus, OH 1,514 1,500 1,473 1,638 2,105 153.2 150.0 145.3 159.5 205.0
Denver-Aurora-Lakewood, CO 965 724 780 1,096 1,403 72.7 53.5 56.4 77.7 99.4
Hartford-West Hartford-East Hartford, CT 422 543 425 310 412 67.7 87.2 68.3 50.0 66.4
Jacksonville, FL 983 1,121 1,288 1,237 1,402 139.1 156.7 176.9 166.5 188.7
Kansas City, MO-KS 1,585 1,424 1,361 1,409 1,875 152.4 136.0 128.9 132.6 176.4
Las Vegas-Henderson-Paradise, NV 847 1,015 1,039 1,129 1,341 85.1 100.5 100.5 106.7 126.7
Louisville-Jefferson County, KY-IN 1,096 1,079 992 1,012 1,278 171.2 167.0 152.6 154.8 195.5
Memphis, TN-MS-AR 2,418 1,550 1,371 1,469 1,818 346.6 222.0 196.0 209.8 259.6
Nashville-Davidson-Murfreesboro-Franklin, TN 858 838 790 888 1,129 97.1 93.1 86.0 94.7 120.4
Oklahoma City, OK 1,081 1,305 1,310 1,267 1,558 164.6 195.1 193.2 183.8 226.1
Pittsburgh, PA 1,857 1,715 1,415 1,239 1,153 152.6 141.1 116.8 102.5 95.4
Portland-Vancouver-Hillsboro, OR-WA 393 325 382 764 1,005 33.9 27.8 32.2 63.2 83.2
Providence-Warwick, RI-MA 294 261 325 260 368 35.6 31.6 39.2 31.3 44.3
Raleigh, NC 807 677 638 857 785 132.7 108.9 100.2 131.4 120.4
Richmond, VA 908 957 1,194 1,141 1,473 142.6 148.7 183.4 173.6 224.2
Salt Lake City, UT 88 263 376 325 480 15.8 46.4 65.5 55.8 82.4
San Diego-Carlsbad, CA 847 827 1,038 1,018 1,479 53.6 51.8 63.9 62.1 90.2
San Jose-Sunnyvale-Santa Clara, CA 372 446 557 642 614 39.5 46.7 57.4 65.4 62.5
Seattle-Tacoma-Bellevue, WA 732 988 1,412 1,662 1,556 41.1 54.7 76.9 89.0 83.3
St. Louis, MO-IL 2,467 2,313 2,087 2,436 2,911 171.1 160.2 144.3 168.1 200.9
81
Table 19. Gonorrhea Among Men Reported Cases and Rates of Reported Cases in Selected Metropolitan
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Birmingham-Hoover, AL 1,057 1,029 979 1,075 152 193.0 187.3 177.9 195.2 27.6
Buffalo-Cheektowaga-Niagara Falls, NY 999 638 678 1,023 1,195 182.1 116.2 123.1 185.8 217.1
Columbus, OH 1,345 1,720 1,787 2,038 2,716 140.8 177.9 182.2 204.9 273.1
Jacksonville, FL 965 1,198 1,316 1,501 1,764 143.8 176.3 190.5 212.5 249.7
Kansas City, MO-KS 1,334 1,272 1,281 1,534 2,134 133.6 126.2 126.1 149.7 208.3
Louisville-Jefferson County, KY-IN 940 969 961 1,170 1,670 153.8 157.2 155.1 187.3 267.3
Memphis, TN-MS-AR 2,080 1,536 1,254 1,674 1,926 323.0 238.6 194.8 260.0 299.2
Nashville-Davidson-Murfreesboro-Franklin, TN 1,034 968 1,130 1,312 1,566 122.6 112.8 129.3 147.0 175.5
Oklahoma City, OK 866 1,047 1,056 1,136 1,394 135.3 160.8 160.3 169.7 208.3
Pittsburgh, PA 1,191 1,110 1,187 1,182 1,448 104.1 96.9 103.7 103.3 126.6
Portland-Vancouver-Hillsboro, OR-WA 790 874 1,116 1,621 2,172 69.8 76.4 96.2 137.3 184.0
Raleigh, NC 724 707 770 1,161 1,130 124.8 119.2 127.0 186.9 181.9
Richmond, VA 761 701 978 1,058 1,712 127.8 116.4 160.6 172.3 278.7
Salt Lake City, UT 254 427 650 753 982 44.9 74.5 112.3 128.1 167.1
San Jose-Sunnyvale-Santa Clara, CA 626 699 995 1,212 1,361 65.8 72.4 101.3 121.8 136.8
St. Louis, MO-IL 2,340 2,178 2,256 2,802 3,646 172.8 160.5 166.0 205.6 267.5
82
Table 20. Gonorrhea Reported Cases and Rates of Reported Cases in Counties and Independent Cities*
Ranked by Number of Reported Cases, United States, 2016
2 Cook County, IL 13,608 259.8 7
3 Harris County, TX 8,496 187.2 9
4 Maricopa County, AZ 7,701 184.8 11
5 Philadelphia County, PA 6,967 444.5 12
6 New York County, NY 6,329 384.9 13
7 Kings County, NY 5,840 221.5 15
8 San Francisco County, CA 5,278 610.3 16
9 San Diego County, CA 4,989 151.2 17
10 Wayne County, MI 4,949 281.3 18
11 Dallas County, TX 4,597 180.0 19
12 Bexar County, TX 4,480 236.1 20
13 Milwaukee County, WI 4,298 448.8 21
14 Franklin County, OH 4,243 339.0 22
15 Marion County, IN 4,030 429.2 23
16 Fulton County, GA 3,838 379.8 23
17 Cuyahoga County, OH 3,744 298.1 24
18 Bronx County, NY 3,682 253.0 25
19 Clark County, NV 3,653 172.7 26
20 Broward County, FL 3,632 191.5 27
21 Baltimore (City), MD 3,534 568.3 27
22 San Bernardino County, CA 3,377 158.7 28
23 King County, WA 3,355 158.5 29
24 Tarrant County, TX 3,134 158.1 29
25 Miami-Dade County, FL 3,064 113.8 30
26 Orange County, CA 3,062 96.6 31
27 Alameda County, CA 3,045 185.9 31
28 Shelby County, TN 2,924 311.7 32
29 Hamilton County, OH 2,866 354.9 33
30 Sacramento County, CA 2,854 190.1 33
31 Queens County, NY 2,808 120.0 34
32 Travis County, TX 2,787 236.9 34
33 Mecklenburg County, NC 2,778 268.6 35
34 Duval County, FL 2,713 297.1 36
35 St. Louis County, MO 2,623 261.4 36
36 Riverside County, CA 2,581 109.3 37
37 Jackson County, MO 2,480 360.7 37
38 Orange County, FL 2,476 192.2 38
39 Hennepin County, MN 2,455 200.7 38
40 Jefferson County, KY 2,447 320.4 39
41 St. Louis (City), MO 2,369 750.4 39
42 Hillsborough County, FL 2,365 175.3 40
43 DeKalb County, GA 2,315 315.0 40
44 Monroe County, NY 2,207 294.4 41
45 Oklahoma County, OK 2,206 284.0 41
46 Collin County, TX 2,058 225.1 42
47 Allegheny County, PA 2,018 164.0 42
48 Fresno County, CA 1,997 204.8 43
49 Denver County, CO 1,975 289.4 43
50 Multnomah County, OR 1,966 248.8 43
51 Orleans Parish, LA 1,956 502.0 44
52 Santa Clara County, CA 1,936 100.9 44
53 Davidson County, TN 1,874 276.0 45
54 Erie County, NY 1,874 203.1 45
55 Prince George's County, MD 1,832 201.4 45
56 Kern County, CA 1,790 202.9 46
57 Etowah County, AL 1,778 1725.3 46
58 Guilford County, NC 1,768 341.6 47
59 Essex County, NJ 1,759 220.6 47
60 Tulsa County, OK 1,723 269.5 47
61 Wake County, NC 1,618 158.0 48
62 Contra Costa County, CA 1,574 139.7 48
63 Bernalillo County, NM 1,567 231.6 48
64 Pinellas County, FL 1,561 164.3 49
65 Bell County, TX 1,466 437.7 49
66 Salt Lake County, UT 1,434 129.5 49
67 Montgomery County, OH 1,415 265.8 50
68 Douglas County, NE 1,402 254.9 50
69 Richmond (City), VA 1,383 627.8 50
70 Baltimore County, MD 1,321 158.9 50
complete for 95% of cases in Alabama, Connecticut, and Massachusetts. See Appendix A1.4 for more information.
83
Table 21. Gonorrhea Reported Cases and Rates of Reported Cases by Age Group and Sex, United States,
20122016
04 198 72 122 4 1.0 0.7 1.2
59 68 16 52 0 0.3 0.2 0.5
1014 3,136 573 2,559 4 15.2 5.4 25.3
1519 81,548 26,578 54,852 118 381.8 242.4 527.5
2024 115,224 52,351 62,711 162 510.2 453.3 568.4
2529 58,441 31,631 26,722 88 273.1 291.7 253.2
2012
3034 31,420 18,936 12,436 48 150.3 180.4 119.4
3539 16,193 10,493 5,670 30 83.1 108.0 58.0
4044 10,965 7,858 3,089 18 52.1 75.1 29.2
4554 12,383 9,773 2,594 16 28.0 44.8 11.5
5564 3,230 2,642 586 2 8.4 14.2 2.9
65+ 644 537 105 2 1.5 2.9 0.4
Unknown Age 1,376 775 568 33
TOTAL 334,826 162,235 172,066 525 106.7 105.0 107.9
04 172 60 111 1 0.9 0.6 1.1
59 75 11 64 0 0.4 0.1 0.6
1014 2,637 508 2,122 7 12.8 4.8 21.0
1519 72,092 24,212 47,749 131 340.7 223.2 463.0
2024 113,035 53,055 59,760 220 495.9 454.3 537.6
2529 62,102 34,718 27,266 118 287.8 316.8 256.7
2013
3034 34,065 20,855 13,143 67 160.2 195.2 124.2
3539 18,034 11,850 6,145 39 92.0 121.1 62.6
4044 11,817 8,590 3,192 35 56.7 82.9 30.4
4554 13,823 11,087 2,714 22 31.6 51.4 12.2
5564 3,802 3,176 621 5 9.7 16.8 3.1
65+ 825 696 128 1 1.8 3.6 0.5
Unknown Age 525 312 193 20
TOTAL 333,004 169,130 163,208 666 105.3 108.7 101.7
04 154 47 105 2 0.8 0.5 1.1
59 53 7 46 0 0.3 0.1 0.5
1014 2,450 440 2,005 5 11.9 4.2 19.8
1519 68,468 23,981 44,399 88 325.0 222.4 431.7
2024 116,200 56,714 59,329 157 507.2 483.1 531.0
2529 69,587 40,602 28,899 86 316.5 363.8 266.9
2014
3034 38,393 24,349 13,988 56 178.3 225.3 130.5
3539 20,803 14,129 6,654 20 104.4 142.1 66.7
4044 12,687 9,349 3,320 18 61.6 91.5 32.0
4554 15,322 12,388 2,917 17 35.3 57.8 13.2
5564 4,549 3,859 680 10 11.4 20.0 3.3
65+ 911 790 121 0 2.0 3.9 0.5
Unknown Age 485 288 145 52
TOTAL 350,062 186,943 162,608 511 109.8 119.1 100.4
04 148 47 98 3 0.7 0.5 1.0
59 78 11 66 1 0.4 0.1 0.7
1014 2,312 385 1,923 4 11.2 3.7 19.0
1519 72,001 26,401 45,477 123 341.1 244.5 441.1
2024 124,592 63,289 61,105 198 547.9 542.4 551.9
25-29 82,867 50,089 32,662 116 368.9 439.0 295.5
2015
3034 45,681 29,751 15,867 63 210.7 273.2 147.1
3539 26,137 18,198 7,897 42 128.3 178.9 77.4
4044 15,042 11,116 3,898 28 74.4 110.8 38.3
4554 18,779 15,379 3,375 25 43.5 72.2 15.4
5564 6,035 5,175 849 11 14.8 26.2 4.0
65+ 1,191 1,032 158 1 2.5 4.9 0.6
Unknown Age 353 197 139 17
TOTAL 395,216 221,070 173,514 632 123.0 139.7 106.3
04 187 72 113 2 0.9 0.7 1.2
59 98 16 81 1 0.5 0.2 0.8
1014 2,436 498 1,929 9 11.8 4.7 19.1
1519 80,172 30,316 49,710 146 379.8 280.8 482.1
2024 138,130 71,967 65,930 233 607.5 616.8 595.5
2529 101,283 62,189 38,881 213 450.9 545.1 351.8
2016
3034 57,646 38,193 19,306 147 265.9 350.7 179.0

3539 34,058 23,744 10,230 84 167.2 233.4 100.3
4044 19,104 14,116 4,935 53 94.5 140.7 48.5
4554 24,142 19,762 4,330 50 55.9 92.8 19.8
5564 8,138 6,947 1,178 13 19.9 35.2 5.6
65+ 1,599 1,403 191 5 3.3 6.7 0.7
Unknown Age 1,521 810 685 26
TOTAL 468,514 270,033 197,499 982 145.8 170.7 121.0
NOTE: This table should be used only for age comparisons. Cases in the 04 age group may include cases due to perinatal transmission.
84
Table 22A. Gonorrhea Reported Cases by Race/Ethnicity, Age Group, and Sex, United States*, 2016

Asians Blacks
04 1 0 1 1 1 0 63 25 38 1 1 0
59 3 0 3 0 0 0 32 7 25 0 0 0
1014 29 3 26 11 3 8 1,306 307 998 3 1 2
1519 810 237 573 397 184 212 40,280 15,755 24,503 150 46 104
2024 1,606 599 1,007 1,221 789 430 63,737 32,652 31,051 256 104 152
2529 1,433 588 845 1,230 940 287 40,771 25,282 15,461 210 122 88
3034 872 386 486 789 637 152 19,653 13,525 6,106 126 76 50
3539 463 195 268 511 402 109 10,708 7,867 2,833 90 62 27
4044 217 104 113 326 263 61 5,659 4,497 1,156 46 32 14
4554 257 135 122 335 292 41 6,787 5,841 943 33 26 7
5564 57 44 13 86 67 19 2,405 2,140 264 13 13 0
65+ 8 7 1 25 17 8 432 401 30 0 0 0
Unknown Age 1 1 0 2 2 0 281 145 135 0 0 0
TOTAL 5,757 2,299 3,458 4,934 3,597 1,327 192,114 108,444 83,543 928 483 444
Other/
Age Unknown
04 35 12 23 2 1 1 27 8 19 57 24 31
59 21 4 17 0 0 0 19 1 18 23 4 18
1014 271 25 246 14 1 13 262 46 216 540 112 420
1519 12,795 3,758 9,033 708 204 504 8,056 3,198 4,854 16,976 6,934 9,927
2024 27,243 13,202 14,025 1,194 576 615 15,976 9,122 6,839 26,897 14,923 11,811
2529 25,018 14,266 10,736 862 570 291 12,414 8,217 4,180 19,345 12,204 6,993
3034 16,660 10,314 6,337 602 474 128 7,475 5,244 2,219 11,469 7,537 3,828
3539 10,272 6,786 3,482 305 239 64 4,515 3,285 1,225 7,194 4,908 2,222
4044 6,018 4,288 1,728 151 125 23 2,395 1,813 577 4,292 2,994 1,263
4554 8,306 6,790 1,514 210 187 23 2,504 2,022 477 5,710 4,469 1,203
5564 2,965 2,567 397 49 48 1 549 440 108 2,014 1,628 376
65+ 593 512 79 5 5 0 75 65 10 461 396 63
Unknown Age 114 57 55 1 1 0 32 11 20 1,090 593 475
TOTAL 110,311 62,581 47,672 4,103 2,431 1,663 54,299 33,472 20,762 96,068 56,726 38,630

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 21 for age-specific cases and rates and Tables 1416 for total and sex-specific
cases and rates. Cases in the 04 age group may include cases due to perinatal transmission.
85
Table 22B. Gonorrhea Rates of Reported Cases per 100,000 Population by Race/Ethnicity, Age Group, and Sex,
Asians Blacks
04 0.6 0.0 1.2 0.1 0.2 0.0 2.3 1.8 2.8 2.5 4.8 0.0
59 1.7 0.0 3.5 0.0 0.0 0.0 1.1 0.5 1.8 0.0 0.0 0.0
1014 16.5 3.4 30.0 1.1 0.6 1.6 46.5 21.6 72.0 7.4 4.9 10.0
1519 444.7 255.7 640.4 38.7 35.5 41.7 1,347.0 1,038.6 1,663.1 369.4 219.7 528.9
2024 806.5 586.7 1,037.7 97.0 123.5 69.4 1,875.9 1,892.7 1,856.5 545.6 432.5 664.6
2529 781.8 630.5 938.6 82.9 129.9 37.7 1,308.8 1,641.0 982.0 403.6 452.5 351.0
3034 535.8 476.1 595.0 52.4 89.6 19.1 709.8 1,016.0 424.7 258.5 304.1 210.4
3539 312.6 264.7 359.9 36.2 61.1 14.4 410.6 636.6 206.5 212.2 287.4 129.5
4044 151.4 147.3 155.3 23.1 39.8 8.1 221.8 375.2 85.4 123.4 169.9 75.9
4554 83.2 90.1 76.6 14.0 26.2 3.2 128.1 234.8 33.6 47.4 75.1 20.0
5564 20.6 33.8 8.9 4.5 7.7 1.8 52.1 101.6 10.5 24.0 49.1 0.0
65+ 3.3 6.3 0.7 1.2 2.0 0.7 10.3 23.7 1.2 0.0 0.0 0.0
Unknown Age
TOTAL 242.9 196.8 287.7 28.3 43.4 14.5 481.2 568.4 400.7 165.8 171.1 160.0

04 0.4 0.2 0.5 0.2 0.2 0.2 0.5 0.3 0.8
59 0.2 0.1 0.3 0.0 0.0 0.0 0.4 0.0 0.7
1014 2.5 0.4 4.6 1.8 0.3 3.4 5.3 1.8 8.9
1519 111.6 63.8 161.9 103.4 58.8 149.1 170.8 132.5 210.9
2024 219.3 207.0 232.0 198.8 191.8 204.9 331.9 365.1 295.4
2529 198.0 222.3 172.7 186.6 257.2 121.1 274.0 344.5 194.7
3034 134.8 165.4 103.5 157.1 262.2 63.2 167.9 225.5 104.4
3539 88.6 116.1 60.6 93.8 156.5 37.1 106.4 150.2 59.6
4044 50.8 72.0 29.3 54.0 95.0 15.5 60.9 91.0 29.7
4554 29.6 48.6 10.7 42.8 80.6 8.9 38.3 61.3 14.7
5564 10.1 17.9 2.6 12.6 25.8 0.5 12.8 21.2 4.9
65+ 1.6 3.1 0.4 1.5 3.3 0.0 2.0 4.0 0.5
Unknown Age
TOTAL 55.7 64.1 47.5 62.3 75.1 49.7 95.9 117.0 74.2

cases and rates. Cases in the 04 age group may include cases due to perinatal transmission. No population data exist for unknown sex, unknown age, or unknown
race; therefore rates are not calculated.
86
Table 23. Gonorrhea Among Women Aged 1524 Years Reported Cases and Rates of Reported Cases by Age,
Age Cases Rate per 100,000 Population
15 4,241 209.4
16 7,316 359.4
17 11,006 530.2
18 15,580 736.2
2012
19 16,709 779.1
20 15,849 717.5
21 15,029 664.7
22 12,800 565.9
23 10,449 480.6
24 8,584 403.4
15 3,776 186.4
16 6,503 320.0
17 9,374 458.8
18 13,393 642.4
2013
19 14,703 691.2
20 14,420 668.8
21 13,394 603.1
22 12,272 539.6
23 10,819 475.3
24 8,855 404.5
15 3,487 171.3
16 6,188 303.9
17 8,830 431.6
18 12,196 591.9
2014
19 13,698 650.5
20 13,801 642.1
21 13,324 611.5
22 12,031 536.0
23 10,746 467.5
24 9,427 409.6
15 3,477 167.4
16 6,090 297.8
17 9,117 444.9
18 12,769 619.3
2015
19 14,024 674.8
20 13,835 651.7
21 13,331 615.2
22 12,597 573.2
23 11,271 497.7
24 10,071 434.2
15 3,678 177.1
16 6,573 321.4
17 9,855 480.9
18 14,304 693.7
2016
19 15,300 736.2
20 14,657 690.4
21 14,149 653.0
22 13,540 616.1
23 12,245 540.8
24 11,339 488.9
NOTE: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
87
Table 24. All Stages of Syphilis* Reported Cases and Rates of Reported Cases by State/Area and Region in
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 705 679 475 657 905 14.6 14.0 9.8 13.5 18.6
Alaska 34 35 45 24 24 4.6 4.8 6.1 3.3 3.3
Arizona 787 962 1,459 1,496 1,904 12.0 14.5 21.7 21.9 27.9
Arkansas 468 527 390 500 567 15.9 17.8 13.1 16.8 19.0
California 8,016 9,973 11,443 14,449 17,602 21.1 26.0 29.5 36.9 45.0
Colorado 503 475 355 553 739 9.7 9.0 6.6 10.1 13.5
Connecticut 121 133 169 220 217 3.4 3.7 4.7 6.1 6.0
Delaware 106 146 110 110 149 11.6 15.8 11.8 11.6 15.8
District of Columbia 589 609 281 322 568 93.1 94.2 42.6 47.9 84.5
Florida 4,483 5,022 6,103 7,132 8,332 23.2 25.7 30.7 35.2 41.1
Georgia 2,434 2,990 3,384 4,156 4,112 24.5 29.9 33.5 40.7 40.3
Hawaii 43 87 106 163 215 3.1 6.2 7.5 11.4 15.0
Idaho 54 42 46 102 127 3.4 2.6 2.8 6.2 7.7
Illinois 2,424 2,661 2,796 3,290 4,039 18.8 20.7 21.7 25.6 31.4
Indiana 531 543 475 699 778 8.1 8.3 7.2 10.6 11.8
Iowa 143 226 239 232 276 4.7 7.3 7.7 7.4 8.8
Kansas 129 196 200 240 303 4.5 6.8 6.9 8.2 10.4
Kentucky 390 395 447 433 570 8.9 9.0 10.1 9.8 12.9
Louisiana 1,780 2,006 2,173 2,466 2,599 38.7 43.4 46.7 52.8 55.6
Maine 22 21 23 38 64 1.7 1.6 1.7 2.9 4.8
Maryland 1,243 1,361 1,475 1,870 1,842 21.1 23.0 24.7 31.1 30.7
Massachusetts 806 990 813 1,263 1,447 12.1 14.8 12.1 18.6 21.3
Michigan 786 1,068 1,095 1,089 1,092 8.0 10.8 11.0 11.0 11.0
Minnesota 335 541 631 653 853 6.2 10.0 11.6 11.9 15.5
Mississippi 456 293 642 760 925 15.3 9.8 21.4 25.4 30.9
Missouri 426 609 771 778 955 7.1 10.1 12.7 12.8 15.7
Montana 3 8 9 20 24 0.3 0.8 0.9 1.9 2.3
Nebraska 35 95 96 81 120 1.9 5.1 5.1 4.3 6.3
Nevada 445 523 893 915 1,313 16.1 18.7 31.5 31.7 45.4
New Hampshire 65 79 79 84 100 4.9 6.0 6.0 6.3 7.5
New Jersey 883 968 1,172 1,306 1,620 10.0 10.9 13.1 14.6 18.1
New Mexico 234 247 283 332 470 11.2 11.8 13.6 15.9 22.5
New York 5,312 6,173 7,129 7,795 9,456 27.1 31.4 36.1 39.4 47.8
North Carolina 1,037 1,153 1,998 2,741 2,653 10.6 11.7 20.1 27.3 26.4
North Dakota 14 25 51 42 61 2.0 3.5 6.9 5.5 8.1
Ohio 1,141 1,096 1,229 1,348 1,599 9.9 9.5 10.6 11.6 13.8
Oklahoma 256 383 414 521 696 6.7 9.9 10.7 13.3 17.8
Oregon 424 527 582 783 810 10.9 13.4 14.7 19.4 20.1
Pennsylvania 1,349 1,486 1,523 1,788 2,037 10.6 11.6 11.9 14.0 15.9
Rhode Island 93 94 160 163 234 8.9 8.9 15.2 15.4 22.2
South Carolina 624 753 750 834 974 13.2 15.8 15.5 17.0 19.9
South Dakota 29 61 95 71 57 3.5 7.2 11.1 8.3 6.6
Tennessee 1,068 980 977 1,241 1,448 16.5 15.1 14.9 18.8 21.9
Texas 7,057 7,044 7,804 8,250 9,564 27.1 26.6 28.9 30.0 34.8
Utah 101 172 149 169 259 3.5 5.9 5.1 5.6 8.6
Vermont 12 10 12 15 37 1.9 1.6 1.9 2.4 5.9
Virginia 906 1,001 702 1,023 1,301 11.1 12.1 8.4 12.2 15.5
Washington 709 711 854 1,109 1,414 10.3 10.2 12.1 15.5 19.7
West Virginia 24 39 55 109 151 1.3 2.1 3.0 5.9 8.2
Wisconsin 268 257 285 262 423 4.7 4.5 5.0 4.5 7.3
Wyoming 12 9 6 10 17 2.1 1.5 1.0 1.7 2.9
U.S. TOTAL 49,915 56,484 63,453 74,707 88,042 15.9 17.9 19.9 23.2 27.4
Northeast 8,663 9,954 11,080 12,672 15,212 15.5 17.8 19.7 22.5 27.0
Midwest 6,261 7,378 7,963 8,785 10,556 9.3 10.9 11.8 12.9 15.5
South 23,626 25,381 28,180 33,125 37,356 20.1 21.4 23.5 27.3 30.8
West 11,365 13,771 16,230 20,125 24,918 15.4 18.5 21.6 26.5 32.8
Guam 27 24 13 22 13 16.9 15.0 8.1 13.6 8.0
Puerto Rico 704 811 960 1,267 1,184 19.2 22.4 27.1 36.5 34.1
Virgin Islands 2 9 6 25 2 1.9 8.6 5.8 24.3 1.9
OUTLYING AREAS 733 844 979 1,314 1,199 18.6 21.8 25.7 35.1 32.1
TOTAL 50,648 57,328 64,432 76,021 89,241 15.9 17.9 20.0 23.4 27.4
* See Section A1.9 in the Appendix for definition.
88
Table 25. All Stages of Syphilis* Reported Cases and Rates of Reported Cases in Selected Metropolitan
Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Austin-Round Rock, TX 478 500 680 623 825 26.1 26.6 35.0 31.1 41.2
Baltimore-Columbia-Towson, MD 726 732 815 1,005 1,025 26.4 26.4 29.3 35.9 36.6
Birmingham-Hoover, AL 226 236 157 197 245 19.9 20.7 13.7 17.2 21.4
Buffalo-Cheektowaga-Niagara Falls, NY 70 115 130 180 141 6.2 10.1 11.4 15.9 12.4
Charlotte-Concord-Gastonia, NC-SC 310 360 530 731 848 13.5 15.4 22.3 30.1 34.9
Cincinnati, OH-KY-IN 529 437 381 319 268 24.9 20.4 17.7 14.8 12.4
Cleveland-Elyria, OH 140 111 199 229 376 6.8 5.4 9.6 11.1 18.2
Columbus, OH 316 342 441 517 578 16.3 17.4 22.1 25.6 28.6
Denver-Aurora-Lakewood, CO 434 382 298 426 552 16.4 14.2 10.8 15.1 19.6
Detroit-Warren-Dearborn, MI 607 830 791 773 738 14.1 19.3 18.4 18.0 17.2
Indianapolis-Carmel-Anderson, IN 336 340 285 408 415 17.4 17.4 14.5 20.5 20.9
Jacksonville, FL 177 189 270 435 445 12.8 13.6 19.0 30.0 30.7
Kansas City, MO-KS 164 320 406 365 434 8.0 15.6 19.6 17.5 20.8
Las Vegas-Henderson-Paradise, NV 403 438 830 826 1,194 20.1 21.6 40.1 39.1 56.5
Louisville-Jefferson County, KY-IN 201 210 239 270 379 16.1 16.6 18.8 21.1 29.6
Memphis, TN-MS-AR 591 578 475 575 760 44.0 43.1 35.4 42.8 56.5
Milwaukee-Waukesha-West Allis, WI 159 153 184 147 228 10.1 9.7 11.7 9.3 14.5
Minneapolis-St. Paul-Bloomington, MN-WI 313 487 585 592 742 9.1 14.1 16.7 16.8 21.1
Nashville-Davidson-Murfreesboro-Franklin, TN 271 239 305 359 383 15.7 13.6 17.0 19.6 20.9
New Orleans-Metairie, LA 547 634 723 757 843 44.6 51.1 57.8 59.9 66.8
Oklahoma City, OK 148 213 231 264 406 11.4 16.1 17.3 19.4 29.9
Orlando-Kissimmee-Sanford, FL 499 631 782 915 1,183 22.4 27.8 33.7 38.3 49.6
Phoenix-Mesa-Scottsdale, AZ 624 713 1,065 1,125 1,501 14.4 16.2 23.7 24.6 32.8
Pittsburgh, PA 128 95 154 273 236 5.4 4.0 6.5 11.6 10.0
Portland-Vancouver-Hillsboro, OR-WA 410 475 470 587 650 17.9 20.5 20.0 24.6 27.2
Raleigh, NC 150 179 315 409 381 12.6 14.7 25.3 32.1 29.9
Richmond, VA 194 204 145 207 305 15.7 16.4 11.5 16.3 24.0
Riverside-San Bernardino-Ontario, CA 775 803 950 1,165 1,554 17.8 18.3 21.4 26.0 34.6
Sacramento-Roseville-Arden-Arcade, CA 249 289 371 607 609 11.3 13.0 16.5 26.7 26.8
Salt Lake City, UT 74 136 109 122 187 6.6 11.9 9.5 10.4 16.0
San Antonio-New Braunfels, TX 983 1,167 1,017 988 1,126 44.0 51.2 43.7 41.4 47.2
San Diego-Carlsbad, CA 717 792 987 1,208 1,419 22.6 24.7 30.2 36.6 43.0
Seattle-Tacoma-Bellevue, WA 559 539 590 759 968 15.7 14.9 16.1 20.3 25.9
St. Louis, MO-IL 280 338 412 417 528 10.0 12.1 14.7 14.8 18.8
Tampa-St. Petersburg-Clearwater, FL 582 632 806 956 1,128 20.5 22.0 27.6 32.1 37.9
Virginia Beach-Norfolk-Newport News, VA-NC 296 302 220 375 516 17.4 17.7 12.8 21.7 29.9
Washington-Arlington-Alexandria, DC-VA-MD-WV 1,374 1,543 811 1,057 1,104 23.4 25.9 13.4 17.3 18.1
* See Section A1.9 in the Appendix for definition.
MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
89
Table 26. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases by State, Ranked by
Rates, United States, 2016
1 Louisiana 750 16.1
2 Nevada 444 15.4
3 California 5,891 15.0
4 Georgia 1,350 13.2
5 New York 2,455 12.4
6 Florida 2,406 11.9
7 Mississippi 326 10.9
9 Arizona 721 10.6
10 Illinois 1,260 9.8
11 New Mexico 189 9.1
U.S. TOTAL 27,814 8.7
12 Rhode Island 90 8.5
13 Maryland 509 8.5
14 Oregon 327 8.1
15 Washington 565 7.9
16 Hawaii 112 7.8
17 Alabama 376 7.7
18 Massachusetts 489 7.2
19 Texas 1,955 7.1
20 Oklahoma 264 6.7
21 Missouri 400 6.6
22 South Carolina 316 6.5
23 Ohio 716 6.2
24 Delaware 58 6.1
25 Tennessee 390 5.9
26 Pennsylvania 755 5.9
27 Minnesota 306 5.6
28 Virginia 459 5.5
29 New Jersey 472 5.3
30 Arkansas 150 5.0
31 Kentucky 219 4.9
32 Indiana 326 4.9
33 Colorado 250 4.6
34 North Dakota 33 4.4
35 Kansas 124 4.3
36 Michigan 365 3.7
37 Vermont 23 3.7
38 Nebraska 67 3.5
39 Maine 42 3.2
40 Utah 92 3.1
41 Connecticut 110 3.1
42 South Dakota 26 3.0
43 Idaho 50 3.0
44 New Hampshire 40 3.0
46 Iowa 89 2.8
47 Wisconsin 132 2.3
48 Montana 14 1.4
49 Wyoming 7 1.2
50 Alaska 8 1.1
Total includes cases reported by the District of Columbia with 161 cases and a rate of 24.0, but excludes outlying areas (Guam with 2 cases and rate of 1.2,
Puerto Rico with 493 cases and rate of 14.2, and Virgin Islands with 0 cases and rate of 0.0).
90
Table 27. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases by State/Area and
Region in Alphabetical Order, United States and Outlying Areas, 20122016
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 216 183 161 280 376 4.5 3.8 3.3 5.8 7.7
Alaska 11 23 15 8 8 1.5 3.1 2.0 1.1 1.1
Arizona 202 287 577 589 721 3.1 4.3 8.6 8.6 10.6
Arkansas 173 177 121 134 150 5.9 6.0 4.1 4.5 5.0
California 2,953 3,532 3,835 4,908 5,891 7.8 9.2 9.9 12.5 15.0
Colorado 208 163 186 245 250 4.0 3.1 3.5 4.5 4.6
Connecticut 55 56 86 92 110 1.5 1.6 2.4 2.6 3.1
Delaware 38 52 47 41 58 4.1 5.6 5.0 4.3 6.1
Florida 1,369 1,513 1,740 2,083 2,406 7.1 7.7 8.7 10.3 11.9
Georgia 937 1,017 1,234 1,413 1,350 9.4 10.2 12.2 13.8 13.2
Hawaii 23 46 68 91 112 1.7 3.3 4.8 6.4 7.8
Idaho 26 15 12 57 50 1.6 0.9 0.7 3.4 3.0
Illinois 804 798 863 1,085 1,260 6.2 6.2 6.7 8.4 9.8
Indiana 224 215 168 285 326 3.4 3.3 2.5 4.3 4.9
Iowa 70 106 72 75 89 2.3 3.4 2.3 2.4 2.8
Kansas 24 51 60 87 124 0.8 1.8 2.1 3.0 4.3
Kentucky 150 122 158 145 219 3.4 2.8 3.6 3.3 4.9
Louisiana 339 423 575 696 750 7.4 9.1 12.4 14.9 16.1
Maine 17 10 16 28 42 1.3 0.8 1.2 2.1 3.2
Maryland 431 456 449 509 509 7.3 7.7 7.5 8.5 8.5
Massachusetts 316 360 301 418 489 4.8 5.4 4.5 6.2 7.2
Michigan 295 487 421 403 365 3.0 4.9 4.2 4.1 3.7
Minnesota 118 193 257 246 306 2.2 3.6 4.7 4.5 5.6
Mississippi 150 78 189 219 326 5.0 2.6 6.3 7.3 10.9
Missouri 157 251 352 307 400 2.6 4.2 5.8 5.0 6.6
Montana 2 5 8 13 14 0.2 0.5 0.8 1.3 1.4
Nebraska 8 41 50 45 67 0.4 2.2 2.7 2.4 3.5
Nevada 113 205 357 335 444 4.1 7.3 12.6 11.6 15.4
New Hampshire 36 28 36 40 40 2.7 2.1 2.7 3.0 3.0
New Jersey 229 233 297 372 472 2.6 2.6 3.3 4.2 5.3
New Mexico 101 78 126 118 189 4.8 3.7 6.0 5.7 9.1
New York 1,224 1,459 1,727 2,006 2,455 6.3 7.4 8.7 10.1 12.4
North Carolina 347 404 733 1,196 1,082 3.6 4.1 7.4 11.9 10.8
North Dakota 4 12 13 11 33 0.6 1.7 1.8 1.5 4.4
Ohio 425 436 568 560 716 3.7 3.8 4.9 4.8 6.2
Oklahoma 83 118 151 209 264 2.2 3.1 3.9 5.3 6.7
Oregon 212 267 272 345 327 5.4 6.8 6.9 8.6 8.1
Pennsylvania 494 471 532 655 755 3.9 3.7 4.2 5.1 5.9
Rhode Island 44 45 71 77 90 4.2 4.3 6.7 7.3 8.5
South Carolina 225 271 250 294 316 4.8 5.7 5.2 6.0 6.5
South Dakota 18 44 53 39 26 2.2 5.2 6.2 4.5 3.0
Tennessee 266 214 237 349 390 4.1 3.3 3.6 5.3 5.9
Texas 1,627 1,475 1,636 1,680 1,955 6.2 5.6 6.1 6.1 7.1
Utah 42 74 47 65 92 1.5 2.6 1.6 2.2 3.1
Vermont 6 3 5 9 23 1.0 0.5 0.8 1.4 3.7
Virginia 285 315 289 334 459 3.5 3.8 3.5 4.0 5.5
Washington 302 284 344 445 565 4.4 4.1 4.9 6.2 7.9
West Virginia 8 15 28 52 53 0.4 0.8 1.5 2.8 2.9
Wisconsin 91 95 86 79 132 1.6 1.7 1.5 1.4 2.3
Wyoming 4 1 4 5 7 0.7 0.2 0.7 0.9 1.2
U.S. TOTAL 15,667 17,375 19,999 23,872 27,814 5.0 5.5 6.3 7.4 8.7
Northeast 2,421 2,665 3,071 3,697 4,476 4.3 4.8 5.5 6.6 8.0
Midwest 2,238 2,729 2,963 3,222 3,844 3.3 4.0 4.4 4.7 5.7
South 6,809 7,001 8,114 9,729 10,824 5.8 5.9 6.8 8.0 8.9
West 4,199 4,980 5,851 7,224 8,670 5.7 6.7 7.8 9.5 11.4
Guam 6 6 7 2 2 3.8 3.7 4.3 1.2 1.2
Puerto Rico 306 385 484 531 493 8.3 10.6 13.6 15.3 14.2
Virgin Islands 0 2 2 8 0 0.0 1.9 1.9 7.8 0.0
OUTLYING AREAS 312 393 493 541 495 7.9 10.1 12.9 14.5 13.2
TOTAL 15,979 17,768 20,492 24,413 28,309 5.0 5.6 6.4 7.5 8.7
91
Table 28. Primary and Secondary Syphilis Among Women Reported Cases and Rates of Reported Cases by
State/Area and Region in Alphabetical Order, United States and Outlying Areas, 20122016

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 38 22 17 37 80 1.5 0.9 0.7 1.5 3.2
Alaska 1 2 1 1 0 0.3 0.6 0.3 0.3 0.0
Arizona 16 27 50 47 80 0.5 0.8 1.5 1.4 2.3
Arkansas 49 44 23 26 37 3.3 2.9 1.5 1.7 2.4
California 116 210 318 476 744 0.6 1.1 1.6 2.4 3.8
Colorado 3 4 6 6 16 0.1 0.2 0.2 0.2 0.6
Connecticut 9 8 7 15 12 0.5 0.4 0.4 0.8 0.7
Delaware 2 3 2 2 3 0.4 0.6 0.4 0.4 0.6
Florida 134 137 137 210 266 1.4 1.4 1.3 2.0 2.6
Georgia 66 87 96 94 113 1.3 1.7 1.9 1.8 2.2
Hawaii 2 0 2 1 10 0.3 0.0 0.3 0.1 1.4
Idaho 2 0 0 9 6 0.3 0.0 0.0 1.1 0.7
Illinois 73 66 81 84 95 1.1 1.0 1.2 1.3 1.5
Indiana 22 18 11 28 36 0.7 0.5 0.3 0.8 1.1
Iowa 7 10 6 5 6 0.5 0.6 0.4 0.3 0.4
Kansas 2 4 14 17 12 0.1 0.3 1.0 1.2 0.8
Kentucky 13 17 22 23 21 0.6 0.8 1.0 1.0 0.9
Louisiana 127 115 132 189 192 5.4 4.9 5.6 7.9 8.0
Maine 2 1 3 6 3 0.3 0.1 0.4 0.9 0.4
Maryland 45 61 49 58 54 1.5 2.0 1.6 1.9 1.7
Massachusetts 15 17 23 25 24 0.4 0.5 0.7 0.7 0.7
Michigan 30 29 31 34 31 0.6 0.6 0.6 0.7 0.6
Minnesota 7 12 21 39 37 0.3 0.4 0.8 1.4 1.3
Mississippi 34 19 17 32 58 2.2 1.2 1.1 2.1 3.8
Missouri 12 19 34 54 66 0.4 0.6 1.1 1.7 2.1
Montana 0 1 2 1 1 0.0 0.2 0.4 0.2 0.2
Nebraska 1 4 4 3 5 0.1 0.4 0.4 0.3 0.5
Nevada 4 14 23 23 50 0.3 1.0 1.6 1.6 3.5
New Hampshire 0 1 4 3 4 0.0 0.1 0.6 0.4 0.6
New Jersey 19 13 16 26 24 0.4 0.3 0.3 0.6 0.5
New Mexico 9 20 14 11 27 0.9 1.9 1.3 1.0 2.6
New York 45 44 49 59 115 0.4 0.4 0.5 0.6 1.1
North Carolina 37 36 68 112 109 0.7 0.7 1.3 2.2 2.1
North Dakota 0 1 5 0 3 0.0 0.3 1.4 0.0 0.8
Ohio 85 63 76 68 94 1.4 1.1 1.3 1.1 1.6
Oklahoma 6 13 15 21 41 0.3 0.7 0.8 1.1 2.1
Oregon 6 12 22 35 35 0.3 0.6 1.1 1.7 1.7
Pennsylvania 34 26 47 52 62 0.5 0.4 0.7 0.8 0.9
Rhode Island 1 1 5 4 3 0.2 0.2 0.9 0.7 0.6
South Carolina 34 39 23 37 52 1.4 1.6 0.9 1.5 2.1
South Dakota 1 15 34 7 6 0.2 3.6 8.0 1.6 1.4
Tennessee 31 22 34 23 56 0.9 0.7 1.0 0.7 1.7
Texas 269 179 242 230 230 2.1 1.3 1.8 1.7 1.7
Utah 0 2 1 2 6 0.0 0.1 0.1 0.1 0.4
Vermont 0 0 0 0 3 0.0 0.0 0.0 0.0 0.9
Virginia 21 17 17 17 47 0.5 0.4 0.4 0.4 1.1
Washington 9 13 18 30 51 0.3 0.4 0.5 0.8 1.4
West Virginia 2 4 6 9 10 0.2 0.4 0.6 1.0 1.1
Wisconsin 11 9 7 0 7 0.4 0.3 0.2 0.0 0.2
Wyoming 0 0 0 1 1 0.0 0.0 0.0 0.3 0.3
U.S. TOTAL 1,458 1,500 1,840 2,298 3,049 0.9 0.9 1.1 1.4 1.9
Northeast 125 111 154 190 250 0.4 0.4 0.5 0.7 0.9
Midwest 251 250 324 339 398 0.7 0.7 0.9 1.0 1.2
South 914 834 905 1,126 1,374 1.5 1.4 1.5 1.8 2.2
West 168 305 457 643 1,027 0.5 0.8 1.2 1.7 2.7
Guam 1 5 2 0 0 1.3 6.3 2.5 0.0 0.0
Puerto Rico 20 35 30 70 86 1.0 1.9 1.6 3.9 4.7
Virgin Islands 0 1 1 4 0 0.0 1.8 1.8 7.3 0.0
OUTLYING AREAS 21 41 33 74 86 1.0 2.0 1.7 3.8 4.4
TOTAL 1,479 1,541 1,873 2,372 3,135 0.9 0.9 1.1 1.4 1.9
92
Table 29. Primary and Secondary Syphilis Among Men Reported Cases and Rates of Reported Cases by
State/Area and Region in Alphabetical Order, United States and Outlying Areas, 20122016

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 178 161 144 243 296 7.6 6.9 6.1 10.3 12.6
Alaska 10 21 14 7 8 2.6 5.4 3.6 1.8 2.1
Arizona 186 260 527 542 641 5.7 7.9 15.8 16.0 18.9
Arkansas 124 133 98 108 113 8.6 9.1 6.7 7.4 7.7
California 2,823 3,319 3,515 4,430 5,143 14.9 17.4 18.2 22.8 26.5
Colorado 205 159 180 239 234 7.9 6.0 6.7 8.7 8.5
Connecticut 46 48 79 77 98 2.6 2.7 4.5 4.4 5.6
Delaware 36 49 45 39 55 8.1 10.9 9.9 8.5 12.0
Florida 1,235 1,376 1,602 1,873 2,140 13.1 14.4 16.5 18.9 21.6
Georgia 870 930 1,138 1,319 1,237 17.9 19.1 23.1 26.5 24.8
Hawaii 21 46 66 90 102 3.0 6.5 9.2 12.4 14.1
Idaho 24 15 12 48 44 3.0 1.9 1.5 5.8 5.3
Illinois 731 731 782 1,001 1,165 11.6 11.6 12.4 15.9 18.4
Indiana 202 197 157 257 290 6.3 6.1 4.8 7.9 8.9
Iowa 63 96 66 70 83 4.1 6.3 4.3 4.5 5.3
Kansas 22 47 46 70 112 1.5 3.3 3.2 4.8 7.7
Kentucky 137 105 136 122 198 6.3 4.9 6.3 5.6 9.1
Louisiana 212 308 443 507 558 9.4 13.6 19.5 22.2 24.4
Maine 15 9 13 22 39 2.3 1.4 2.0 3.4 6.0
Maryland 386 395 400 451 455 13.5 13.7 13.8 15.5 15.6
Massachusetts 301 343 277 391 464 9.3 10.6 8.5 11.9 14.1
Michigan 265 458 390 369 334 5.5 9.4 8.0 7.6 6.8
Minnesota 111 178 235 207 267 4.2 6.6 8.7 7.6 9.8
Mississippi 116 59 172 187 268 8.0 4.1 11.8 12.9 18.5
Missouri 145 232 318 253 334 4.9 7.8 10.7 8.5 11.2
Montana 2 4 6 12 13 0.4 0.8 1.2 2.3 2.5
Nebraska 7 37 46 42 62 0.8 4.0 4.9 4.4 6.6
Nevada 109 191 334 312 394 7.8 13.6 23.4 21.5 27.2
New Hampshire 36 27 32 37 36 5.5 4.1 4.9 5.6 5.5
New Jersey 210 220 281 346 448 4.9 5.1 6.4 7.9 10.2
New Mexico 92 58 112 107 162 8.9 5.6 10.8 10.4 15.7
New York 1,175 1,408 1,675 1,933 2,319 12.4 14.8 17.5 20.1 24.1
North Carolina 310 368 665 1,084 973 6.5 7.7 13.7 22.2 19.9
North Dakota 4 11 8 11 30 1.1 3.0 2.1 2.8 7.7
Ohio 340 373 492 492 622 6.0 6.6 8.7 8.7 10.9
Oklahoma 77 105 136 188 223 4.1 5.5 7.1 9.7 11.5
Oregon 206 255 250 310 292 10.7 13.1 12.7 15.6 14.7
Pennsylvania 460 445 485 602 693 7.4 7.1 7.8 9.6 11.1
Rhode Island 43 44 66 73 87 8.5 8.6 12.9 14.3 17.0
South Carolina 191 232 227 257 264 8.3 10.0 9.7 10.8 11.1
South Dakota 17 29 19 32 20 4.1 6.8 4.4 7.4 4.6
Tennessee 235 192 203 326 334 7.5 6.1 6.4 10.1 10.4
Texas 1,358 1,296 1,394 1,450 1,725 10.5 9.9 10.4 10.6 12.6
Utah 42 72 46 63 86 2.9 4.9 3.1 4.2 5.7
Vermont 6 3 5 9 20 1.9 1.0 1.6 2.9 6.5
Virginia 264 298 272 316 403 6.6 7.3 6.6 7.7 9.8
Washington 293 271 326 414 514 8.5 7.8 9.2 11.5 14.3
West Virginia 6 11 22 43 43 0.7 1.2 2.4 4.7 4.7
Wisconsin 80 86 79 79 125 2.8 3.0 2.8 2.8 4.4
Wyoming 4 1 4 4 6 1.4 0.3 1.3 1.3 2.0
U.S. TOTAL 14,190 15,861 18,146 21,547 24,724 9.2 10.2 11.6 13.6 15.6
Northeast 2,292 2,547 2,913 3,490 4,204 8.4 9.3 10.7 12.7 15.3
Midwest 1,987 2,475 2,638 2,883 3,444 6.0 7.4 7.9 8.6 10.3
South 5,894 6,167 7,203 8,596 9,437 10.2 10.6 12.3 14.5 15.9
West 4,017 4,672 5,392 6,578 7,639 10.9 12.6 14.4 17.4 20.2
Guam 5 1 5 2 2 6.2 1.2 6.1 2.4 2.4
Puerto Rico 286 350 454 461 407 16.3 20.2 26.6 27.8 24.6
Virgin Islands 0 1 1 4 0 0.0 2.0 2.1 8.4 0.0
OUTLYING AREAS 291 352 460 467 409 15.4 18.9 25.1 26.1 22.9
TOTAL 14,481 16,213 18,606 22,014 25,133 9.3 10.3 11.7 13.8 15.7
93
Table 30. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases in Selected
Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 20122016

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Atlanta-Sandy Springs-Roswell, GA 745 789 996 1,097 1,018 13.7 14.3 17.7 19.2 17.8
Baltimore-Columbia-Towson, MD 307 288 282 343 332 11.2 10.4 10.1 12.3 11.9
Chicago-Naperville-Elgin, IL-IN-WI 759 763 811 1,047 1,202 8.0 8.0 8.5 11.0 12.6
Columbus, OH 159 167 250 274 316 8.2 8.5 12.5 13.6 15.6
Dallas-Fort Worth-Arlington, TX 391 445 508 476 542 5.8 6.5 7.3 6.7 7.6
Houston-The Woodlands-Sugar Land, TX 537 363 414 439 411 8.7 5.7 6.4 6.6 6.2
Jacksonville, FL 44 40 69 91 118 3.2 2.9 4.9 6.3 8.1
Kansas City, MO-KS 65 155 220 191 201 3.2 7.5 10.6 9.1 9.6
Las Vegas-Henderson-Paradise, NV 97 164 318 305 398 4.8 8.1 15.4 14.4 18.8
Memphis, TN-MS-AR 110 105 94 121 173 8.2 7.8 7.0 9.0 12.9
Miami-Fort Lauderdale-West Palm Beach, FL 705 762 821 884 925 12.2 13.1 13.8 14.7 15.4
Oklahoma City, OK 54 78 91 113 162 4.2 5.9 6.8 8.3 11.9
Orlando-Kissimmee-Sanford, FL 168 201 239 299 384 7.6 8.9 10.3 12.5 16.1
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 369 396 446 458 639 6.1 6.6 7.4 7.5 10.5
Phoenix-Mesa-Scottsdale, AZ 162 219 416 452 574 3.7 5.0 9.3 9.9 12.5
Pittsburgh, PA 61 39 78 150 100 2.6 1.7 3.3 6.4 4.2
Raleigh, NC 56 70 129 168 137 4.7 5.8 10.4 13.2 10.8
Richmond, VA 64 70 68 73 104 5.2 5.6 5.4 5.7 8.2
Riverside-San Bernardino-Ontario, CA 166 203 288 341 445 3.8 4.6 6.5 7.6 9.9
Salt Lake City, UT 34 65 39 49 69 3.0 5.7 3.4 4.2 5.9
San Antonio-New Braunfels, TX 329 310 247 237 243 14.7 13.6 10.6 9.9 10.2
San Diego-Carlsbad, CA 331 333 371 493 524 10.4 10.4 11.4 14.9 15.9
San Francisco-Oakland-Hayward, CA 744 814 767 830 872 16.7 18.0 16.7 17.8 18.7
St. Louis, MO-IL 95 108 153 112 215 3.4 3.9 5.5 4.0 7.6
Tampa-St. Petersburg-Clearwater, FL 230 226 320 393 436 8.1 7.9 11.0 13.2 14.7
Washington-Arlington-Alexandria, DC-VA-MD-WV 358 418 226 230 273 6.1 7.0 3.7 3.8 4.5
94
Table 31. Primary and Secondary Syphilis Among Women Reported Cases and Rates of Reported Cases in
Selected Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 20122016

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Atlanta-Sandy Springs-Roswell, GA 33 52 58 61 61 1.2 1.8 2.0 2.1 2.1
Chicago-Naperville-Elgin, IL-IN-WI 77 65 76 86 88 1.6 1.3 1.6 1.8 1.8
Columbus, OH 14 18 34 27 48 1.4 1.8 3.4 2.6 4.7
Jacksonville, FL 4 5 9 8 26 0.6 0.7 1.2 1.1 3.5
Kansas City, MO-KS 1 9 23 41 39 0.1 0.9 2.2 3.9 3.7
Los Angeles-Long Beach-Anaheim, CA 26 50 67 108 144 0.4 0.8 1.0 1.6 2.1
Memphis, TN-MS-AR 22 17 22 13 25 3.2 2.4 3.1 1.9 3.6
New York-Newark-Jersey City, NY-NJ-PA 57 46 52 69 123 0.6 0.4 0.5 0.7 1.2
Oklahoma City, OK 1 5 7 14 27 0.2 0.7 1.0 2.0 3.9
Pittsburgh, PA 5 2 6 11 11 0.4 0.2 0.5 0.9 0.9
Raleigh, NC 5 9 6 13 10 0.8 1.4 0.9 2.0 1.5
Richmond, VA 10 4 2 4 15 1.6 0.6 0.3 0.6 2.3
Salt Lake City, UT 0 1 1 1 5 0.0 0.2 0.2 0.2 0.9
St. Louis, MO-IL 9 6 17 14 24 0.6 0.4 1.2 1.0 1.7
SELECTED MSAs TOTAL 933 912 1,095 1,280 1,615 1.1 1.0 1.2 1.4 1.8
95
Table 32. Primary and Secondary Syphilis Among Men Reported Cases and Rates of Reported Cases in
Selected Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 20122016

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Atlanta-Sandy Springs-Roswell, GA 712 737 938 1,036 957 26.8 27.5 34.5 37.5 34.6
Chicago-Naperville-Elgin, IL-IN-WI 682 697 735 961 1,114 14.6 14.9 15.7 20.6 23.8
Columbus, OH 145 149 216 247 268 15.2 15.4 22.0 24.8 26.9
Jacksonville, FL 40 35 60 83 92 6.0 5.2 8.7 11.7 13.0
Kansas City, MO-KS 64 146 197 150 162 6.4 14.5 19.4 14.6 15.8
Memphis, TN-MS-AR 88 88 72 108 148 13.7 13.7 11.2 16.8 23.0
Oklahoma City, OK 53 73 84 99 135 8.3 11.2 12.8 14.8 20.2
Pittsburgh, PA 56 37 72 139 89 4.9 3.2 6.3 12.1 7.8
Raleigh, NC 51 61 123 155 127 8.8 10.3 20.3 24.9 20.4
Richmond, VA 54 66 66 69 87 9.1 11.0 10.8 11.2 14.2
Salt Lake City, UT 34 64 38 48 64 6.0 11.2 6.6 8.2 10.9
St. Louis, MO-IL 86 102 136 98 191 6.4 7.5 10.0 7.2 14.0
96
Table 33. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases in Counties and
Independent Cities* Ranked by Number of Reported Cases, United States, 2016
2 Cook County, IL 1,018 19.4 10
3 New York County, NY 719 43.7 12
4 Maricopa County, AZ 542 13.0 14
5 Miami-Dade County, FL 537 19.9 16
6 San Diego County, CA 524 15.9 18
7 San Francisco County, CA 522 60.4 20
8 Kings County, NY 497 18.8 22
9 Philadelphia County, PA 428 27.3 23
10 Fulton County, GA 410 40.6 25
11 Clark County, NV 398 18.8 26
12 Bronx County, NY 396 27.2 28
13 Fresno County, CA 390 40.0 29
14 Harris County, TX 357 7.9 30
15 Dallas County, TX 333 13.0 31
16 Orange County, CA 309 9.7 33
17 Orange County, FL 297 23.1 34
18 Mecklenburg County, NC 295 28.5 35
19 Broward County, FL 295 15.6 36
20 King County, WA 293 13.8 37
21 Queens County, NY 287 12.3 38
22 Franklin County, OH 286 22.8 39
23 Riverside County, CA 279 11.8 40
24 Travis County, TX 278 23.6 41
25 San Joaquin County, CA 266 36.6 42
26 DeKalb County, GA 265 36.1 43
27 Kern County, CA 257 29.1 44
28 Sacramento County, CA 228 15.2 45
29 Bexar County, TX 224 11.8 45
30 Hillsborough County, FL 217 16.1 46
31 Santa Clara County, CA 217 11.3 47
32 Baltimore (City), MD 197 31.7 48
33 Pinellas County, FL 187 19.7 48
34 Alameda County, CA 184 11.2 49
35 Hennepin County, MN 170 13.9 50
36 San Bernardino County, CA 166 7.8 50
37 Multnomah County, OR 165 20.9 51
38 Wayne County, MI 158 9.0 51
39 Shelby County, TN 149 15.9 52
40 Orleans Parish, LA 143 36.7 52
41 Jackson County, MO 141 20.5 53
42 Cuyahoga County, OH 139 11.1 53
43 Marion County, IN 138 14.7 54
44 Oklahoma County, OK 129 16.6 54
45 Wake County, NC 127 12.4 55
46 El Paso County, TX 126 15.1 55
47 Tarrant County, TX 125 6.3 56
48 Bernalillo County, NM 120 17.7 56
49 Jefferson County, KY 117 15.3 57
50 Prince George's County, MD 110 12.1 57
51 Pima County, AZ 108 10.7 57
52 Caddo Parish, LA 107 42.6 58
53 Denver County, CO 107 15.7 58
54 Gwinnett County, GA 107 11.9 58
55 Hudson County, NJ 103 15.3 59
56 East Baton Rouge Parish, LA 102 22.8 59
57 Duval County, FL 102 11.2 60
58 Jefferson County, AL 100 15.1 60
59 Middlesex County, MA 99 6.2 60
60 Essex County, NJ 98 12.3 61
61 Guilford County, NC 96 18.5 61
62 Palm Beach County, FL 93 6.5 61
63 Cobb County, GA 88 11.9 62
64 Allegheny County, PA 87 7.1 62
65 Contra Costa County, CA 86 7.6 62
66 St. Louis (City), MO 85 26.9 63
67 Alachua County, FL 84 32.3 63
68 Stanislaus County, CA 83 15.4 63
69 Honolulu County, HI 83 8.3 63
70 Richland County, SC 80 19.7 64
complete for 95% of cases in Massachusetts. See Appendix A1.4 for more information.
97
Table 34. Primary and Secondary Syphilis Reported Cases and Rates of Reported Cases by Age Group and
Sex, United States, 20122016
04 1 1 0 0 0.0 0.0 0.0
59 0 0 0 0 0.0 0.0 0.0
1014 9 5 4 0 0.0 0.0 0.0
1519 880 640 238 2 4.1 5.8 2.3
2024 3,280 2,859 418 3 14.5 24.8 3.8
2529 2,911 2,641 266 4 13.6 24.4 2.5
2012
3034 2,209 2,023 182 4 10.6 19.3 1.7
3539 1,563 1,443 120 0 8.0 14.9 1.2
4044 1,618 1,544 70 4 7.7 14.8 0.7
4554 2,439 2,310 128 1 5.5 10.6 0.6
5564 614 586 27 1 1.6 3.2 0.1
65+ 123 121 2 0 0.3 0.6 0.0
Unknown Age 20 17 3 0
TOTAL 15,667 14,190 1,458 19 5.0 9.2 0.9
04 5 2 3 0 0.0 0.0 0.0
59 0 0 0 0 0.0 0.0 0.0
1014 23 14 9 0 0.1 0.1 0.1
1519 900 700 200 0 4.3 6.5 1.9
2024 3,642 3,204 435 3 16.0 27.4 3.9
2529 3,329 3,037 286 6 15.4 27.7 2.7
2013
3034 2,447 2,272 172 3 11.5 21.3 1.6
3539 1,800 1,674 125 1 9.2 17.1 1.3
4044 1,693 1,587 105 1 8.1 15.3 1.0
4554 2,614 2,495 119 0 6.0 11.6 0.5
5564 750 716 34 0 1.9 3.8 0.2
65+ 162 152 10 0 0.4 0.8 0.0
TOTAL 17,375 15,861 1,500 14 5.5 10.2 0.9
04 0 0 0 0 0.0 0.0 0.0
59 0 0 0 0 0.0 0.0 0.0
1014 12 4 8 0 0.1 0.0 0.1
1519 1,023 761 262 0 4.9 7.1 2.5
2024 4,137 3,632 503 2 18.1 30.9 4.5
2529 4,092 3,727 361 4 18.6 33.4 3.3
2014
3034 2,887 2,635 248 4 13.4 24.4 2.3
3539 2,045 1,868 177 0 10.3 18.8 1.8
4044 1,758 1,654 103 1 8.5 16.2 1.0
4554 2,966 2,830 135 1 6.8 13.2 0.6
5564 897 860 36 1 2.2 4.5 0.2
65+ 176 169 7 0 0.4 0.8 0.0
Unknown Age 6 6 0 0
TOTAL 19,999 18,146 1,840 13 6.3 11.6 1.1
04 2 0 1 1 0.0 0.0 0.0
59 1 0 1 0 0.0 0.0 0.0
1014 9 1 8 0 0.0 0.0 0.1
1519 1,148 865 283 0 5.4 8.0 2.7
2024 4,766 4,186 573 7 21.0 35.9 5.2
2529 5,168 4,671 491 6 23.0 40.9 4.4
2015
3034 3,549 3,234 311 4 16.4 29.7 2.9
3539 2,482 2,249 229 4 12.2 22.1 2.2
4044 1,897 1,744 152 1 9.4 17.4 1.5
4554 3,488 3,294 190 4 8.1 15.5 0.9
5564 1,153 1,099 54 0 2.8 5.6 0.3
65+ 207 202 5 0 0.4 1.0 0.0
Unknown Age 2 2 0 0
TOTAL 23,872 21,547 2,298 27 7.4 13.6 1.4
04 2 0 2 0 0.0 0.0 0.0
59 2 1 1 0 0.0 0.0 0.0
1014 15 6 9 0 0.1 0.1 0.1
1519 1,298 957 340 1 6.1 8.9 3.3
2024 5,172 4,418 744 10 22.7 37.9 6.7
2529 6,177 5,538 624 15 27.5 48.5 5.6
2016
3034 4,278 3,806 464 8 19.7 35.0 4.3

3539 3,043 2,729 311 3 14.9 26.8 3.0
4044 2,140 1,944 193 3 10.6 19.4 1.9
4554 3,953 3,691 261 1 9.2 17.3 1.2
5564 1,418 1,338 80 0 3.5 6.8 0.4
65+ 279 269 10 0 0.6 1.3 0.0
TOTAL 27,814 24,724 3,049 41 8.7 15.6 1.9
NOTE: This table should be used only for age comparisons.
98
Table 35A. Primary and Secondary Syphilis Reported Cases by Race/Ethnicity, Age Group, and Sex,
Asians Blacks
04 0 0 0 0 0 0 2 0 2 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0 0
1014 0 0 0 1 1 0 12 4 8 0 0 0
1519 9 6 3 28 26 2 614 412 201 4 2 2
2024 39 31 8 107 99 8 2,184 1,811 367 16 14 2
2529 47 34 13 151 144 6 2,522 2,227 287 15 15 0
3034 35 25 10 121 114 7 1,406 1,241 162 9 9 0
3539 20 14 6 86 77 9 835 733 100 10 7 3
4044 9 6 3 75 69 5 470 418 51 8 8 0
4554 26 24 2 86 85 1 835 736 98 10 10 0
5564 5 5 0 16 14 2 269 243 26 0 0 0
65+ 0 0 0 3 3 0 46 43 3 0 0 0
Unknown Age 0 0 0 0 0 0 27 19 8 0 0 0
TOTAL 190 145 45 674 632 40 9,222 7,887 1,313 72 65 7
Other/
Age Unknown
04 0 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 2 1 1 0 0 0
1014 0 0 0 0 0 0 1 1 0 1 0 1
1519 268 207 61 11 7 4 304 253 51 60 44 16
2024 1,230 1,047 183 88 74 14 1,291 1,148 139 217 194 23
2529 1,698 1,507 188 94 85 9 1,374 1,270 103 276 256 18
3034 1,377 1,216 160 78 72 4 1,054 948 105 198 181 16
3539 1,150 1,029 121 34 31 3 742 690 52 166 148 17
4044 940 863 77 39 34 5 497 458 38 102 88 14
4554 1,996 1,886 110 45 43 2 712 675 37 243 232 11
5564 841 803 38 14 14 0 181 171 10 92 88 4
65+ 180 176 4 2 2 0 33 31 2 15 14 1
Unknown Age 8 7 1 0 0 0 1 1 0 1 0 1
TOTAL 9,688 8,741 943 405 362 41 6,192 5,647 538 1,371 1,245 122

cases and rates.
99
Table 35B. Primary and Secondary Syphilis Rates of Reported Cases per 100,000 Population by Race/
Ethnicity, Age Group, and Sex, United States*, 2016
Asians Blacks
04 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0
59 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
1014 0.0 0.0 0.0 0.1 0.2 0.0 0.4 0.3 0.6 0.0 0.0 0.0
1519 4.9 6.5 3.4 2.7 5.0 0.4 20.5 27.2 13.6 9.9 9.6 10.2
2024 19.6 30.4 8.2 8.5 15.5 1.3 64.3 105.0 21.9 34.1 58.2 8.7
2529 25.6 36.5 14.4 10.2 19.9 0.8 81.0 144.6 18.2 28.8 55.6 0.0
3034 21.5 30.8 12.2 8.0 16.0 0.9 50.8 93.2 11.3 18.5 36.0 0.0
3539 13.5 19.0 8.1 6.1 11.7 1.2 32.0 59.3 7.3 23.6 32.5 14.4
4044 6.3 8.5 4.1 5.3 10.4 0.7 18.4 34.9 3.8 21.5 42.5 0.0
4554 8.4 16.0 1.3 3.6 7.6 0.1 15.8 29.6 3.5 14.4 28.9 0.0
5564 1.8 3.8 0.0 0.8 1.6 0.2 5.8 11.5 1.0 0.0 0.0 0.0
65+ 0.0 0.0 0.0 0.1 0.3 0.0 1.1 2.5 0.1 0.0 0.0 0.0
Unknown Age
TOTAL 8.0 12.4 3.7 3.9 7.6 0.4 23.1 41.3 6.3 12.9 23.0 2.5

04 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
59 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
1014 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
1519 2.3 3.5 1.1 1.6 2.0 1.2 6.4 10.5 2.2
2024 9.9 16.4 3.0 14.7 24.6 4.7 26.8 46.0 6.0
2529 13.4 23.5 3.0 20.4 38.4 3.7 30.3 53.3 4.8
3034 11.1 19.5 2.6 20.4 39.8 2.0 23.7 40.8 4.9
3539 9.9 17.6 2.1 10.5 20.3 1.7 17.5 31.6 2.5
4044 7.9 14.5 1.3 14.0 25.8 3.4 12.6 23.0 2.0
4554 7.1 13.5 0.8 9.2 18.5 0.8 10.9 20.4 1.1
5564 2.9 5.6 0.3 3.6 7.5 0.0 4.2 8.2 0.5
65+ 0.5 1.1 0.0 0.6 1.3 0.0 0.9 1.9 0.1
Unknown Age
TOTAL 4.9 9.0 0.9 6.2 11.2 1.2 10.9 19.7 1.9

cases and rates. No population data exist for unknown sex, unknown age, or unknown race; therefore rates are not calculated.
100
Table 36. Early Latent Syphilis Reported Cases and Rates of Reported Cases by State/Area and Region in
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 237 202 144 177 293 4.9 4.2 3.0 3.6 6.0
Alaska 8 8 25 13 13 1.1 1.1 3.4 1.8 1.8
Arizona 147 207 311 361 488 2.2 3.1 4.6 5.3 7.1
Arkansas 152 163 152 216 280 5.2 5.5 5.1 7.3 9.4
California 2,519 2,844 3,396 4,435 5,289 6.6 7.4 8.8 11.3 13.5
Colorado 194 195 164 212 274 3.7 3.7 3.1 3.9 5.0
Connecticut 52 55 62 97 84 1.4 1.5 1.7 2.7 2.3
Delaware 38 30 33 47 57 4.1 3.2 3.5 5.0 6.0
Florida 1,384 1,540 1,886 2,288 2,634 7.2 7.9 9.5 11.3 13.0
Georgia 639 863 1,078 1,477 1,263 6.4 8.6 10.7 14.5 12.4
Hawaii 9 22 25 56 89 0.6 1.6 1.8 3.9 6.2
Idaho 21 6 12 24 33 1.3 0.4 0.7 1.5 2.0
Illinois 690 809 819 889 1,138 5.4 6.3 6.4 6.9 8.8
Indiana 148 157 129 220 247 2.3 2.4 2.0 3.3 3.7
Iowa 15 63 82 69 59 0.5 2.0 2.6 2.2 1.9
Kansas 54 84 92 153 178 1.9 2.9 3.2 5.3 6.1
Kentucky 139 167 169 164 189 3.2 3.8 3.8 3.7 4.3
Louisiana 343 276 372 439 568 7.5 6.0 8.0 9.4 12.2
Maine 2 6 7 10 6 0.2 0.5 0.5 0.8 0.5
Maryland 361 387 529 594 598 6.1 6.5 8.9 9.9 10.0
Massachusetts 231 350 282 355 538 3.5 5.2 4.2 5.2 7.9
Michigan 150 204 243 282 290 1.5 2.1 2.5 2.8 2.9
Minnesota 96 139 159 185 251 1.8 2.6 2.9 3.4 4.6
Mississippi 253 184 336 405 490 8.5 6.2 11.2 13.5 16.4
Missouri 135 220 240 247 276 2.2 3.6 4.0 4.1 4.5
Montana 0 2 1 5 6 0.0 0.2 0.1 0.5 0.6
Nebraska 8 14 19 5 19 0.4 0.7 1.0 0.3 1.0
Nevada 214 232 389 439 510 7.8 8.3 13.7 15.2 17.6
New Hampshire 9 21 22 16 33 0.7 1.6 1.7 1.2 2.5
New Jersey 410 539 612 714 755 4.6 6.1 6.8 8.0 8.4
New Mexico 68 67 76 71 118 3.3 3.2 3.6 3.4 5.7
New York 1,413 1,945 2,307 2,802 3,504 7.2 9.9 11.7 14.2 17.7
North Carolina 244 236 468 753 799 2.5 2.4 4.7 7.5 8.0
North Dakota 0 2 22 17 12 0.0 0.3 3.0 2.2 1.6
Ohio 171 211 265 326 389 1.5 1.8 2.3 2.8 3.3
Oklahoma 146 237 198 222 339 3.8 6.2 5.1 5.7 8.7
Oregon 94 127 149 214 250 2.4 3.2 3.8 5.3 6.2
Pennsylvania 484 581 641 770 982 3.8 4.5 5.0 6.0 7.7
Rhode Island 24 22 49 38 63 2.3 2.1 4.6 3.6 6.0
South Carolina 336 415 467 496 613 7.1 8.7 9.7 10.1 12.5
South Dakota 3 5 23 11 14 0.4 0.6 2.7 1.3 1.6
Tennessee 255 267 236 312 337 3.9 4.1 3.6 4.7 5.1
Texas 1,767 1,902 1,984 2,471 2,872 6.8 7.2 7.4 9.0 10.5
Utah 8 47 41 31 61 0.3 1.6 1.4 1.0 2.0
Vermont 6 2 7 6 14 1.0 0.3 1.1 1.0 2.2
Virginia 303 354 274 410 602 3.7 4.3 3.3 4.9 7.2
Washington 181 204 198 293 446 2.6 2.9 2.8 4.1 6.2
West Virginia 10 10 23 40 51 0.5 0.5 1.2 2.2 2.8
Wisconsin 86 62 91 95 150 1.5 1.1 1.6 1.6 2.6
Wyoming 2 1 1 1 5 0.3 0.2 0.2 0.2 0.9
U.S. TOTAL 14,503 16,929 19,452 24,173 28,924 4.6 5.4 6.1 7.5 9.0
Northeast 2,631 3,521 3,989 4,808 5,979 4.7 6.3 7.1 8.5 10.6
Midwest 1,556 1,970 2,184 2,499 3,023 2.3 2.9 3.2 3.7 4.5
South 6,851 7,476 8,491 10,711 12,340 5.8 6.3 7.1 8.8 10.2
West 3,465 3,962 4,788 6,155 7,582 4.7 5.3 6.4 8.1 10.0
Guam 1 3 1 2 1 0.6 1.9 0.6 1.2 0.6
Puerto Rico 222 270 375 565 570 6.1 7.5 10.6 16.3 16.4
Virgin Islands 0 2 0 7 2 0.0 1.9 0.0 6.8 1.9
OUTLYING AREAS 223 275 376 574 573 5.7 7.1 9.9 15.4 15.3
TOTAL 14,726 17,204 19,828 24,747 29,497 4.6 5.4 6.1 7.6 9.1
101
Table 37. Early Latent Syphilis Reported Cases and Rates of Reported Cases in Selected Metropolitan
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Atlanta-Sandy Springs-Roswell, GA 491 672 863 1,067 1,053 9.0 12.2 15.4 18.7 18.4
Chicago-Naperville-Elgin, IL-IN-WI 630 751 734 814 1,058 6.6 7.9 7.7 8.5 11.1
Columbus, OH 49 71 82 130 149 2.5 3.6 4.1 6.4 7.4
Dallas-Fort Worth-Arlington, TX 604 550 644 932 1,038 9.0 8.1 9.3 13.1 14.6
Jacksonville, FL 57 73 69 162 137 4.1 5.2 4.9 11.2 9.5
Kansas City, MO-KS 61 111 132 133 140 3.0 5.4 6.4 6.4 6.7
Memphis, TN-MS-AR 188 188 143 195 246 14.0 14.0 10.6 14.5 18.3
Miami-Fort Lauderdale-West Palm Beach, FL 831 885 1,094 1,220 1,282 14.4 15.2 18.4 20.3 21.3
Oklahoma City, OK 79 124 107 114 195 6.1 9.4 8.0 8.4 14.4
Pittsburgh, PA 46 45 63 111 125 1.9 1.9 2.7 4.7 5.3
Raleigh, NC 31 41 77 115 135 2.6 3.4 6.2 9.0 10.6
Richmond, VA 78 75 68 98 162 6.3 6.0 5.4 7.7 12.7
Salt Lake City, UT 7 37 31 23 43 0.6 3.2 2.7 2.0 3.7
St. Louis, MO-IL 89 125 139 138 151 3.2 4.5 5.0 4.9 5.4
102
Table 38. Late and Late Latent Syphilis* Reported Cases and Rates of Reported Cases by State/Area and
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 248 292 167 197 232 5.1 6.0 3.4 4.1 4.8
Alaska 14 3 5 3 3 1.9 0.4 0.7 0.4 0.4
Arizona 424 455 558 532 680 6.5 6.9 8.3 7.8 10.0
Arkansas 132 175 110 145 131 4.5 5.9 3.7 4.9 4.4
California 2,509 3,539 4,110 4,966 6,216 6.6 9.2 10.6 12.7 15.9
Colorado 101 117 5 96 211 1.9 2.2 0.1 1.8 3.9
Connecticut 14 22 21 30 23 0.4 0.6 0.6 0.8 0.6
Delaware 29 63 30 21 34 3.2 6.8 3.2 2.2 3.6
Florida 1,693 1,934 2,429 2,723 3,233 8.8 9.9 12.2 13.4 15.9
Georgia 842 1,090 1,055 1,245 1,478 8.5 10.9 10.4 12.2 14.5
Hawaii 11 19 13 14 13 0.8 1.4 0.9 1.0 0.9
Idaho 6 21 22 21 44 0.4 1.3 1.3 1.3 2.7
Illinois 902 1,031 1,087 1,285 1,623 7.0 8.0 8.4 10.0 12.6
Indiana 159 171 170 189 197 2.4 2.6 2.6 2.9 3.0
Iowa 58 57 84 88 127 1.9 1.8 2.7 2.8 4.1
Kansas 51 61 48 0 0 1.8 2.1 1.7 0.0 0.0
Kentucky 99 102 117 123 159 2.3 2.3 2.7 2.8 3.6
Louisiana 1,065 1,267 1,180 1,277 1,233 23.1 27.4 25.4 27.3 26.4
Maine 3 5 0 0 16 0.2 0.4 0.0 0.0 1.2
Maryland 439 504 481 749 719 7.5 8.5 8.0 12.5 12.0
Massachusetts 258 276 227 486 416 3.9 4.1 3.4 7.2 6.1
Michigan 334 368 416 393 424 3.4 3.7 4.2 4.0 4.3
Minnesota 120 209 215 220 289 2.2 3.9 3.9 4.0 5.3
Mississippi 53 31 116 136 107 1.8 1.0 3.9 4.5 3.6
Missouri 133 135 178 220 271 2.2 2.2 2.9 3.6 4.5
Montana 1 1 0 2 4 0.1 0.1 0.0 0.2 0.4
Nebraska 18 40 26 31 34 1.0 2.1 1.4 1.6 1.8
Nevada 117 84 142 133 347 4.2 3.0 5.0 4.6 12.0
New Hampshire 19 30 21 28 27 1.4 2.3 1.6 2.1 2.0
New Jersey 243 196 263 220 381 2.7 2.2 2.9 2.5 4.3
New Mexico 64 100 80 141 160 3.1 4.8 3.8 6.8 7.7
New York 2,667 2,758 3,073 2,975 3,484 13.6 14.0 15.6 15.0 17.6
North Carolina 444 509 791 783 756 4.6 5.2 8.0 7.8 7.5
North Dakota 10 11 16 14 16 1.4 1.5 2.2 1.8 2.1
Ohio 526 431 381 445 483 4.6 3.7 3.3 3.8 4.2
Oklahoma 27 28 59 83 90 0.7 0.7 1.5 2.1 2.3
Oregon 117 133 159 218 227 3.0 3.4 4.0 5.4 5.6
Pennsylvania 365 431 346 356 295 2.9 3.4 2.7 2.8 2.3
Rhode Island 25 27 40 48 81 2.4 2.6 3.8 4.5 7.7
South Carolina 56 66 28 41 36 1.2 1.4 0.6 0.8 0.7
South Dakota 8 12 16 21 15 1.0 1.4 1.9 2.4 1.7
Tennessee 545 497 502 575 713 8.4 7.7 7.7 8.7 10.8
Texas 3,585 3,593 4,110 4,047 4,666 13.8 13.6 15.2 14.7 17.0
Utah 51 51 61 73 106 1.8 1.8 2.1 2.4 3.5
Vermont 0 5 0 0 0 0.0 0.8 0.0 0.0 0.0
Virginia 317 329 137 276 235 3.9 4.0 1.6 3.3 2.8
Washington 226 223 310 366 400 3.3 3.2 4.4 5.1 5.6
West Virginia 6 14 4 17 45 0.3 0.8 0.2 0.9 2.4
Wisconsin 91 100 108 88 140 1.6 1.7 1.9 1.5 2.4
Wyoming 6 7 1 4 5 1.0 1.2 0.2 0.7 0.9
U.S. TOTAL 19,411 21,819 23,541 26,170 30,676 6.2 6.9 7.4 8.1 9.5
Northeast 3,594 3,750 3,991 4,143 4,723 6.4 6.7 7.1 7.4 8.4
Midwest 2,410 2,626 2,745 2,994 3,619 3.6 3.9 4.1 4.4 5.3
South 9,760 10,690 11,339 12,464 13,918 8.3 9.0 9.5 10.3 11.5
West 3,647 4,753 5,466 6,569 8,416 5.0 6.4 7.3 8.6 11.1
Guam 20 14 5 16 10 12.5 8.7 3.1 9.9 6.2
Puerto Rico 175 154 101 166 117 4.8 4.3 2.8 4.8 3.4
Virgin Islands 2 5 4 10 0 1.9 4.8 3.8 9.7 0.0
OUTLYING AREAS 197 173 110 192 127 5.0 4.5 2.9 5.1 3.4
TOTAL 19,608 21,992 23,651 26,362 30,803 6.2 6.9 7.3 8.1 9.5
* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, and late syphilis with clinical manifestations (including late benign
syphilis and cardiovascular syphilis).
103
Table 39. Late and Late Latent Syphilis* Reported Cases and Rates of Reported Cases in Selected Metropolitan
Statistical Areas (MSAs) in Alphabetical Order, United States, 20122016
MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Atlanta-Sandy Springs-Roswell, GA 573 782 804 926 1,135 10.5 14.2 14.3 16.2 19.9
Chicago-Naperville-Elgin, IL-IN-WI 853 963 988 1,169 1,529 9.0 10.1 10.3 12.2 16.0
Columbus, OH 101 98 101 105 109 5.2 5.0 5.1 5.2 5.4
Dallas-Fort Worth-Arlington, TX 1,132 1,081 1,065 837 1,069 16.9 15.9 15.3 11.8 15.1
Jacksonville, FL 73 75 128 179 181 5.3 5.4 9.0 12.3 12.5
Kansas City, MO-KS 38 54 54 40 87 1.9 2.6 2.6 1.9 4.2
Memphis, TN-MS-AR 291 283 236 256 334 21.7 21.1 17.6 19.0 24.8
Oklahoma City, OK 15 11 31 32 47 1.2 0.8 2.3 2.4 3.5
Pittsburgh, PA 21 11 13 11 11 0.9 0.5 0.6 0.5 0.5
Raleigh, NC 63 68 109 124 106 5.3 5.6 8.8 9.7 8.3
Richmond, VA 51 58 9 36 35 4.1 4.7 0.7 2.8 2.8
Salt Lake City, UT 33 34 39 50 75 2.9 3.0 3.4 4.3 6.4
St. Louis, MO-IL 95 104 119 165 160 3.4 3.7 4.2 5.9 5.7
* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, and late syphilis with clinical manifestations (including late benign
syphilis and cardiovascular syphilis).
MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
104
Table 40. Congenital Syphilis Reported Cases and Rates of Reported Cases by State, Ranked by Rates,
United States, 2016
Rank* State Cases Rate per 100,000 Live Births
1 Louisiana 48 74.4
2 California 206 41.0
3 Nevada 12 33.5
4 Florida 59 26.8
5 Maryland 16 21.6
6 Texas 71 17.8
7 Arizona 15 17.3
8 South Dakota 2 16.3
9 Georgia 21 16.0
U.S. TOTAL 628 15.7
10 South Carolina 9 15.6
11 Arkansas 6 15.6
12 North Carolina 16 13.2
13 Oregon 6 13.2
14 New Jersey 12 11.6
15 New Mexico 3 11.5
16 Michigan 13 11.4
17 Illinois 18 11.4
18 Missouri 8 10.6
19 Minnesota 7 10.0
21 Tennessee 8 9.8
22 Indiana 8 9.5
HP 2020 TARGET 9.1
23 Ohio 11 7.9
24 Alabama 4 6.7
25 Colorado 4 6.1
26 Oklahoma 3 5.6
27 Massachusetts 4 5.6
28 New York 13 5.4
29 Hawaii 1 5.4
30 Kentucky 3 5.3
31 Mississippi 2 5.2
32 Virginia 5 4.8
33 Pennsylvania 5 3.5
34 Washington 3 3.4
35 Kansas 1 2.5
36 Iowa 1 2.5
37 Wisconsin 1 1.5
Alaska 0 0.0
Connecticut 0 0.0
Delaware 0 0.0
Idaho 0 0.0
Maine 0 0.0
Montana 0 0.0
Nebraska 0 0.0
New Hampshire 0 0.0
North Dakota 0 0.0
Rhode Island 0 0.0
Utah 0 0.0
Vermont 0 0.0
Wyoming 0 0.0
Mothers state of residence was used to assign case.
Total includes cases reported by the District of Columbia with 1 case, but excludes outlying areas (Guam with 0 cases, Puerto Rico with 4 cases, and Virgin Islands
with 0 cases).
105
Table 41. Congenital Syphilis Reported Cases and Rates of Reported Cases by Year of Birth, State/Area*, and
Cases Rates per 100,000 Live Births
State/Area* 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 4 2 3 3 4 6.8 3.4 5.0 5.0 6.7
Alaska 1 1 0 0 0 8.9 8.7 0.0 0.0 0.0
Arizona 14 13 13 14 15 16.2 15.2 15.0 16.1 17.3
Arkansas 11 12 7 5 6 28.7 31.7 18.2 13.0 15.6
California 35 58 102 140 206 6.9 11.7 20.3 27.8 41.0
Colorado 0 0 0 0 4 0.0 0.0 0.0 0.0 6.1
Connecticut 0 0 0 1 0 0.0 0.0 0.0 2.8 0.0
Delaware 1 1 0 1 0 9.1 9.2 0.0 9.1 0.0
Florida 37 35 48 38 59 17.4 16.2 21.8 17.3 26.8
Georgia 16 20 17 21 21 12.3 15.5 13.0 16.0 16.0
Hawaii 0 0 0 2 1 0.0 0.0 0.0 10.8 5.4
Idaho 1 0 0 0 0 4.4 0.0 0.0 0.0 0.0
Illinois 28 23 27 31 18 17.6 14.7 17.0 19.6 11.4
Indiana 0 0 8 5 8 0.0 0.0 9.5 5.9 9.5
Iowa 0 0 1 0 1 0.0 0.0 2.5 0.0 2.5
Kansas 0 0 0 0 1 0.0 0.0 0.0 0.0 2.5
Kentucky 2 4 3 1 3 3.6 7.2 5.3 1.8 5.3
Louisiana 33 40 46 54 48 52.7 63.3 71.3 83.7 74.4
Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Maryland 12 14 16 18 16 16.5 19.5 21.6 24.4 21.6
Massachusetts 1 4 3 4 4 1.4 5.6 4.2 5.6 5.6
Michigan 7 9 15 11 13 6.2 7.9 13.1 9.6 11.4
Minnesota 1 0 0 2 7 1.5 0.0 0.0 2.9 10.0
Mississippi 0 0 1 0 2 0.0 0.0 2.6 0.0 5.2
Missouri 1 3 1 4 8 1.3 4.0 1.3 5.3 10.6
Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Nebraska 1 0 1 0 0 3.9 0.0 3.7 0.0 0.0
Nevada 1 2 5 8 12 2.9 5.7 13.9 22.3 33.5
New Hampshire 1 0 0 0 0 8.1 0.0 0.0 0.0 0.0
New Jersey 1 0 0 0 12 1.0 0.0 0.0 0.0 11.6
New Mexico 1 2 1 2 3 3.7 7.6 3.8 7.7 11.5
New York 8 11 22 12 13 3.3 4.6 9.2 5.0 5.4
North Carolina 2 4 6 9 16 1.7 3.4 5.0 7.4 13.2
North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Ohio 19 18 15 17 11 13.7 13.0 10.8 12.2 7.9
Oklahoma 0 0 6 7 3 0.0 0.0 11.2 13.1 5.6
Oregon 1 0 2 6 6 2.2 0.0 4.4 13.2 13.2
Pennsylvania 6 3 4 7 5 4.2 2.1 2.8 4.9 3.5
Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
South Carolina 7 1 5 3 9 12.2 1.8 8.7 5.2 15.6
South Dakota 0 0 3 0 2 0.0 0.0 24.4 0.0 16.3
Tennessee 2 2 2 5 8 2.5 2.5 2.5 6.1 9.8
Texas 78 74 74 52 71 20.4 19.1 18.5 13.0 17.8
Utah 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Virginia 1 3 2 3 5 1.0 2.9 1.9 2.9 4.8
Washington 0 0 2 5 3 0.0 0.0 2.3 5.6 3.4
West Virginia 0 0 0 0 2 0.0 0.0 0.0 0.0 9.9
Wisconsin 0 0 0 0 1 0.0 0.0 0.0 0.0 1.5
Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
U.S. TOTAL 334 361 461 492 628 8.4 9.2 11.6 12.3 15.7
Northeast 17 18 29 24 34 2.7 2.9 4.6 3.8 5.4
Midwest 57 53 71 70 70 6.8 6.4 8.5 8.4 8.4
South 206 214 236 221 274 13.7 14.2 15.3 14.4 17.8
West 54 76 125 177 250 5.5 7.9 12.8 18.1 25.6
Guam 0 1 0 2 0 0.0 30.4 0.0 58.9 0.0
Puerto Rico 1 2 0 5 4 2.6 5.5 0.0 14.5 11.6
Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
OUTLYING AREAS 1 3 0 7 4 2.3 7.3 0.0 17.9 10.2
TOTAL 335 364 461 499 632 8.4 9.2 11.4 12.4 15.7
* Mothers state of residence was used to assign case.
106
Table 42. Congenital Syphilis Reported Cases and Rates of Reported Cases per 100,000 Live Births by Year of
Birth and Race/Ethnicity of Mother, United States, 20122016
Asians/ American
Whites Blacks Hispanics Pacific Indians/ Other Unknown Total
Islanders Alaska Natives
Year of Birth Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates
2012 50 2.3 189 32.1 80 8.8 6 2.3 2 5.1 3 NA 4 NA 334 8.4
2013 62 2.9 185 31.4 93 10.3 9 3.5 5 12.8 3 NA 4 NA 361 9.2
2014 79 3.6 227 38.2 112 12.3 18 6.6 5 13.2 9 NA 11 NA 461 11.6
2015 97 4.5 207 34.9 143 15.6 15 5.5 4 10.5 7 NA 19 NA 492 12.3
2016 116 5.3 256 43.1 187 20.5 25 9.2 12 31.6 7 NA 25 NA 628 15.7
NA = Not applicable.
107
Table 43. Chancroid Reported Cases and Rates of Reported Cases by State/Area in Alphabetical Order,
United States and Outlying Areas, 20122016
State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Alabama 1 1 0 0 1 0.0 0.0 0.0 0.0 0.0
Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Arizona 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0
Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
California 7 6 4 2 2 0.0 0.0 0.0 0.0 0.0
Colorado 0 0 0 0 1 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
Florida 0 0 0 0 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 1 0 0 1 0 0.0 0.0 0.0 0.0 0.0
Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Kentucky 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Louisiana 0 0 0 0 0 0.0 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 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Massachusetts 1 2 1 3 1 0.0 0.0 0.0 0.0 0.0
Michigan 2 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Nevada 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
New Jersey 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
New Mexico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
New York 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
North Carolina 1 0 0 0 1 0.0 0.0 0.0 0.0 0.0
North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Ohio 0 0 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 0 0 0 1 0.0 0.0 0.0 0.0 0.0
South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Tennessee 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Texas 0 1 1 2 0 0.0 0.0 0.0 0.0 0.0
Utah 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Virginia 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Washington 0 0 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 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Wyoming 0 0 0 1 0 0.0 0.0 0.0 0.2 0.0
U.S. TOTAL 15 10 6 11 7 0.0 0.0 0.0 0.0 0.0
Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Puerto Rico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
OUTLYING AREAS 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0
TOTAL 15 10 6 11 7 0.0 0.0 0.0 0.0 0.0
108
Table 44. Selected STDs and Complications Initial Visits to Physicians Offices, National Disease
and Therapeutic Index, United States, 19662015
Other Pelvic
Trichomonas vaginalis Vaginal Inflammatory
Year Infections* Infections* Disease
1966 579,000 1,155,000 NA
1967 515,000 1,277,000 NA
1968 463,000 1,460,000 NA
1969 421,000 1,390,000 NA
1970 529,000 1,500,000 NA
1971 484,000 1,281,000 NA
1972 574,000 1,810,000 NA
1973 466,000 1,858,000 NA
1974 427,000 1,907,000 NA
1975 500,000 1,919,000 NA
1976 473,000 1,690,000 NA
1977 324,000 1,713,000 NA
1978 329,000 2,149,000 NA
1979 363,000 1,662,000 NA
1980 358,000 1,670,000 423,000
1981 369,000 1,742,000 283,000
1982 268,000 1,859,000 374,000
1983 424,000 1,932,000 424,000
1984 381,000 2,450,000 381,000
1985 291,000 2,728,000 425,000
1986 338,000 3,118,000 457,000
1987 293,000 3,087,000 403,000
1988 191,000 3,583,000 431,000
1989 165,000 3,374,000 413,000
1990 213,000 4,474,000 358,000
1991 198,000 3,822,000 377,000
1992 182,000 3,428,000 335,000
1993 207,000 3,755,000 407,000
1994 199,000 4,123,000 332,000
1995 141,000 3,927,000 262,000
1996 245,000 3,472,000 286,000
1997 176,000 3,100,000 260,000
1998 164,000 3,200,000 233,000
1999 171,000 3,077,000 250,000
2000 222,000 3,470,000 254,000
2001 210,000 3,365,000 244,000
2002 150,000 3,315,000 197,000
2003 179,000 3,516,000 123,000
2004 221,000 3,602,000 132,000
2005 165,000 4,071,000 176,000
2006 200,000 3,891,000 106,000
2007 205,000 3,723,000 146,000
2008 204,000 3,571,000 104,000
2009 216,000 3,063,000 100,000
2010 149,000 3,192,000 113,000
2011 168,000 3,102,000 90,000
2012 219,000 3,452,000 106,000
2013 225,000 3,278,000 88,000
2014 155,000 3,419,000 51,000
2015 139,000 3,215,000 68,000
* Females only.

Females aged 1544 years only.
NA = Not available.
NOTE: Standard errors for estimates under 100,000 are not available. The relative standard errors for estimates 100,000-299,999 are from 19%
to 23%; 300,000-599,999 are from 16% to 19%; 600,000-999,999 are from 13% to 16%; and 1,000,000-5,000,000 are from 7% to 13%.
SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional Services. IMS Health report, 19662015. The 2016 data
were not obtained in time to include them in this report. See Section A2.5 in the Appendix for more information.
109
110
Appendix
A. Interpreting STD Surveillance Data
Sexually Transmitted Disease Surveillance 2016 presents surveillance information derived from the official statistics for
the reported occurrence of nationally notifiable STDs in the United States, including data from sentinel surveillance and
national surveys.
A1. 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, United States 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.
A1.1 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).
111
Centers for Disease Control and Prevention: STD Surveillance 2016 Appendix
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 19842002 to report summary data for primary and secondary (P&S) 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 19632002 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 1995 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 case-specific 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 19812002 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 1995, 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 CDCs Morbidity and Mortality Weekly Report.
As of December 31, 2003, all 50 states and the District of Columbia had converted from summary hard copy reporting
to electronic submission of line-listed (i.e., case-specific) STD data through NETSS (41 reporting areas submitted
congenital syphilis surveillance data through NETSS in 2016). Puerto Rico converted to electronic reporting in 2006 for
all STDs excluding congenital syphilis. 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, 2017, are included
in this report. The data presented in the figures and tables in this report supersede those in all earlier publications.
A1.2 Population Denominators and Rate Calculations

20002016 Rates and Population
For those figures and tables presenting race using the 1997 Office of Management and Budget (OMB) standards, non-
bridged-race data provided directly by the United States Census Bureau were used to calculate race. The latest available
year for population estimates at the time this report was written was 2015. Thus, 2015 population estimates were used to
calculate 2016 rates.
Once published, the 2016 population estimates will be used to calculate 2016 rates in the Sexually Transmitted Disease
Surveillance 2017.
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Appendix Centers for Disease Control and Prevention: STD Surveillance 2016
Population estimates for Puerto Rico were obtained from the U.S. Census Bureau Web site at:
https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml.
Population estimates for Guam and the Virgin Islands were obtained from the U.S. Census Bureau International
Programs Web site at: https://www.census.gov/population/international/data/idb/informationGateway.php.
The 2016 rates by age and sex for Guam and the Virgin Islands were calculated using 2010 population estimates
available at: https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml.
Because of the use of the updated population data, rates for 20002015 may be different from those presented in
previous STD surveillance reports.
Several figures throughout this report depict state- or county-specific rates of reported cases of STDs. Rates were
grouped and displayed by quintiles in Figures 3, 4, 15, 16, 32, D, E, H, I, J, K, L, M, N, O, P, Q, and Y. Rates were
grouped and displayed in 4 categories zero cases and tertiles in Figure 33.

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.

Rates were calculated by using U.S. Census Bureau population estimates for 1981 through 1989.1,2

Rates for 1941 through 1980 were based on population estimates from the U.S. Census Bureau and are currently
maintained by CDCs Division of STD Prevention.
19412016 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 19412016. Previous publications presented congenital syphilis rates per 100,000 population
during 19411994 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 of 1941 through 2016, 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 2014 were
calculated by using live birth data based on information coded by the states and provided to the National Center for
Health Statistics (NCHS) through the Vital Statistics Cooperative Program. Rates for 2015 and 2016 were calculated by
using live birth data for 2014.
20102015 Gay, Bisexual, and Other Men Who Have Sex with Men Rates and Population
Figures BB and Y show rates of reported cases of gonorrhea and P&S syphilis among gay, bisexual, and other men
who have sex with men (collectively referred to as MSM). Population estimates of MSM are based on a method that
combines published estimates of the prevalence of same-sex behavior among adult men with housing and population
data from the American Community Survey 5-year summary file (20112015).4-7 County-specific estimates begin with
MSM prevalence estimates that are determined by their urbanicity according to the NCHS urban-rural classification
scheme for counties and their United States region.8 Estimates are then multiplied by a modified ratio of each countys
percentage of male same-sex households to the total percentage of male same-sex households among all counties at the
same level of urbanicity and within the same region. Thus, the final estimate for each county reflects what would be
expected based on the countys geography, urban-rural classification, and observed concentration of households with a
male head of household and a male partner.
113
A1.3 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 (CSTE) 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.
A1.4 Reporting of Surveillance Data by Metropolitan Statistical Area

Sexually Transmitted Disease Surveillance 2016 continues the presentation of STD incidence data and rates for the 50
metropolitan statistical areas (MSA) with the largest populations according to 2010 United States census 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.9 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 2010 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.
Reported cases are assigned to MSAs based on the reported county; cases reported with a missing a value for the county
variable cannot be assigned to an MSA. Consequently, if a jurisdiction reports cases missing values for the county
variable, reported rates for MSAs in their jurisdiction may be incomplete. Additionally, relative rankings of case counts
by counties may be impacted by completeness of the variable used to identify county. Table A1 reports the percentage of
cases reported with missing county information in each state for P&S syphilis, chlamydia, and gonorrhea.
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:
https://www.census.gov/programs-surveys/metro-micro.html.
A1.5 Reporting of Data for Race/Ethnicity

In April 2008, the NETSS record layout was updated to conform to the OMBs current government-wide standard
for race/ethnicity data. The OMB standards were first issued in 1997.10 Beginning with the publication of Sexually
Transmitted Disease Surveillance 2012, the race/ethnicity data are presented according to the current standard
categories: American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian
or Other Pacific Islander, White and Multirace. For this report, jurisdictions are considered to be OMB compliant for a
condition if 97% of cases for that condition are reported using current OMB standards. As of reporting year 2016, all
jurisdictions were compliant with the current OMB race/ethnicity standards for chlamydia, gonorrhea, and P&S syphilis.
For chlamydia and gonorrhea figures showing trends for 20122016, data are included for all jurisdictions except five
not consistently reporting race/ethnicity data according to the current standard categories for the five consecutive years
(Alaska, Maryland, Michigan, New York, and the District of Columbia). For P&S syphilis figures showing trends for
2012 2016, data are included for all jurisdictions except five not consistently reporting race/ethnicity data according
to the current standard categories for the five consecutive years (Alaska, Maryland, New York, Utah, and the District of
Columbia).
114
A1.6 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 states 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 states 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
year2016.
As a result, rate data that are stratified by one or more of these variables reflect rates based on reported data only.
A1.7 Classification of STD Morbidity Reporting Sources

Before 1996, states classified the source of case reports as either private source (including private physicians, hospitals,
and institutions) or public source (primarily STD clinics). As states began reporting morbidity data electronically in
1996, the classification categories for source of case reports expanded to include the following data sources: STD
clinics, HIV counseling and testing sites, drug treatment clinics, family planning clinics, prenatal/obstetrics clinics,
tuberculosis clinics, private physicians/health maintenance organizations (HMOs), 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. Figures 7, 8, 21,
and 22 display trends in the proportion of cases reported in 2016 categorized by reporting source. Categories displayed
vary across these figures and include the five most commonly reported sources for the population included in the figure,
along with trends for all other reporting sources combined into the All Other category, and trends in the proportion of
cases with unknown reporting source.
A1.8 Interpreting Chlamydia Case Reporting

Trends in rates of reported cases of chlamydia are influenced by changes in incidence of infection, as well as changes
in diagnostic, screening, and reporting practices. As chlamydial infections are usually asymptomatic, the number of
infections identified and reported can increase as more people are screened even when incidence is flat or decreasing.
During 20002011, the expanded use of more sensitive diagnostic tests (e.g., nucleic acid amplification tests [NAATs])
likely increased the number of infections identified and reported independently of increases in incidence. Also, although
chlamydia has been a nationally notifiable condition since 1994, it was not until 2000 that all 50 states and the District
of Columbia required reporting of chlamydia cases. National case rates prior to 2000 reflect incomplete reporting.
The increased use of electronic laboratory reporting over the last decade or so also likely increased the proportion of
diagnosed cases reported. Consequently, an increasing chlamydia case rate over time may reflect increases in incidence
of infection, screening coverage, and use of more sensitive tests, as well as more complete reporting. Likewise,
decreases in chlamydia case rates may suggest decreases in incidence of infection or screening coverage.
A1.9 Syphilis Morbidity Reporting

The category of total syphilis or all stages of syphilis includes primary syphilis, secondary syphilis, early latent
syphilis, late latent syphilis, late syphilis with clinical manifestations (including late benign syphilis and cardiovascular
syphilis), and congenital syphilis.
Although neurosyphilis can occur at almost any stage of syphilis, during 19962005 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.
115
A1.10 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.11 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 19891991. 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 February 2013). 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. Similarly, since 1995, congenital
syphilis cases are reported by state and city of residence of the mother.
Congenital syphilis reporting may be delayed as a result of case investigation and validation. Cases for previous years
are added to CDCs surveillance databases throughout the year. Congenital syphilis data reported after publication of the
current annual STD surveillance report will appear in subsequent reports and are assigned by the case patients year of
birth.
A2. Other Sources of Surveillance Data

A2.1 National Job Training Program
Chlamydia and gonorrhea prevalence was calculated for men and women entering the 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 NJTPs 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. Prevalence data for state-specific figures were published with permission from the
Department of Labor. Prevalence data are presented in figures N, O, P, and Q.
A2.2 STD Surveillance Network

In 2005, CDC established the STD Surveillance Network (SSuN) as a collaborative network of state, county and/or city
health departments following protocols to conduct sentinel and enhanced STD surveillance activities. The purpose of
SSuN is to improve the capacity of national, state and local STD programs to detect, monitor, and respond to trends in
STDs through enhanced collection, reporting, analysis, visualization, and interpretation of disease information.
Cycle 3 (20132018) of SSuN provides funding to 10 jurisdictions to conduct two core STD surveillance activities
including; (1) sentinel facility component, providing clinical and demographic information on
a full census of patients attending categorical STD clinics and women aged 1544 years presenting for care in
reproductive health settings, and, (2) population component, conducting enhanced health department look-back,
provider, and patient investigations on a probability sample of all persons diagnosed and reported with gonorrhea.
Funded jurisdictions for both core activities in SSuN Cycle 3 include Baltimore City (Maryland), California (excluding
San Francisco County), Florida, Massachusetts, Minnesota, Multnomah County (Oregon), Philadelphia City
(Pennsylvania), New York City (New York), San Francisco County (California), and Washington State.
In both the facility and population components of SSuN Cycle 3, unique patients can be anonymously identified using
non-identifying IDs to provide longitudinal information. In the facility component, the primary unit of analysis is
the patient visit, which is merged with multiple laboratory, diagnostic, and treatment observations. In the population
component, the primary unit of analysis is a reported episode of gonorrhea for a unique person merged with multiple
laboratory observations, health department disease registry history, provider-based clinical information, and patient
demographic and behavioral interview data. For analysis in the population component, cases in the probability sample
are weighted to reflect study design and to adjust for non-response by demographic category of the patient. Weighted
analyses provide estimates of case and person characteristics representative of all reported cases in the collaborating
jurisdictions.
116
MSM are defined in all SSuN data collection activities as men who either reported having sex with another man in the
preceding 23 months, reported current history of male sex partners, and/or those who reported that they considered
themselves gay/homosexual or bisexual. Men who have sex with women (MSW) are defined as men who reported
having sex with women only or who did not report the sex of their sex partners but reported that they considered
themselves to be straight/heterosexual.
Data presented in this report from the facility component of SSuN are from nine participating jurisdictions (Baltimore
City [Maryland], California [excluding San Francisco County], Massachusetts, Minnesota, Multnomah County
[Oregon], New York City [New York], Philadelphia City [Pennsylvania], San Francisco County [California] and
Washington State). Figures 11, 24, CC, DD, EE, and FF are based on STD clinic data and Figure F is based on data from
facilities that provide family planning and reproductive health services. Data presented in this report from the population
component of SSuN include Figures 23 and BB. Figure 23 presents data collected JanuaryDecember 2016 showing the
proportion of cases attributable to MSM, men who have sex with both men and women (MSMW), MSW, and women
for all SSuN jurisdictions. Figure BB presents data collected January 2010June 2013 and JuneDecember 2015 for
six SSuN jurisdictions collaborating in both SSuN Cycle 2 and SSuN Cycle 3 (Baltimore City [Maryland], California
[excluding San Francisco County], New York City [New York], Philadelphia City [Pennsylvania], San Francisco County
[California], and Washington State).
A2.3 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 2530 GISP sentinel sites and regional
laboratories in the United States. For more details on findings from GISP, go to: https://www.cdc.gov/std/GISP/.
For 2016, the antimicrobial agents tested by GISP were ceftriaxone, cefixime, azithromycin, ciprofloxacin, penicillin,
tetracycline, and gentamicin.
The antimicrobial susceptibility criteria used in GISP for 2016 are as follows:
Ceftriaxone, minimum inhibitory concentration (MIC) 0.5 g/ml (decreased susceptibility)*
Ceftriaxone, MIC 0.125 g/ml (elevated MICs)*
Cefixime, MIC 0.5 g/ml (decreased susceptibility)*
Cefixime, MIC 0.25 g/ml (elevated MICs)*
Azithromycin, MIC 2.0 g/ml (elevated MICs)*
Ciprofloxacin, MIC 1.0 g/ml (resistance)
Ciprofloxacin, MIC 0.1250.5 g/ml (intermediate resistance)
Penicillin, MIC 2.0 g/ml (resistance)
Tetracycline, MIC 2.0 g/ml (resistance)
Gentamicin (MIC values correlated with susceptibility and resistance have not been established).
The majority of these criteria are also recommended by the Clinical and Laboratory Standards Institute (CLSI).12
* The CLSI criteria for decreased susceptibility and resistance to ceftriaxone, cefixime, gentamicin, and azithromycin and for susceptibility to azithromycin have not
been established for N. gonorrhoeae.
A2.4 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
two years. The sampling plan of the survey is a stratified, multistage, probability cluster design that selects a sample
representative of the United States civilian, non-institutionalized population. For more information,
see: https://www.cdc.gov/nchs/nhanes.htm.
117
A2.5 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 2015; the 2016 NDTI data were not obtained in time to include them in this report). 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) 5235334.
References
1. U.S. Census Bureau. United States population estimates by age, sex and race: 19801988. 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. American Community Survey. 5-year summary file, 20112015. US Census Bureau: 2016.
5. Grey JA, Bernstein KT, Sullivan PS, et al. Estimating the population sizes of men who have sex with men in US states and counties using data from the
American Community Survey. JMIR Public Health Surveill 2016; 2(1):e14.
6. Oster AM, Sternberg M, Lansky A, et al. Population size estimates for men who have sex with men and persons who inject drugs. J Urban Health 2015;
92(4):733743.
7. Purcell DW, Johnson CH, Lansky A, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates.
Open AIDS J 2012; 6(Suppl 1):98107.
8. Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. National Center for Health Statistics. Vital Health Stat 2014; 2(166):181.
9. Office of Management and Budget. Standards for defining metropolitan and micropolitan statistical areas. Federal Register 2000; 65(249):8222882238.
10. Office of Management and Budget. Revisions to the Standards for Classification of Federal Data on Race and Ethnicity. Federal Register Notice. October 30,
1997.
11. Kaufman RE, Jones OG, Blount JH, et al. Questionnaire survey of reported early congenital syphilis: problems in diagnosis, prevention, and treatment. Sex
Transm Dis 1977; 4(4):135139.
12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement. M100-S25,
35(3). Wayne (PA): Clinical and Laboratory Standards Institute; 2015.
118
by State and by Nationally Notifiable STD, 2016
Primary and Secondary Syphilis
Percentage Percentage
Unknown Percentage Percentage Unknown Percentage
Race/ Unknown Unknown Sex Unknown
State Ethnicity Age Sex Partner County
Alabama 0.3 8.8 0.0 32.2 4.5
Alaska* 0.0 0.0 0.0 12.5 0.0
Arizona 1.9 0.0 0.0 6.8 0.0
Arkansas 1.3 0.0 0.0 4.7 0.0
California 6.2 0.0 0.1 16.0 0.0
Colorado 3.6 0.0 0.0 6.4 0.0
Connecticut 0.0 0.0 0.0 20.0 0.9
Delaware 6.9 0.0 0.0 84.5 0.0
District of Columbia 30.4 0.0 2.5 26.7 NA
Florida 2.6 0.0 0.0 12.1 0.0
Georgia 1.4 0.0 0.0 28.4 0.0
Hawaii 5.4 0.0 0.0 19.6 0.0
Idaho 8.0 0.0 0.0 22.0 0.0
Illinois 1.8 0.0 0.0 26.8 0.0
Indiana 0.3 0.0 0.0 6.1 0.0
Iowa 1.1 0.0 0.0 9.0 0.0
Kansas 0.0 0.0 0.0 6.5 0.0
Kentucky 0.0 0.0 0.0 16.0 0.0
Louisiana 0.0 0.0 0.0 4.4 0.0
Maine 0.0 0.0 0.0 28.6 0.0
Maryland 1.8 0.0 0.0 12.4 0.0
Massachusetts 4.7 0.0 0.2 13.5 9.2
Michigan 1.6 0.0 0.0 5.2 0.0
Minnesota 3.3 0.0 0.7 4.9 0.0
Mississippi 3.4 0.0 0.0 4.0 0.0
Missouri 0.0 0.0 0.0 6.3 0.0
Montana 0.0 0.0 0.0 14.3 0.0
Nebraska 7.5 0.0 0.0 43.3 0.0
Nevada 1.4 0.0 0.0 7.4 0.2
New Hampshire 10.0 0.0 0.0 2.5 0.0
New Jersey 4.4 0.0 0.0 30.5 0.0
New Mexico 14.8 0.0 0.0 7.9 0.0
New York 7.7 0.1 0.9 31.6 0.0
North Carolina 0.1 0.0 0.0 6.2 0.0
North Dakota 9.1 0.0 0.0 12.1 0.0
Ohio 0.0 0.0 0.0 8.2 0.0
Oklahoma 0.0 0.0 0.0 0.4 0.0
Oregon 4.6 0.0 0.0 16.8 0.0
Pennsylvania 6.5 0.0 0.0 9.4 0.0
Rhode Island 13.3 0.0 0.0 41.1 0.0
South Carolina 3.8 0.0 0.0 2.8 0.0
South Dakota 0.0 0.0 0.0 3.8 0.0
Tennessee 0.0 0.0 0.0 58.7 0.0
Texas 0.6 0.0 0.0 6.0 0.1
Utah 0.0 0.0 0.0 5.4 0.0
Vermont 0.0 0.0 0.0 4.3 0.0
Virginia 8.7 0.0 2.0 12.9 0.0
Washington 5.8 0.0 0.0 4.2 0.0
West Virginia 0.0 0.0 0.0 5.7 0.0
Wisconsin 7.6 0.0 0.0 50.0 0.0
Wyoming* 14.3 0.0 0.0 100.0 0.0
U.S. TOTAL 3.8 0.1 0.1 15.9 0.2
Continued on next page.
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Table A1. Selected STDs Percentage of Unknown, Missing, or Invalid Values for Selected Variables by State
and by Nationally Notifiable STD, 2016 (continued)
Gonorrhea Chlamydia
Percentage Percentage
Unknown Percentage Percentage Percentage Unknown Percentage Percentage Percentage
Race/ Unknown Unknown Unknown Race/ Unknown Unknown Unknown
State Ethnicity Age Sex County Ethnicity Age Sex County
Alabama 31.3 14.2 0.7 26.5 38.6 13.1 0.7 25.4
Alaska* 0.1 0.0 0.0 0.3 0.1 0.0 0.0 0.4
Arizona 17.8 0.0 0.0 0.0 29.3 0.0 0.0 0.0
Arkansas 0.6 0.0 0.0 0.0 0.4 0.0 0.0 0.0
California 21.8 0.2 0.6 0.0 41.5 0.2 0.3 0.0
Colorado 30.1 0.0 0.0 0.1 46.2 0.0 0.0 0.2
Connecticut 30.9 0.1 0.1 5.7 66.4 0.1 1.1 3.0
Delaware 4.1 0.0 0.0 0.0 4.8 0.0 0.0 0.0
District of Columbia 69.9 0.6 2.2 NA 76.6 0.7 2.1 NA
Florida 9.7 0.0 0.0 0.0 15.4 0.0 0.1 0.0
Georgia 26.5 0.1 0.1 3.7 38.0 0.1 0.1 3.9
Hawaii 36.1 0.1 0.1 0.1 47.9 0.1 0.0 0.1
Idaho 24.7 0.0 0.3 0.0 39.4 0.0 0.1 0.0
Illinois 18.8 0.0 0.1 0.0 20.4 0.0 0.1 0.0
Indiana 7.4 0.0 0.0 0.0 11.5 0.0 0.0 0.0
Iowa 3.4 0.0 0.0 0.0 6.0 0.0 0.0 0.0
Kansas 9.6 0.0 0.0 0.0 33.3 0.0 0.0 0.0
Kentucky 24.6 0.1 1.5 0.0 35.1 0.1 1.9 0.0
Louisiana 0.2 0.0 0.0 0.2 0.2 0.0 0.0 0.3
Maine 1.8 0.9 0.2 0.9 31.6 0.0 0.1 1.4
Maryland 23.4 0.0 0.1 0.0 40.0 0.0 0.1 0.0
Massachusetts 36.1 0.1 0.3 14.4 67.4 0.1 0.3 17.2
Michigan 24.2 0.1 0.0 0.0 28.6 0.1 0.0 0.0
Minnesota 17.3 0.1 0.2 2.9 24.4 0.1 0.1 4.0
Mississippi 19.6 0.0 0.1 0.0 25.9 0.0 0.2 0.0
Missouri 8.9 0.0 0.0 0.0 13.8 0.0 0.0 0.0
Montana 1.3 0.0 0.0 0.0 1.4 0.1 0.0 0.0
Nebraska 16.2 0.0 0.2 0.0 26.5 0.1 0.3 0.0
Nevada 36.6 0.0 0.1 0.5 44.9 0.0 0.2 0.9
New Hampshire 21.1 0.0 0.0 0.0 25.5 0.0 0.0 0.0
New Jersey 38.8 0.6 0.2 1.1 52.1 0.4 0.2 1.0
New Mexico 21.3 0.0 0.1 0.0 27.1 0.0 0.1 0.0
New York 24.9 0.1 0.2 0.0 38.4 0.1 0.1 0.0
North Carolina 15.5 0.0 0.0 0.0 20.3 0.0 0.0 0.0
North Dakota 3.0 0.0 0.0 0.0 9.6 0.0 0.0 0.0
Ohio 18.6 0.0 0.0 2.0 25.0 0.1 0.0 2.5
Oklahoma 9.9 0.0 0.0 0.0 13.6 0.0 0.0 0.0
Oregon 9.7 0.0 0.0 0.1 27.2 0.0 0.0 0.0
Pennsylvania 22.8 0.0 0.1 0.0 33.3 0.0 0.1 0.0
Rhode Island 14.4 0.1 0.0 1.3 23.1 0.0 0.0 0.5
South Carolina 20.7 0.0 0.5 0.0 27.3 0.0 0.4 0.0
South Dakota 1.8 0.0 0.0 0.0 10.5 0.0 0.0 0.0
Tennessee 1.1 0.0 0.0 0.0 1.8 0.0 0.0 0.0
Texas 17.0 0.1 0.2 0.4 22.3 0.1 0.2 0.4
Utah 6.4 0.0 0.0 0.1 6.4 0.0 0.0 0.1
Vermont 0.8 0.0 0.0 0.0 4.0 0.0 0.1 0.0
Virginia 26.1 0.1 0.3 0.3 36.0 0.2 0.3 0.2
Washington 13.1 0.1 0.0 0.0 19.2 0.1 0.0 0.0
West Virginia 11.8 0.0 0.0 0.0 26.6 0.0 0.0 0.0
Wisconsin 23.8 0.0 0.1 0.0 19.6 0.0 0.1 0.0
Wyoming* 26.2 0.0 0.0 0.0 37.1 0.0 0.0 0.0
U.S. TOTAL 19.0 0.3 0.2 1.0 28.8 0.3 0.2 1.1
* Percentages for primary and secondary syphilis are based on less than 10 cases.
NA = Not applicable.
NOTE: For all categories, unknown included cases reported as unknown or missing. In addition, unknown race/ethnicity included cases reported in non-OMB
compliant categories.
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Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2016
Non-STD Clinic STD Clinic Total
Disease Male Female Total* Male Female Total* Male
Female Total
Chlamydia 385,522 868,276 1,255,933 57,357 44,552 102,022 522,870 1,072,719 1,598,354
Gonorrhea 196,422 156,304 353,487 35,286 13,909 49,248 270,033 197,499 468,514
Primary Syphilis 5,969 608 6,584 1,784 108 1,894 8,565 793 9,369
Secondary Syphilis 11,691 1,757 13,465 2,903 320 3,226 16,159 2,256 18,445
Early Latent Syphilis 18,547 2,969 21,571 3,815 561 4,382 24,919 3,939 28,924
Late and Late Latent Syphilis 16,489 5,861 22,386 2,245 648 2,895 22,785 7,850 30,676
Chancroid 4 1 5 0 0 0 6 1 7
* Total includes cases reported with unknown sex.
Total includes cases reported with unknown reporting source.
Total includes cases reported with unknown sex and reporting source.
Late and late latent syphilis includes late latent syphilis and late syphilis with clinical manifestations (including late benign syphilis and cardiovascular syphilis).
121
122
B. National Objectives and Goals
B1. 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.1 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 Nations health. HP2020 is the result of a multiyear process that reflects input from a diverse group of individuals
and organizations. HP2020 is organized into 42 topic areas, with more than 1,200 measures designed to 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 B1. The year 2020 targets for the diseases addressed
in this report are as follows: primary and secondary (P&S) syphilis (males), 6.8 cases per 100,000 males; P&S syphilis
(females), 1.4 cases per 100,000 females; congenital syphilis, 9.1 cases per 100,000 live births; gonorrhea (females aged
1544 years), 257.0 cases per 100,000 females and gonorrhea (males aged 1544 years), 198.0 cases per 100,000 males.
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.
B2. 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 pelvic inflammatory disease (PID) and eliminating congenital syphilis. Each of these goals has specific
measures of progress, which are outlined in Table B2.
References
1. U.S. Department of Health and Human Services. Healthy People 2020 (Healthy People 2020 Web site). Available at https://www.healthypeople.gov/2020/default.
Accessed on August 4, 2017.
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Table B1. Healthy People 2020 (HP 2020) Sexually Transmitted Diseases Objectives
Baseline 2020
HP2020 Objectives Baseline 2014 2015 2016
Year Target
1 Reduce the proportion of adolescents and young adults with
Chlamydia trachomatis infections
a. Among females aged 15 to 24 years attending family planning
2008 7.4% N/A 8.6% 8.4% 6.7%
clinics
b. Among females aged 24 years and under enrolled in a National Job
2008 12.8% 12.8% 12.7% 11.4% 11.5%
Training Program
c. Among males aged 24 years and under enrolled in a National Job
2008 7.0% 7.0% 7.5% 7.1% 6.3%
Training Program
2 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% 52.3% 51.2% N/A 70.9%
b. Females aged 21 to 24 years 2008 59.4% 62.0% 60.1% N/A 80.0%
3 Increase the proportion of sexually active females aged 24 years
and under enrolled in commercial health insurance plans who are
screened for genital Chlamydia infections during the measurement
year
a. Females aged 16 to 20 years 2008 40.1% 42.7% 42.4% N/A 61.3%
b. Females aged 21 to 24 years 2008 43.5% 52.1% 52.4% N/A 74.6%
4 Reduce the proportion of females aged 15 to 44 years who have ever
20062010 4.2% N/A 3.0% N/A 3.8%
required treatment for pelvic inflammatory disease (PID)
5 Reduce gonorrhea rates
a. Females aged 15 to 44 years 2008 279.9 248.1 263.4 297.1 251.9
b. Males aged 15 to 44 years 2008 216.5 262.8 307.6 370.2 194.8
6 Reduce sustained domestic transmission of primary and
secondary syphilis
a. Among females 2008 1.4 1.1 1.4 1.9 1.3
b. Among males 2008 7.4 11.6 13.7 15.6 6.7
7 Reduce congenital syphilis 2008 10.7 11.6 12.4 15.7 9.6
8 Reduce the proportion of young adults with genital herpes
20052008 10.5% 8.3%* N/A N/A 9.5%
infection due to herpes simplex type 2
HP2020
Objective Data Source
1a STD Surveillance Network (SSuN), CDC
1b, 1c National Job Training Program (NJTP)
2a, 2b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)
3a, 3b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)
4 National Survey of Family Growth (NSFG), CDC
5a, 5b National Notifiable Disease Surveillance System (NNDSS), CDC
6a, 6b National Notifiable Disease Surveillance System (NNDSS), CDC
7 National Notifiable Disease Surveillance System (NNDSS), CDC
8 National Health and Nutrition Examination Survey (NHANES), CDC
NOTE: Data presented in this table reflect data reported to HP2020 in current and prior years. Data for years prior to 2016 may not match estimates presented in
other sections of this report. More information about HP2020 is available at: https://www.healthypeople.gov/
* 20112012
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Table B2. Government Performance and Results Act (GPRA) Sexually Transmitted Diseases Goals, Measures,
and Target
Actual Target
GPRA Goals 2014 2015 2016 2017
Goal 1: Reduction in PID (as measured by initial visits to physicians in women 1544 years of age) 98,800 68,000 N/A 86,423
a. Proportion of high-risk women aged 1620 infected with chlamydia* 13.9% 13.4% 12.3% 11.7%
b. Proportion of high-risk women aged 2124 infected with chlamydia* 7.3% 8.5% 7.4% 8.3%
c. Rate of gonorrhea/100,000 population in women aged 1620 523.9 537.0 586.0 523.9
d. Rate of gonorrhea/100,000 population in women aged 2124 508.1 523.9 573.0 511.8
e. Black: white ratio of gonorrhea in women aged 1624 10.3 9.5 8.4 10.1
f. Proportion of sexually active females aged 1620 years enrolled in Medicaid who are screened for
52.3% 51.2% N/A 62.5%
chlamydia infections
g. Proportion of sexually active females aged 2124 years enrolled in Medicaid who are screened for
62.0% 60.1% N/A 66.0%
chlamydia infections
h. Proportion of sexually active females aged 1620 years enrolled in commercial health insurance plans
42.7% 42.4% N/A 43.5%
who are screened for chlamydia infections
i. Proportion of sexually active females aged 2124 years enrolled in commercial health insurance plans
52.1% 52.4% N/A 52.7%
who are screened for chlamydia infections
Goal 2: Elimination of Congenital Syphilis
a. Incidence of P&S syphilis/100,000 population in women aged 1544 2.6 3.2 4.2 0.8
b. Incidence of congenital syphilis/100,000 live births 11.5 12.4 15.7 6.2
c. Proportion of pregnant women that are screened for syphilis at least one month before delivery 85.9% 84.0% N/A 84.0%
GPRA Goals Data Source

1 National Disease and Therapeutic Index (IMS Health)
1a, 1b National Job Training Program (NJTP)
1c, 1d, 1e National Notifiable Disease Surveillance System (NNDSS), CDC
1f, 1g, 1h, 1i Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)
2a, 2b National Notifiable Disease Surveillance System (NNDSS),CDC
2c MarketScan Commercial Claims and Encounters Database, Truven Health Analytics
NOTE: Data presented in this table reflect data reported to GPRA in current and prior years. Data for years prior to 2016 may not match estimates presented in
other sections of this report.
* Median state-specific chlamydia prevalence/positivity among states with >100 females in this age group entering the National Job Training Program.
In FY 2013 CDC improved the calculation of these data to increase the stability of estimate over time. Data for 2010 and later years reflect this improved
calculation method.
GPRA = Government Performance and Results Act; PID = pelvic inflammatory disease; P&S = primary and secondary.
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126
C. STD Surveillance Case Definitions
C1. Case Definitions For Nationally Notifiable Infectious Diseases
The Council of State and Territorial Epidemiologists (CSTE) recommends that state health departments report cases
of selected diseases to CDCs National Notifiable Diseases Surveillance System (NNDSS). Case definitions are
periodically revised using CSTEs Position Statements and provide uniform criteria of nationally notifiable conditions
for reporting purposes. The most current surveillance case definitions for nationally notifiable STDs are listed below.
Please see the NNDSS website (https://wwwn.cdc.gov/nndss/case-definitions.html) for historical case definitions.
C1.1 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.
C1.2 Chlamydia trachomatis Infection (Revised 6/09)

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.

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.
127
C1.3 Gonorrhea (Effective 1/14)
A sexually transmitted infection commonly manifested by urethritis, cervicitis, proctitis, salpingitis, or pharyngitis.
Infection may be asymptomatic.

Observation of gram-negative intracellular diplococci in a urethral smear obtained from a male or an endocervical
smear obtained from a female, or
Isolation of typical gram-negative, oxidase-positive diplococci by culture (presumptive Neisseria gonorrhoeae)
from a clinical specimen, or
Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid
Case classification
Probable: demonstration of gram-negative intracellular diplococci in a urethral smear obtained from a male or an
endocervical smear obtained from a female.
Confirmed: a person with laboratory isolation of typical gram-negative, oxidase-positive diplococci by culture
(presumptive Neisseria gonorrhoeae) from a clinical specimen, or demonstration of N. gonorrhoeae in a clinical
specimen by detection of antigen or detection of nucleic acid via nucleic acid amplification (e.g., PCR) or hybridization
with a nucleic acid probe.
C1.4 Syphilis (Effective 1/14)

Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Adherence to the following
surveillance case definitions will facilitate understanding the epidemiology of this disease across the U.S.
Syphilis, primary (Effective 1/14)

A stage of infection with Treponema pallidum characterized by one or more ulcerative lesions (e.g. chancre), which
might differ considerably in clinical appearance.

Demonstration of T. pallidum in clinical specimens by darkfield microscopy, or by polymerase chain reaction (PCR) or
equivalent direct molecular methods.
Case classification
Probable: a case that meets the clinical description of primary syphilis with a reactive serologic test (nontreponemal:
Venereal Disease Research Laboratory [VDRL], rapid plasma reagin [RPR], or equivalent serologic methods;
treponemal: fluorescent treponemal antibody absorbed [FTA-ABS], T. pallidum particle agglutination [TP-PA], enzyme
immunoassay [EIA], chemiluminescence immunoassay [CIA], or equivalent serologic methods). These treponemal tests
supersede older testing technologies, including microhemagglutination assay for antibody to T. pallidum [MHA-TP].
Confirmed: a case that meets the clinical description of primary syphilis that is laboratory confirmed.
128
Syphilis, secondary (Effective 1/14)
A stage of infection caused by T. pallidum characterized by localized or diffuse mucocutaneous lesions (e.g., rash
such as non-pruritic macular, maculopapular, popular, or pustular lesions), often with generalized lymphadenopathy.
Other symptoms can include mucous patches, condyloma lata, and alopecia. The primary ulcerative lesion may still be
present. Because of the wide array of symptoms possibly indicating secondary syphilis, serologic tests for syphilis and a
thorough sexual history and physical examination are crucial to determining if a case should be classified as secondary
syphilis.

Demonstration of T. pallidum in clinical specimens by darkfield microscopy, or by polymerase chain reaction (PCR) or
equivalent direct molecular methods.
Case classification
Probable: a case that meets the clinical description of secondary syphilis with a nontreponemal (VDRL, RPR, or
equivalent serologic methods) titer 4 and a reactive treponemal test (FTA-ABS, TP-PA, EIA, CIA, or equivalent
serologic methods).
Confirmed: a case that meets the clinical description of secondary syphilis (with at least one sign or symptom) that is
laboratory confirmed.
Syphilis, early latent (Effective 1/14)

A subcategory of latent syphilis (a stage of infection caused by T. pallidum in which organisms persist in the body of the
infected person without causing symptoms or signs) when initial infection has occurred within the previous 12 months.
Case classification
Probable: A person with no clinical signs or symptoms of syphilis who has one of the following:
No past diagnosis of syphilis, and a reactive nontreponemal test (e.g., VDRL, RPR, or equivalent serologic
methods), and a reactive treponemal test (e.g., FTA-ABS, TP-PA, EIA, CIA, or equivalent serologic methods), or
A current nontreponemal test titer demonstrating fourfold or greater increase from the last nontreponemal test titer
AND 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
Documented seroconversion of a treponemal 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 within the previous 12 months who had primary, secondary, or early latent
syphilis (documented independently as duration <12 months)
Only sexual contact was within the last 12 months (sexual debut).
There is no confirmed case classification for early latent syphilis.
129
Syphilis, late latent (Effective 1/14)
A subcategory of latent syphilis (a stage of infection caused by T. pallidum in which organisms persist in the body of the
infected person without causing symptoms or signs) when initial infection has occurred >12 months previously.
Case classification
Probable: a person with no clinical signs or symptoms of syphilis who has one of the following:
No past diagnosis of syphilis, and a reactive nontreponemal test (e.g., VDRL, RPR, or equivalent serologic
methods), and a reactive treponemal test (e.g., FTA-ABS, TP-PA, EIA, CIA, or equivalent serologic methods), or
A past history of syphilis therapy and a current nontreponemal test titer demonstrating fourfold or greater increase
from the last nontreponemal test titer.
AND who has no evidence of having acquired the disease within the preceding 12 months (see Syphilis, early latent).
There is no confirmed case classification for late latent syphilis.
Neurosyphilis (Effective 1/14)

Neurosyphilis can occur at any stage of syphilis. If the patient has neurologic manifestations of syphilis, the case should
be reported with the appropriate stage of infection (as if neurologic manifestations were not present) and neurologic
manifestations should be noted in the case report data. If no other stage is appropriate, the case should be staged as late,
with clinical manifestations.
Neurosyphilis can apply to all stages of infection of syphilis listed, including: primary syphilis, secondary syphilis, early
latent syphilis, late latent syphilis, and late syphilis with clinical manifestations.
Infection of the central nervous system with T. pallidum, as evidenced by manifestations including syphilitic meningitis,
meningovascular syphilis, optical involvement including interstitial keratitis and uveitis, general paresis, including
dementia, and tabes dorsalis.

A reactive VDRL in cerebrospinal fluid (CSF) and either (1) a reactive treponemal serologic test for syphilis (e.g.,
FTA- ABS, TP-PA, EIA, CIA, or equivalent serologic methods) or (2) a reactive nontreponemal serologic test for
syphilis (VDRL, RPR, or equivalent serologic method).
Case classification
Probable: syphilis of any stage with a negative VDRL test in CSF specimen and either (1) a reactive treponemal
serologic test for syphilis (e.g., FTA-ABS, TP-PA, EIA, CIA, or equivalent serologic methods) or (2) a reactive non-
treponemal serologic test for syphilis (VDRL, RPR, or equivalent serologic method), and both of the following:
Elevated CSF protein (>50 mg/dL2) or leukocyte count (>5 white blood cells/cubic millimeter CSF) in the absence
of other known causes of these abnormalities, and
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.
130
Syphilis, late with clinical manifestations (including late benign syphilis and cardiovascular
syphilis) (Effective 1/14)
Clinical manifestations of late syphilis may include inflammatory lesions of the cardiovascular system (e.g., aortitis,
coronary vessel disease), skin (e.g., gummatous lesions) bone (e.g., osteitis) or other tissue. 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 1530 years
of untreated infection. If only neurologic manifestations of syphilis (e.g., tabes dorsalis, dementia) are present and
infection occurred more than 12 months ago, the case should be reported as late syphilis.

Demonstration of T. pallidum in late lesions by special stains (although organisms are rarely visualized in late lesions),
or equivalent methods, or by polymerase chain reaction (PCR) or equivalent direct molecular methods.
Case classification
Probable: characteristic abnormalities or lesions of the cardiovascular system (e.g., aortitis, coronary vessel disease),
skin (e.g., gummatous lesions), bone (e.g., osteitis), or other tissue and a reactive treponemal test (e.g., FTA-ABS,
TP-PA, EIA, CIA, or equivalent serologic methods), in the absence of other known causes of these abnormalities. CSF
abnormalities and clinical symptoms or signs consistent with neurologic manifestations of syphilis might be present.
Confirmed: a case that meets the clinical description of late syphilis that is laboratory confirmed.
Syphilis, Congenital (Revised 1/15)

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, from inapparent
infection to severe cases that are clinically apparent at birth. An infant or child (aged less than 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).

Demonstration of T. pallidum by darkfield microscopy of lesions, body fluids, or neonatal nasal discharge, or
Polymerase chain reaction (PCR) or other equivalent direct molecular methods of lesions, placenta, umbilical cord,
or autopsy material, or
Immunohistochemistry (IHC), or special stains (e.g., silver staining) of specimens from lesions, neonatal nasal
discharge, 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 non-treponemal test for syphilis (Venereal
Disease Research Laboratory [VDRL], rapid plasma reagin [RPR], or equivalent serologic methods) AND any one of
the following:
Any evidence of congenital syphilis on physical examination (see Clinical description)
Any evidence of congenital syphilis on radiographs of long bones
A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test
In a nontraumatic lumbar puncture, an elevated CSF leukocyte (white blood cell, WBC) count or protein (without
other cause):
* Adequate treatment is defined as completion of a penicillin-based regimen, in accordance with CDC treatment guidelines, appropriate for stage of infection,
initiated 30 or more days before delivery.
131
Suggested parameters for abnormal CSF WBC and protein values:
During the first 30 days of life, a CSF WBC count of >15 WBC/mm3 or a CSF protein >120 mg/dL.
After the first 30 days of life, a CSF WBC count of >5 WBC mm3 or a CSF protein >40 mg/dL, regardless of
CSF serology.
The treating clinician should be consulted to interpret the CSF values for the specific patient.
Confirmed: a case that is laboratory confirmed.
Syphilitic Stillbirth
Clinical case definition
A fetal death that occurs after a 20-week gestation or in which the fetus weighs greater than 500 g and the mother had
untreated or inadequately treated* syphilis at delivery.
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,
WBC cell count, and protein 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. While maternal antibodies can complicate interpretation of serologic tests in an infant,
reactive tests past 18 months of age are considered to reflect the status of the child. 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.
* Adequate treatment is defined as completion of a penicillin-based regimen, in accordance with CDC treatment guidelines, appropriate for stage of infection,
initiated 30 or more days before delivery.
C2. Case Definitions For Non-Notifiable Infectious Diseases

Although the conditions below are not currently nationally notifiable, they may be reportable in some jurisdictions. To
provide uniform criteria for those jurisdictions, case definitions are provided by CSTE. Case definitions are periodically
revised. The most current surveillance case definitions for non-notifiable STDs are listed below. Please see the NNDSS
website (https://wwwn.cdc.gov/nndss/case-definitions.html) for historical case definitions.
C2.1 Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

A condition characterized by visible, painful genital or anal lesions.

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.
132
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.
Comment
Genital herpes should be reported only once per patient. The first diagnosis for a patient with no previous diagnosis
should be reported.
C2.2 Genital Warts (Revised 9/96)

An infection characterized by the presence of visible, exophytic (raised) growths on the internal or external genitalia,
perineum, or perianal region.

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.
Comment
Genital warts should be reported only once per patient. The first diagnosis for a patient with no previous diagnosis
should be reported.
C2.3 Granuloma Inguinale

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.

Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained smears or biopsies of granulation
tissue.
Case classification
133
C2.4 Lymphogranuloma Venereum
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.

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.
C2.5 Mucopurulent Cervicitis (Revised 9/96)

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, cotton-tipped swab
(positive swab test)
Induced endocervical bleeding (bleeding when the first swab is placed in the endocervix).

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). If gonorrhea, trichomoniasis, and chlamydia are excluded, a clinically
compatible illness should be classified as MPC. An illness in a female that meets the case definition of MPC and C.
trachomatis infection should be classified as chlamydia.
134
C2.6 Nongonococcal Urethritis (Revised 9/96)
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.

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). 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.
C2.7 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 clinicians report of PID should be counted as a case.
135
136
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 24, 2017.
State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors
Alabama Anthony Merriweather Anthony Merriweather Mary McIntyre Sharon Massingale
Alaska Susan Jones Donna Cecere Joe McLaughlin Bernard Jilly
Arizona Roxanne Ereth Roxanne Ereth Kenneth Komatsu Victor Waddell
Arkansas Rene Montgomery Brandi Roberts Dirk Haselow Glen Baker
California Heidi Bauer Romni Neiman Gilberto Chavez Paul Kimsey
Los Angeles Michael Green Sonali Kulkarni Gilberto Chavez Nicole Green
San Francisco Susan Philip Trang Nguyen Gilberto Chavez Severin Gose (Acting)
Colorado Melanie Mattson Rebecca Jordan-Yehle Lisa Miller Hugh Maguire (Acting)
Connecticut Lynn Sosa Heidi Jenkins Matthew Cartter Jafar Razeq
Delaware Catherine Mosley Catherine Mosley Tabatha Offutt-Powell Sergio Huerta
District of Columbia Michael Kharfen Travis Gayles John Davies-Cole Morris Blaylock (Acting)
Florida Craig Wilson Lisa Thompson Anna Likos Carina Blackmore
Georgia Michelle Allen LaTasha Terry Cherie Drenzek Elizabeth Franko
Hawaii Peter Whiticar Gerald Luke Hasty, Jr. Sarah Park A. Christian Whelen
Idaho Aimee Shipman Kimberly Matulonis Christine Hahn Christopher Ball
Illinois Danny Brikshavana Danny Brikshavana Constance Austin E. Matt Charles (Acting)
Chicago Irina Tabidze Irina Tabidze Constance Austin Massimo Pacilli (QA Manager)
Indiana Dennis L. Stover Caitlin Conrad Pamela Pontones Judith Lovchik
Iowa Randy Mayer George Walton Patricia Quinlisk Christopher Atchison
Kansas Stephanie Green Stephanie Green Charles Hunt N. Myron Gunsalus
Kentucky Robert Brawley Chang Lee Doug Thoroughman Jeremy Hart
Louisiana DeAnn Gruber Chaquetta Johnson Raoult Ratard Stephen Martin
Maine Jayson Hunt Emer Smith Siiri Bennett Kenneth Pote
Maryland Kenneth Ruby Marcia Pearlowitz David Blythe Robert Myers
Baltimore Glen Olthoff Hilda Ndirangu David Blythe n/a
Massachusetts Kathleen Roosevelt David Goudreau Alfred DeMaria Michael Pentella
Michigan Patricia Villegas Kristine Judd-Tuinier Sarah Lyon-Callo Sandip Shah
Minnesota Krissie Guerard Krissie Guerard Ruth Lynfield Joanne Bartkus
Mississippi James Stewart David Peyton Thomas Dobbs Daphne Ware
Missouri Nicole Massey Craig Highfill George Turabelidze Bill Whitmar
Montana Cara Murolo Cara Murolo Carol Ballew Ron Paul
Nebraska Jeri Weberg-Bryce Jeri Weberg-Bryce Thomas Safranek Peter Iwen
Nevada Andrea Rivers Elizabeth Kessler Ihsan Azzam Yashpal Agrawal (Interim)
New Hampshire Lindsay Pierce Lisa Ouellette Benjamin Chan Christine Bean
New Jersey Connie Meyers Amelia Hamarman Christina Tan Onesia Bishop
New Mexico Andrew Gans Janine Waters Michael Landen Lixia Liu
New York Alison Muse Margaret Carroll Debra Blog Jill Taylor
New York City Susan Blank Kate Washburn Debra Blog Jennifer Rakeman
North Carolina Jacquelyn Clymore Roger Follas Scott Zimmerman
North Dakota Lindsey VanderBusch Lindsey VanderBusch Tracy Miller Myra Kosse
Ohio Amanda Dennison Amanda Dennison Mary DiOrio Quanta Brown (Acting)
Oklahoma Jan Fox Kristen Eberly Kristy Bradley S. Terrance Dunn
Oregon Annick Benson-Scott Ruth Helsley Katrina Hedberg John Fontana
Pennsylvania Beth Butler Kristine King Sharon Watkins James Lute (Acting)
Philadelphia Greta Anschuetz Cherie Walker-Baban Sharon Watkins Kerry Buchs
137
Centers for Disease Control and Prevention: STD Surveillance 2016 Contributors
State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors
Rhode Island Thomas Bertrand Valentina Adamova Utpala Bandy Ewa King
South Carolina Ali B. Mansaray Bernard Gilliard Linda Bell Shahiedy Shahied
South Dakota Amanda Gill Amanda Gill Lon Kightlinger Timothy Southern
Tennessee Carolyn Wester Parul Patel Tim Jones Richard Steece
Texas Shelley Lucas Tammy Foskey Linda Gaul Grace Kubin
Utah Erin Fratto Ameila Self Allyn Nakashima Robyn Atkinson-Dunn
Vermont Daniel Daltry Daniel Daltry Patsy Kelso/Lori Cragin Mary Celotti
Virginia Jeff Stover Oana Vasiliu Laurie Forlano Denise Toney
Washington Mark Aubin Mark Aubin Scott Lindquist/Cathy Wasserman Romesh Gautom
West Virginia Pamela Reynolds Pamela Reynolds Loretta Haddy Sharon Lee Cibrik
Wisconsin Stephanie Smiley Anthony Wade Jeffrey Davis Peter Shult (Acting)
Wyoming Debi Nelson-Anderson Brittany Wardle Tracy Murphy Sarah Buss
American Samoa Fara M. Utu Fetaui V. Saelua Scott Anesi Mary Matau
Kessler Lakutak/
Herbert Johnny/
Federated States of Micronesia Mayleen Ekiek Mayleen Ekiek Afeke Kambui
Kasian Otoko/
Maria Marfel
Government of the Marshall Islands Francyne Wase-Jacklick Adela Sibok Lokkas Lakmij Anne Chang Gum
Northern Marianas (CNMI) John Dax Moreno John Dax Moreno Paul White Philip Dauterman
Guam Josephine OMallan Bernadette P. Schumann Robert Haddock Josephine OMallan
Puerto Rico Sandra Miranda de Leon Raymond Perez Rivera Brenda Rivera-Garcia Myriam Garcia-Negron
Republic of Palau Sherilynn Madraisau Columbo Sakuma Tmong Cheryl Udui Francis Termeteet
Virgin Islands Vanessa Farrell Vanessa Farrell Esther Ellis Joseph Mark
138
Contributors Centers for Disease Control and Prevention: STD Surveillance 2016
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Sexually Transmitted Disease

U.S Department of Health and Human Services

Surveillance and Data Management Branch

Others contributing to the production and dissemination of this publication

Division of STD Prevention

Selected STD Surveillance and Prevention References and Web Sites

STD Data in the NCHHSTP Atlas

STD Data on Wonder

STD Data Management & Information Technology

STD Fact Sheets

STD Treatment Guidelines

STD Program Evaluation Guidelines

STD Program Operation Guidelines

Recommendations for Public Health Surveillance of Syphilis in the United States

National Survey of Family Growth

Beyond the impact on an individuals health, STDs are

The collection of information on race/ethnicity has been

Special Focus Profiles

STDs in Adolescents and Young Adults

STDs in Racial and Ethnic Minorities

West Midwest South Northeast

National Overview of STDs, 2016

Figure 10. Chlamydia Prevalence Among Sexually-Active Women

increase during 20152016, at 7.0%. coverage in men, especially increased

0 4. Oakeshott P, Kerry S, Aghaizu A, et al.

145.8 cases per 100,000 population

rate among females increased 13.8% >139 (n= 647)

(106.3 to 121.0 cases per 100,000

Percentage Cefixime Susceptibility

* Isolates not tested for cefixime susceptibility in 2007 and 2008.

Figure 27. Neisseria gonorrhoeae Distribution of Azithromycin

Gonorrhea Among Special Gonorrhea Summary

Rate (per 100,000 population)

MSW* Women MSM* 4. Ingraham NR. The value of penicillin alone

Cases (in thousands)

Figure 44. Congenital Syphilis Reported Cases by Year of Birth

CS* Cases P&S* Rate (per 100,000 women)

0 NHANES data on the gender- and

18 NHANES data also show that among

This has been attributed, in part, infection during their child-bearing

STDs in Women and Infants

0.0 After reaching a 40-year low in

were observed in the West and in 0.2 0.8

the South (Figures H and I, Tables 1.7

during 20152016 (Table 41).

confidentiality (e.g., Explanation of 3126 2967

factors (e.g., peer norms and media 4832

the social and cultural conditions

2024 Year Old Females In 2016,

9.2 Adolescents and Young

ethnicity, ranging from no missing 839.0 Blacks 1387.2

cases to 30.4% missing information 219.8 Hispanics 532.4

101.7 Multirace 197.0

Observations 330.5 Total 657.3

was Other) (Table 22A). The rate 43.4 Asians 14.5

the rate among Whites (55.7 cases 171.1 NHOPI* 160.0

per 100,000 population) (Table 22B). 64.1 Whites 47.5

data in race and ethnicity categories

Rate Ratio Asians In 2016, the rate of

Considering all race, ethnicity, sex, 7.6 Asians 0.4

and age categories, rates of reported 41.3 Blacks 6.3

The rate of reported P&S syphilis 9.0 Whites 0.9

cases among Black men aged 2024 11.2 Multirace 1.2