Your zip code can influence how easy it is for you to find a doctor, get tested, or receive treatment. It can also influence your chances of getting a sexually transmitted infection.
But when a city appears on a list of places with high STD rates, the numbers only tell part of the story. Behind these statistics lie questions about access to health care, prevention, stigma and the ability to seek treatment before an infection spreads.
Public health professionals generally use the term sexually transmitted infections or STIsbecause someone can have an infection without symptoms. This distinction is important: feeling healthy does not necessarily mean that a person is not infected.
Understanding Rankings
The list below comes from Innerbody Research 2025 Analysis of 2023 CDC Datawhich combines reported cases of chlamydia, gonorrhea, syphilis and HIV. It describes metropolitan areas, which may extend beyond city limits. This is an independent analysis of CDC data, rather than an official CDC city ranking.
These figures are cases reported per 100,000 inhabitantsand not the percentage of residents with an STD. A person can have more than one infection. The ranking also does not take into account all STIs, including HPV and herpes. Chlamydia and gonorrhea account for most of the cases reported in the 10 regions.
More recent national numbers provide additional context: preliminary CDC data for 2024 shows a decline in the combined number of reported cases of chlamydia, gonorrhea and syphilis. However, national improvement does not mean that every community has experienced the same progress, and these preliminary numbers do not provide an up-to-date ranking of cities.
10. San Francisco, California
Infections causing the burden: Chlamydia and gonorrhea, with syphilis also being a major concern.
San Francisco demonstrates why an older ranking should not be treated as a permanent label. Local prevention efforts have produced evidence of improvement.
Why rates may be high: Transmission within relevant sexual networks and differences in access to effective prevention may contribute. However, classification cannot determine causes or separate modes of transmission from differences in case detection.
A study in San Francisco found a substantial drop in reported cases of chlamydia and early syphilis among men who have sex with men and transgender women after the city introduced guidelines for doxycycline post-exposure prophylaxis, or doxy PEP. Gonorrhea did not show the same decline during the study period. The findings suggest that targeted prevention can change the trajectory of a community.
9. Baton Rouge, Louisiana
Infections causing the burden: Chlamydia and gonorrhea, with syphilis and HIV additional priorities.
Baton Rouge’s concerns extend beyond its combined STI ranking. The Fourth Quarter 2024 Louisiana HIV and Syphilis Report identifies the Baton Rouge metro area as having a particularly high HIV diagnosis rate compared to other large metropolitan areas.
Why rates may be high: When infections are already common in a community, gaps in testing, prevention or treatment can fuel transmission. Stigma and unstable access to health care may contribute, but the available classification does not isolate their local effects.
Louisiana’s STI/HIV/Hepatitis program emphasizes prompt medical treatment and supportive social services, recognizing that a diagnosis must be followed by accessible, ongoing care.
8. St. Louis, Missouri
Infections causing the burden: Chlamydia and gonorrhea, alongside syphilis and HIV.
The St. Louis metropolitan ranking describes a larger region than the city itself. Prevention therefore requires access to screening and treatment in several communities.
Why rates may be high: Transportation, housing stability, and access to affordable health care can impact the consistency of a person’s care. St. Louis’ HIV service system explicitly includes assistance with transportation, housing, mental health care, and other needs – services that recognize how daily circumstances influence access to treatment. This does not allow us to establish to what extent these circumstances explain the STI ranking.
The city’s Health Stop offers free confidential HIV and STI testing, providing a point of entry for residents who might otherwise delay testing.
7. Washington, D.C.
Infections causing the burden: Chlamydia and gonorrhea, with syphilis and HIV contributing to the combined total.
DC Health describes the district as facing overlapping epidemics involving HIV, STIs, hepatitis and tuberculosis. However, the metro area ranking includes communities beyond the district itself, so it should not be interpreted as a rate for DC residents alone.
Why rates may be high: A major consideration is the degree of infection that already exists within connected groups of sexual partners. When an infection is more common in a network, exposure can occur even without a large number of partners.
Unequal access to prevention and treatment can worsen this risk. These are established public health mechanisms, not results that prove why the Washington metro area has this particular rank.
6. New Orleans, Louisiana
Infections causing the burden: Chlamydia and gonorrhea, with significant concerns about syphilis and HIV.
The New Orleans Health Department reported that the incidence of chlamydia exceeded state and national averages. Its report, based on data from 2018 to 2023, also highlights the increase in syphilis and new HIV diagnoses among adolescents.
Why rates may be high: Local officials identify several priorities: improving sexual health education, expanding easy access to testing, reducing stigma and ensuring fair treatment.
The city also identified missed prenatal syphilis screening as a prevention opportunity. When syphilis during pregnancy is left untreated, it can affect the baby and cause serious complications, including stillbirth. The New Orleans experience shows why routine sexual health care and prenatal care must work together.
5. Baltimore, Maryland
Infections causing the burden: Chlamydia and gonorrhea, as well as syphilis and HIV, are also important.
Baltimore’s experience illustrates how sexual health intersects with broader health care inequities. The city’s 2023-2024 Community Health Needs Assessment identifies income disparities and barriers to quality care among uninsured and underinsured residents.
Why rates may be high: Financial difficulties and unequal access to care can delay diagnosis or treatment. These are documented local health care challenges, although the assessment does not calculate their contribution to Baltimore’s STI ranking.
Access to prevention is also important. Research involving Baltimore sexual health clinics identifies the need to reduce barriers to HIV pre-exposure prophylaxis, or PrEP, which helps prevent HIV.
4. Memphis, Tennessee
Infections causing the burden: Chlamydia and gonorrhea, as well as documented local concern regarding HIV and syphilis.
Memphis and surrounding Shelby County have faced challenges related to HIV and syphilis. The CDC reports that state and county officials have identified a statistically significant increase in HIV and syphilis diagnoses among youth ages 15 to 19 in 2024.
Why rates may be high: Local response capacity is part of the picture. The CDC has deployed disease response professionals to help Shelby County close a backlog in syphilis reporting and investigation.
That doesn’t explain the entire metropolitan ranking, but it does identify a concrete challenge: Health departments need enough staff to investigate infections, notify exposed partners, and refer people for treatment.
3. Montgomery, Alabama
Infections causing the burden: Chlamydia and gonorrhea, with syphilis being an additional concern.
Montgomery’s high overall ranking makes access to testing for multiple infections particularly important. A person being tested for an infection should not assume that all other STIs are included.
Why rates may be high: The classification cannot establish a specific cause in Montgomery. However, untreated infections, stigma, and difficulty obtaining timely care are plausible factors, based on established research on STIs. These challenges can persist even when free services exist, because people need to know about these services and feel comfortable using them.
Montgomery County’s Fast Track program tests for chlamydia, gonorrhea, syphilis and HIV. The Alabama Department of Health also offers free STI testing and treatment through its public health services.
2. Philadelphia, Pennsylvania
Infections causing the burden: Chlamydia and gonorrhea, alongside syphilis and HIV.
One local concern is reaching young people before an untreated infection causes complications or spreads. The Philadelphia High School STI Testing Program brings testing and education into schools and respects confidentiality during the testing process.
Why rates may be high: Infections without symptoms may go unnoticed, while uncertainty about privacy or access to care may discourage testing. Testing and walk-in services in Philadelphia schools fill these gaps, although the rankings do not measure the contribution of each factor.
The city also offers confidential services to partners of people diagnosed with an STI, helping to interrupt transmission beyond initial diagnosis.
1. Detroit, Michigan
Infections causing the burden: Chlamydia and gonorrhea, syphilis and HIV also contribute.
The Detroit Health Department reports that city residents experience nearly 15,000 cases of chlamydia, gonorrhea and syphilis each year, as well as more than 200 new cases of HIV. These city figures cover a different geographic area than the metropolitan rankings, but they reinforce the scale of the local challenge.
Why rates may be high: Delays in testing and treatment may allow…
Gn Health
