Alabama has among the highest rates of sexually transmitted diseases and infections of any state in the U.S., ranking in the top 10 for chlamydia and gonorrhea and near the top 25% for syphilis. Not only is Alabama one of the states where sexually transmitted diseases (STDs) are most common, rates of many different STDs are on the rise here in Alabama, which reflects a broader trend in the United States that has seen rates of several STDs climb for four consecutive years.

Which sexually transmitted diseases and infections are most common here in Alabama, how have their rates changed over time, and which cities and counties around the state are the biggest STD hotbeds? To answer all of those questions, we’ll examine data from the federal Centers for Disease Control and Prevention and the Alabama Department of Public Health.

Chlamydia Rates in Alabama

Alabama has the seventh-highest rate of chlamydia infections in the U.S., and the state’s rate is about 15% higher than the overall national rate of such infections.

Chlamydia infections per 100,000 people

Highest
Alaska 799.8
Louisiana 742.4
Mississippi 707.6
New Mexico 651.6
South Carolina 649.8
Georgia 623.7
Alabama 615.5
North Carolina 612.2
New York 591.6
Total 528.8
Lowest
North Dakota 432.5
Massachusetts 425.7
New Jersey 392
Idaho 368.4
Wyoming 365.8
Maine 342.1
New Hampshire 330.5
Utah 323.7
Vermont 297.5
West Virginia 226.1

While Alabama’s rate of chlamydia has fallen from the decade high recorded in 2012, the rate has nearly doubled over the past 15 years.

Alabama chlamydia rate by year (cases per 100,000 people)

2003 327.8
2004 294.4
2005 390.6
2006 490.4
2007 540.8
2008 527.9
2009 549.1
2010 573.3
2011 611.6
2012 635
2013 609.6
2014 598.2
2015 542.5
2016 553.6
2017 615.5

Six of the 10 states with the highest rates of chlamydia are in the South, and Alabama is fifth regionally, though Alabama’s rate is more than 15% lower than the regional leader, Louisiana.

Chlamydia infection rate, Southern states (cases per 100,000 people)

Louisiana 742.4
Mississippi 707.6
South Carolina 649.8
Georgia 623.7
Alabama 615.5
North Carolina 612.2
Maryland 586.3
Arkansas 576.7
Delaware 566.3
Oklahoma 554.4
Texas 543.9
Tennessee 522.5
Virginia 488.3
Florida 485.2
Kentucky 435.4
West Virginia 226.1

 Gonorrhea Rates in Alabama

Alabama ranks No. 5 overall in the United States with a population-adjusted gonorrhea rate that’s about 40% higher than the overall U.S. level.

Gonorrhea infections per 100,000 people

Highest
Mississippi 309.8
Alaska 295.1
Louisiana 256.7
South Carolina 254.4
Alabama 245.7
Oklahoma 231.4
Arkansas 223.5
North Carolina 220.9
Georgia 217.5
Ohio 216.3
Total 171.9
Lowest
Rhode Island 102.9
Hawaii 95.1
Utah 81.2
Montana 75
West Virginia 70.8
Wyoming 70.4
Idaho 58.6
Maine 46.6
New Hampshire 38.4
Vermont 32.5

The gonorrhea rate in Alabama had been trending in a good direction, but the rate has gone up for the past two straight years and stands at about 66% higher than the 21st century low recorded in 2015.

Alabama gonorrhea rate by year (cases per 100,000 people)

2003 206.9
2004 180.6
2005 214.2
2006 227.8
2007 234.2
2008 206.8
2009 158.6
2010 168.8
2011 188.4
2012 192.2
2013 173.3
2014 158.3
2015 148.1
2016 173
2017 245.7

Only two states in the top 10 for the prevalence of gonorrhea are outside the South, and Alabama has the region’s fourth-highest rate.

Gonorrhea infection rate, Southern states (cases per 100,000 people)

Mississippi 309.8
Louisiana 256.7
South Carolina 254.4
Alabama 245.7
Oklahoma 231.4
Arkansas 223.5
North Carolina 220.9
Georgia 217.5
Delaware 187.4
Tennessee 185
Maryland 170.3
Texas 170.2
Kentucky 167.2
Florida 153.7
Virginia 143.3
West Virginia 70.8

Syphilis Rates in Alabama

Alabama’s population-adjusted rate of primary and secondary syphilis places the state at No. 15 overall, but Alabama’s rate is lower than the overall U.S. infection rate.

Primary and secondary syphilis infections per 100,000 people

Highest
Nevada 19.7
California 17.1
Georgia 14.5
Louisiana 14.5
Arizona 13.1
Maryland 12.2
New York 11.9
Florida 11.6
North Carolina 10.6
Mississippi 10.4
Alabama 8.7
Total 9.5
Lowest
Utah 3.7
West Virginia 3.4
New Hampshire 3.2
Connecticut 3.1
Wisconsin 3
Iowa 2.7
Nebraska 2.3
Vermont 2.1
Alaska 1.8
Wyoming 0.7

Primary and secondary syphilis has become much more common in Alabama over the past half-decade, with the rate rising by nearly 130% since 2013.

Alabama primary and secondary syphilis rate by year (cases per 100,000 people)

2012 4.5
2013 3.8
2014 3.3
2015 5.8
2016 7.7
2017 8.7

Six of the 10 states where syphilis is most common are in the South, but Alabama ranks right in the middle of the pack regionally.

Primary and secondary syphilis infection rates, Southern states (cases per 100,000 people)

Georgia 14.5
Louisiana 14.5
Maryland 12.2
Florida 11.6
North Carolina 10.6
Mississippi 10.4
Oklahoma 9.5
Alabama 8.7
Texas 8
Arkansas 7.8
Tennessee 7.3
South Carolina 7.3
Virginia 6
Delaware 6
Kentucky 5.9
West Virginia 3.4

HIV & Other STD Rates in Alabama

HIV

More than 650 people were newly diagnosed with HIV in Alabama in 2017, giving the state the 11th-highest population-adjusted HIV rate in the country. However, Alabama did record a slight drop in the HIV rate (about 1%) between 2016 and 2017. See best HIV test options.

Hepatitis B & C

Acute infections of hepatitis B occur in Alabama at a rate higher than the overall U.S. rate, though such infections are on the decline in our state. In fact, hep B has fallen by half since 2014. Acute hep C infections have fallen as well and now stand at about 30% below the overall national rate. See best hepatitis test options.

HPV

Alabama has the No. 13 rate of cancers related to human papillomavirus, which would indicate the state has a large number of untreated cases of HPV. Human papillomavirus is the most common STD in the world; in fact, most sexually active people will get at least one strain in their lives. Most cases of HPV either clear up on their own or never cause serious health problems, but some strains are dangerous and, when untreated, can lead to cancer, such as cervical, penile and anal cancer. The incredible prevalence of HPV is difficult to pinpoint, which is why understanding HPV-caused cancer can be used to reveal the depth of the HPV crisis in a state. In addition to Alabama’s place just outside the top 10, the state’s population-adjusted HPV-caused cancer rate of 13.1 per 100,000 is higher than the national median of 11.7 per 100,000. See best HPV test options.

STDs in Alabama Cities & Counties

Alabama’s position near the top of the country for several different sexually transmitted diseases is buoyed, in part, by how common STDs are in three metro areas, Birmingham, Mobile and Huntsville, which all account for an outsized proportion of cases, particularly Birmingham.

Chlamydia

Nearly half of all chlamydia cases in Alabama are diagnosed in people living in Birmingham, Mobile or Huntsville, and Birmingham alone accounts for almost 1 in 4. The Birmingham metro area, in fact, has the eighth-highest chlamydia rate of all major U.S. metro areas.

Alabama counties by chlamydia infection rate (cases per 100,000 people), top 10

Macon 1,088.7
Montgomery 994.2
Lowndes 984.9
Dallas 911.7
Wilcox 840.9
Sumter 831.9
Hale 822.9
Greene 802.0
Pike 759.5
Butler 729.4

Gonorrhea

Nearly 60% of all gonorrhea cases are diagnosed in people living in Birmingham, Mobile or Huntsville, and Birmingham alone accounts for about 31%. Additionally, Birmingham’s gonorrhea rate is the third highest among all major U.S. metro centers.

Alabama counties by gonorrhea infection rate (cases per 100,000 people), top 10

Bullock 289.8
Montgomery 266.6
Jefferson 223.8
Macon 214.6
Butler 208.4
Greene 200.5
Coosa 195.8
Russell 194.4
Dallas 189.6
Madison 186.6

Primary and secondary syphilis

About 1 in 3 syphilis cases in Alabama occur in individuals living in Birmingham, and Mobile and Huntsville add another 24%.

Alabama counties by syphilis infection rate (cases per 100,000 people), top 10*

Dallas 36.5
Wilcox 36.2
Montgomery 30.9
Greene 23.6
Choctaw 22.8
Jefferson 21.2
Tallapoosa 19.6
Sumter 15.3
Pike 15.1
Tuscaloosa 14.2

* Data from the state of Alabama includes all syphilis cases, not just primary and secondary syphilis, which our overall national ranking is limited to. Countywide data for only primary and secondary syphilis for Alabama was unavailable.

Conclusion

The STD crisis in Alabama is serious and worsening. Alabama already ranks among the nation’s leaders when it comes to how prevalent several different sexually transmitted diseases and infections are in our state, and most STDs have seen their rates surge in recent years. Combatting the high rates of STDs in Alabama is up to everyday people. That’s because almost all sexually active people will contract at least one STD at some point in their lives, so the truth is that most people who are infected don’t know it and so they pass infections along unwittingly. Bringing down Alabama’s high rates of STDs means equipping yourself with knowledge and making sure that you get yourself tested for the infections you’re most at risk of contracting so that you can stop the cycle of STDs.

Take Charge of Your Sexual Health Today

At-home, private, testing is probably the best way to maintain a long and healthy sex life, and you should continue to do it until you are with a monogamous partner and you’ve both tested negative for all STDs. To get started, review our At Home STD Test Kit options today because knowledge, is power.

Additional References

Note: Some states have published more recent data for chlamydia, gonorrhea, and primary and secondary syphilis. For states in which that’s the case, we have substituted the individual state data for 2018 and used that in our rankings, while other states’ rankings are based on 2017 numbers. In some cases, we assume that when the full national dataset is published by the CDC, states’ positions relative to other states will change some, though those changes are unlikely to be dramatic, since the CDC data comes from the states.