According to the federal Centers for Disease Control and Prevention, several sexually transmitted diseases (STDs) are becoming more common across the United States, and those trends largely can be seen here in North Carolina as well. Rates of chlamydia, gonorrhea, and primary and secondary syphilis have risen nationally, and the same is true in North Carolina.

Which STDs are most common in North Carolina, how does the state rank nationally, and which cities and counties in North Carolina have the highest rates of sexually transmitted diseases? To answer those questions, we’ll check out data from the CDC as well as the North Carolina Department of Health and Human Services.

Chlamydia Rates in North Carolina

North Carolina has the eighth-highest rate of chlamydia infections after adjusting for population differences among the states, and North Carolina’s rate is about 17% higher than the national rate.

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
Illinois 589.9
Total 528.8
Lowest
Massachusetts 430.4
Minnesota 426.4
New Jersey 394
Idaho 368.4
Wyoming 365.8
Maine 342.1
Utah 332.2
New Hampshire 330.5
Vermont 297.5
West Virginia 226.1

North Carolina’s chlamydia rate rose slightly between 2016 and 2017, but the state has seen an increase of nearly 25% since 2013.

Percentage increase in chlamydia infection rate. 2013-2017 (top 15)

New Hampshire 40.2%
Connecticut 39.7%
Georgia 33.8%
Maine 32.2%
Nevada 31.0%
Utah 27.9%
California 27.7%
Oregon 26.2%
Colorado 25.9%
Iowa 25.1%
Virginia 24.9%
North Carolina 24.5%
Massachusetts 24.1%
Arizona 23.9%
New Jersey 23.8%

Chlamydia is most prevalent in the South, and North Carolina ranks in the top half of the region.

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
Arkansas 579.6
Delaware 566.3
Maryland 555.4
Oklahoma 554.4
Texas 543.9
Tennessee 527.5
Virginia 503.7
Florida 485.2
Kentucky 435.4
West Virginia 226.1

 Gonorrhea Rates in North Carolina

North Carolina has the eighth-highest rate of gonorrhea infections, and the state’s rate is more than one-quarter higher than the national frequency.

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 224.5
North Carolina 220.9
Georgia 217.5
Ohio 216.3
Total 171.9
Lowest
Rhode Island 102.9
Hawaii 95.1
Utah 83.3
Montana 75
West Virginia 70.8
Wyoming 70.4
Idaho 58.6
Maine 46.6
New Hampshire 38.4
Vermont 32.5

Gonorrhea is more common today in our state than it was about a half-decade ago, and the state’s rate of gonorrhea infections has jumped by nearly 60%, but that’s far below the leaders nationally when it comes to rising gonorrhea rates. In fact, several states have seen their gonorrhea rates jump by more than 300% — New Hampshire (+322%), Idaho (+347%) and Wyoming (+523%).

Percentage increase in gonorrhea infection rate, 2013-2017 (bottom 15)

Pennsylvania 10%
West Virginia 24%
Delaware 25%
Texas 33%
New Jersey 34%
Louisiana 37%
Connecticut 38%
Alabama 42%
Florida 44%
Michigan 45%
Illinois 46%
Ohio 51%
North Carolina 59%
South Dakota 61%
Indiana 64%

Eight of the 10 states with the highest rates of gonorrhea are in the South, and North Carolina ranks near the middle of the region.

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 224.5
North Carolina 220.9
Georgia 217.5
Delaware 187.4
Tennessee 186.8
Maryland 182.5
Texas 170.2
Kentucky 167.2
Florida 153.7
Virginia 149.7
West Virginia 70.8

Syphilis Rates in North Carolina

North Carolina’s rate of primary and secondary syphilis is No. 8 in the nation, though the state’s rate is only about 12% higher than the national level.

Primary and secondary syphilis infections per 100,000 people

Highest
Nevada 20
California 17.1
Louisiana 14.5
Georgia 14.5
Arizona 13.6
New York 11.9
Florida 11.6
North Carolina 10.6
Mississippi 10.4
Illinois 9.6
Total 9.5
Lowest
South Dakota 3.8
West Virginia 3.4
New Hampshire 3.2
Iowa 3.2
Connecticut 3.1
Wisconsin 3
Nebraska 2.3
Vermont 2.1
Alaska 1.8
Wyoming 0.7

Cases of primary and secondary syphilis have risen by nearly two-fold in North Carolina since 2013.

Percentage increase in primary and secondary syphilis infection rate, 2013-2017 (top 15)

Montana 820%
Maine 513%
West Virginia 325%
Idaho 322%
Vermont 320%
Mississippi 300%
Wyoming 250%
North Dakota 241%
Arizona 216%
Oklahoma 206%
Nevada 174%
North Carolina 159%
Kansas 156%
New Mexico 151%
Alabama 129%

North Carolina ranks fourth among all Southern states in the rate of syphilis infections.

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

Louisiana 14.5
Georgia 14.5
Florida 11.6
North Carolina 10.6
Mississippi 10.4
Maryland 9.5
Oklahoma 9.5
Alabama 8.7
Texas 8
Arkansas 7.8
Tennessee 7.3
South Carolina 7.3
Virginia 6.4
Delaware 6
Kentucky 5.9
West Virginia 3.4

HIV & Other STD Rates in North Carolina

HIV

North Carolina’s rate of new HIV cases ranks among the top in the nation at 15.2 infections per 100,000 people, quite a bit higher than the national rate of 11.8 per 100,000. In a spot of good news, though, the state has seen prevalence of HIV drop, declining by nearly 7% between 2016 and 2017. See also HIV test options.

Hepatitis B & C

Acute infections of hepatitis B are more common in North Carolina than the nation overall, as the state’s infection rate for hep B is about 41% higher than the national level. Acute infections of hep C also occurred at higher-than-national rates in North Carolina, with our state’s hep C rate sitting at more than double the national level. Rates of both types of hepatitis have risen in our state in recent years. See also hepatitis test options.

HPV

Human papillomavirus, the most common STD, causes most cases of cervical, penile, anal and vulvar cancer, among others. North Carolina has a higher-than-median rate of HPV-related cancer, 13.1 per 100,000 vs. the national median of 11.7 per 100,000. See also HPV test options.

STDs in North Carolina Counties

While STDs are more common in North Carolina than in many other states, a handful of the state’s counties are helping elevate the state’s national rankings.

Chlamydia

More than 1 in 4 chlamydia cases in North Carolina occurred in Charlotte, Durham and Raleigh.

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

Pitt 1,170.1
Cumberland 1,096.7
Vance 1,065.3
Richmond 977.7
Robeson 957
Edgecombe 949.8
Guilford 946.4
Onslow 917
Scotland 889.1
Durham 878.6

Gonorrhea

Charlotte, Durham and Raleigh accounted for more than 25% of gonorrhea cases in North Carolina, but the disease is more prevalent outside those cities.

North Carolina counties by gonorrhea infection rate (cases per 100,000 population), top 10

Vance 576.8
Edgecombe 449.3
Cumberland 446.6
Robeson 444.9
Scotland 441.7
Columbus 384.4
Pitt 382
Northampton 362.5
Guilford 362.1
Cleveland 357.5

Primary and secondary syphilis

About one-quarter of syphilis cases in North Carolina in 2017 were in the Charlotte area, while the Raleigh-Durham area accounted for another 22%.*

North Carolina counties by primary, secondary and early latent syphilis infection rate (cases per 100,000 population), top 10

Mecklenburg 40.6
Durham 38.8
Edgecombe 30.3
Cumberland 24.1
New Hanover 22.4
Wake 22.4
Wilson 22
Jones 20.8
Forsyth 20.7
Robeson 19.6

* In its county-by-county breakdown, the state of North Carolina separates syphilis into slightly different categories than the CDC does nationally, so this includes primary, secondary and early latent syphilis, which encompasses more cases than the CDC data, which our earlier rankings were based on.

Conclusion

While it’s, sadly, true that North Carolina has among the nation’s highest STD rates for several major conditions, every person in the state has it within their power to work to bring those rates down. Having safer sex and taking precautions against STD transmission are two big ways you can help, but responsible sexual behavior also must include finding out your STD status by getting yourself tested.

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.