Sexually transmitted diseases (STDs) are on the rise in Texas and across much of the United States. According to the federal Centers for Disease Control and Prevention, nearly 2.3 million cases of three of the most common STDs, chlamydia, gonorrhea and syphilis, were reported in 2017, making it the fourth straight year of increases in those diseases.

Which STDs are most common in the state of Texas, where in the state are rates the highest, and how has the state made progress (or not) in the battle against sexually transmitted infections over the past few years?

Let’s explore data from the CDC as well as the Texas Department of State Health Services.

Chlamydia Rates in Texas

The state of Texas alone accounted for about 8% of all new chlamydia infections in 2017, and the state ranked second overall in total diagnoses. But while the state’s chlamydia rate has gone up by about 10% since 2013, Texas does not rank in the top 20 when it comes to the population-adjusted chlamydia rate. Still, Texas’ rate is higher than the overall national rate.

Chlamydia infections per 100,000 people, top 20

Alaska 799.8
Louisiana 742.4
Mississippi 707.6
New Mexico 651.6
South Carolina 649.8
Georgia 631.4
North Carolina 619.7
Alabama 615.5
New York 591.6
Illinois 589.9
Arkansas 579.6
Arizona 571.3
Delaware 566.3
California 557.4
Maryland 555.4
Oklahoma 554.4
Nevada 553.1
Texas 543.9
Missouri 536.4
Total 528.8

The rate of chlamydia infections in Texas has gone up every year since 2014 and has risen about 11% since 2012.

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

2012 487.5
2013 491
2014 486.8
2015 513.9
2016 520.4
2017 543.9

Texas ranks in the lower half among all Southern states and has the lowest rate of all bordering states.

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

Louisiana 742.4
Mississippi 707.6
South Carolina 649.8
Georgia 631.4
North Carolina 619.7
Alabama 615.5
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 Texas

Texas had the second-most gonorrhea infections of any state in 2017, just behind California with more than 47,000 infections. Adjusted for population, though, the state’s rate is actually lower than the national rate.

Gonorrhea infections per 100,000 people, top 25

Mississippi 309.8
Alaska 295.1
Louisiana 256.7
South Carolina 254.4
Alabama 245.7
Oklahoma 231.4
North Carolina 225.4
Arkansas 224.5
Georgia 219.8
New Mexico 215.7
Missouri 214.8
Ohio 206.4
California 192
Nevada 187.8
Delaware 187.4
Tennessee 186.8
Illinois 186.4
Maryland 182.5
Arizona 180.4
Indiana 178.4
New York 172.7
Texas 170.2
Kentucky 167.2
Michigan 158.6
Total 171.9

In every state, the gonorrhea rate has risen over the past few years, and Texas is no exception to that. Between 2012 and 2017, Texas’ gonorrhea infection rate jumped by more than one-third.

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

2012 124.6
2013 127.9
2014 131
2015 144.6
2016 154.6
2017 170.2

Texas ranks in the lower half when it comes to other Southern states, and all Southern states that border Texas have higher gonorrhea rates.

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
North Carolina 225.4
Arkansas 224.5
Georgia 219.8
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 Texas

More than 2,200 cases of primary or secondary syphilis were reported in Texas in 2017, putting the state in fourth place overall for total diagnoses. When adjusting for population, Texas falls to 18th and has a population-adjusted rate lower than the national rate.

Primary and secondary syphilis infections per 100,000 people (top 20)

Nevada 20
California 17.1
Louisiana 14.5
Georgia 14.4
Arizona 13.6
New York 11.9
Florida 11.6
North Carolina 11.2
Mississippi 10.4
Illinois 9.6
Maryland 9.5
Oklahoma 9.5
Washington 9.3
New Mexico 9.3
Alabama 8.7
Oregon 8.6
Missouri 8.3
Texas 8
Massachusetts 7.9
Arkansas 7.8
Total 9.5

The infection rate for primary and secondary syphilis has risen every year since 2013 and has surged by more than 40% since then.

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

2012 6.2
2013 5.6
2014 6.1
2015 6.1
2016 7.1
2017 8

Texas ranks near the middle of all Southern states in syphilis rates, but the state’s rate is lower than most of its direct neighbors, with the exception of Arkansas.

Syphilis infection rates, Southern states (cases per 100,000 people)

Louisiana 14.5
Georgia 14.4
Florida 11.6
North Carolina 11.2
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 Texas

HIV

More than 4,300 people were newly diagnosed with HIV in our state in 2017, the third-most in the country. While that number equates to a rate that places Texas in the top 10 (No. 8), it represents a drop in total HIV cases and the per-100,000 rate since 2016. See How to Test for HIV

Hepatitis B & C

Texas’ rates of acute infections of both hep B and hep C are below the national rates. Texas has seen a drop in acute hep C infections since 2012 (-50%), but the rate of acute hep B infections has risen slightly posting a low in 2013 (+20%). See How to Test for Hepatitis

HPV

Cancers related to human papillomavirus include cervical and penile cancer and cancers of the anus, vulva and back of the throat. A majority of all of these cases are caused by HPV, the single most common STD in the world. Texas’ HPV-related cancer rate of 11.4 per 100,000 is among the lowest in the nation. See How to Test for HPV

STDs in Texas Cities

Texas often ranks near the top when it comes to overall infections of the three federally notifiable STDs, chlamydia, gonorrhea and syphilis. But this is driven largely by the number of major metro areas in the state, which often serve to skew the state’s health data thanks to population density.

Chlamydia

About 1 in 5 chlamydia cases in Texas in 2017 were in people living in Houston.

Texas cities by percentage of all chlamydia cases, top 10

Houston 21%
Dallas 11%
San Antonio 11%
Austin 7%
Fort Worth 4%
El Paso 4%
Corpus Christi 2%
Lubbock 2%
Arlington 2%
Killeen 2%

Gonorrhea

Houston, Dallas and San Antonio combined for nearly half of the gonorrhea cases in the entire state.

Texas cities by percentage of gonorrhea cases, top 10

Houston 21%
Dallas 14%
San Antonio 12%
Austin 8%
Fort Worth 5%
Lubbock 3%
Killeen 3%
Arlington 2%
Waco 2%
El Paso 2%

Primary and secondary syphilis

San Antonio and Houston each accounted for 16% of primary and secondary syphilis cases in Texas.

Texas cities by percentage of primary and secondary syphilis cases, top 10

San Antonio 16%
Houston 16%
Dallas 15%
Austin 15%
Fort Worth 6%
El Paso 6%
Corpus Christi 3%
Lubbock 3%
Arlington 3%
Irving 1%

Conclusion

Sexually transmitted diseases are becoming more and more common here in Texas and across the United States. That’s because many (maybe even most) STDs are difficult to diagnose through symptoms alone, as many of them often show no obvious signs in the body. So people unknowingly pass along infections to their sexual partners because they aren’t aware of their STD status. Getting tested is easy, and it means that you may be able to keep yourself and others from getting sick.

Additional References

Note: The CDC publishes comprehensive STD data on only three of the many conditions that are sexually transmitted — chlamydia, gonorrhea, and primary and secondary syphilis. Many other STDs are not classified as nationally notifiable diseases, meaning states are not legally obligated to report infection rates. Also, while the CDC collects data for the District of Columbia, the population density of the district prevents it from being included in rankings.