The United States is in the midst of a growing public health problem — rates of several common sexually transmitted diseases have risen for four consecutive years. According to the federal Centers for Disease Control and Prevention, the U.S. as a whole has seen rates of chlamydia, gonorrhea, and primary and secondary syphilis rise four years in a row.

But what’s the STD situation here in Washington, D.C.? Which sexually transmitted diseases are the most common here, how have their rates changed over time, how does the District stack up against the states? To answer all those questions, we’ll dig into STD data from the CDC as well as the District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration.

It’s important to note that in most STD publications, the CDC does not compare the District to states, and that’s because D.C. has by far the highest population density when compared to any other state, even ones that are very heavily populated.

Chlamydia Rates in D.C.

Among the 50 states, Alaska has the highest rate of chlamydia infections after adjusting for population differences. But if the District were included, it would have a rate that’s nearly double that of Alaska. D.C.’s rate is nearly three times the overall U.S. rate, which does include cases reported in the District.

Chlamydia infections per 100,000 people

Highest
Alaska 799.8
Louisiana 742.4
Mississippi 708.7
South Carolina 649.8
New Mexico 645
Georgia 623.7
Alabama 615.5
North Carolina 612.2
New York 591.6
Illinois 589.9
Total 528.8
District of Columbia 1,463.6
Lowest
North Dakota 432.5
Massachusetts 425.7
New Jersey 392
Wyoming 372.1
Idaho 368.4
Maine 342.1
New Hampshire 330.5
Utah 323.7
Vermont 297.5
West Virginia 226.1

Chlamydia has become more common in the District over the past half-decade, with the infection rate in D.C. rising by more than one-third between 2013 and 2017.

District of Columbia chlamydia rate by year (cases per 100,000 people)

2013 1,065.7
2014 953.3
2015 1,250.9
2016 1,259.3
2017 1,463.6

Six of the 10 states with the highest chlamydia rates are in the South, but the South also is home to the state with the lowest rate, West Virginia.

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

Louisiana 742.4
Mississippi 708.7
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
District of Columbia 1,463

 Gonorrhea Rates in D.C.

Mississippi leads the states in the prevalence of gonorrhea with a rate of 310 per 100,000 people, nearly 10 times higher than that of Vermont, with the lowest rate among the states. Including D.C. in the ranking pushes Mississippi down to No. 2, as the District’s rate is more than double Mississippi’s.

Gonorrhea infections per 100,000 people

Highest
Mississippi 310
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
District of Columbia 730
Lowest
Rhode Island 102.9
Hawaii 95.1
Utah 81.2
Montana 75
West Virginia 70.8
Idaho 58.6
Wyoming 53.7
Maine 46.6
New Hampshire 38.4
Vermont 32.5

In three of the past five years, D.C. has recorded an increase in the gonorrhea rate, and between 2013 and 2017, the rate climbed by more than 70%.

District of Columbia gonorrhea rate by year (cases per 100,000 people)

2013 429.5
2014 348.5
2015 437.6
2016 558.3
2017 730.6

Eight of the 10 states with the highest gonorrhea rates are in the South, and D.C.’s gonorrhea rate is more than 10 times higher than that of West Virginia, which has the region’s lowest rate.

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

Mississippi 310
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
District of Columbia 730

Syphilis Rates in D.C.

The overall infection rate in the U.S. for primary and secondary syphilis cases is 9.5 per 100,000, which is about half that of Nevada, which has the highest rate among the states. The District’s rate is nearly 5 times higher than the overall national rate and is just over double that of Nevada.

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
Total 9.5
District of Columbia 45
Lowest
South Dakota 3.8
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
Wyoming 0.7

After a few years of decline, the syphilis rate has grown rapidly in D.C. over the past couple of years and it now stands at nearly 60% higher than it was in 2013.

District of Columbia primary and secondary syphilis rate by year (cases per 100,000 people)

2013 29.4
2014 21.6
2015 20.3
2016 31.4
2017 45.8

Six in 10 of the states with the highest rates of syphilis are in the South, and D.C.’s rate is about 13 times higher than that of West Virginia, which has the region’s lowest rate.

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
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
District of Columbia 45

HIV & Other STD Rates in D.C.

HIV

More than 300 people were newly diagnosed with HIV in D.C. in 2017, and the District’s population adjusted HIV rate of 46.3 per 100,000 is considerably higher than Georgia, which has the highest rate among the states at 24.9 per 100,000. Still, D.C. did record a nearly 8% decline in the rate of new HIV infections.  See How to Test for HIV

Hepatitis B & C

Acute infections of viral hepatitis, both hep B and hep C, have not been reported for the District for several years, but both infections occur nationally at a rate of about 1 per 100,000. See How to Test for Hepatitis

HPV

Human papillomavirus (HPV), in addition to being the single most common STD in the world, is also the chief cause of several types of cancer, including cervical, anal and penile cancers. So common is this infection that pinpointing exact numbers and rates for it is virtually impossible. That’s why examining the rate of HPV-related cancers can help provide a window into how commonly HPV goes untreated. In the District of Columbia, these cancers occur at a rate of about 13.9 per 100,000, higher than the national median of 11.7 per 100,000, but not the highest rate in the U.S. The highest rate is in Kentucky, where these cancers are diagnosed at a rate of 15.7 per 100,000. See How to Test for HPV

Conclusion

There’s no doubt that sexually transmitted diseases are a great and growing problem here in Washington, D.C, as in the rest of the country. But remember that while rates of chlamydia, gonorrhea and syphilis all have risen here, D.C. saw the rate of new HIV cases fall, which should signal to everyone that progress is possible. A key to helping bring down STD rates is for sexually active people to get tested so that they can be treated for any infections they may have but also so that they can break the cycle of STDs.

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.