Despite an initial slowdown in early 2020, the rates of most sexually transmitted infections (STIs) in the United States continued to climb during the first year of the COVID-19 pandemic and remain “a significant public health concern,” concludes the Centers for Disease Control and Prevention (CDC) in its latest annual report on STIs.

(Note: The terms STIs and STDs, for sexually transmitted diseases, are often used interchangeably.)

Rates of gonorrhea and syphilis (including primary and secondary syphilis and cases among newborns) increased in 2020. Although reported cases of chlamydia dropped, health officials noted that chlamydia traditionally makes up the bulk of reported STIs and the decrease in 2020 rates is likely due to a decline in screenings.

Specifically, according to a CDC press release, the report on 2020 data found:

  • Reported cases of gonorrhea and primary and secondary syphilis were up 10% and 7%, respectively, compared to 2019.

  • Syphilis among newborns (congenital syphilis) also increased, with reported cases up nearly 15% from 2019 and 235% from 2016. Early data indicate that cases of primary and secondary syphilis and congenital syphilis (syphilis in newborns) continued to increase in 2021 as well.

  • Reported cases of chlamydia declined 13% from 2019.

The report breaks down reported STI cases by state. In general, states in the South fare much worse, while those in the Northeast (Vermont, New Hampshire and Maine) see the lowest rates. To see where your state ranks, click here.) Here’s a rundown of the top five states with the highest rates:


Highest rates of chlamydia per 100,00 people:

  • Mississippi: 803.7
  • Louisiana: 709.8
  • Alaska: 695.8
  • South Carolina: 662.7
  • North Carolina: 616.3

Highest rates of gonorrhea per 100,000 people: 

  • Mississippi: 462.8
  • Louisiana: 333.1
  • South Carolina: 324.4
  • Alabama: 294.2
  • Oklahoma: 283.1

Highest rates of primary and secondary syphilis per 100,000 people: 

  • Nevada: 24.9
  • Mississippi: 24.9
  • Alaska: 24.1
  • Oklahoma: 23.8
  • New Mexico: 22.3

Highest rates of congenital syphilis per 100,000 live births:

  • New Mexico: 182.9
  • Arizona: 151.2
  • Texas: 148.6
  • Nevada: 131.2
  • Oklahoma: 107.8

What’s more, the 2,148 reported cases of congenital syphilis in 2020 represent a 235% spike from 2016.

“The COVID-19 pandemic increased awareness of a reality we’ve long known about STDs . Social and economic factors—such as poverty and health insurance status—create barriers, increase health risks and often result in worse health outcomes for some people,” said Leandro Mena, MD, MPH, director of the CDC’s Division of STD Prevention, in a press release. “If we are to make lasting progress against STDs in this country, we have to understand the systems that create inequities and work with partners to change them. No one can be left behind.”

The report was released during STD Awareness Week, observed the second full week of April; this year, it’s April 10 to 16. (STD stands for sexually transmitted disease, used intermittently with STI.) Looking at 2018 data, the CDC points out that one in five Americans had an STI on any given day, totaling nearly 68 million infections, and that STIs cost the U.S. health care system nearly $16 billion that year.

“In this context,” the CDC notes, “innovative STD testing strategies are critical for STD prevention. With new opportunities for phone, video, or online health care visits, STD care is expanding beyond the clinic setting. Expanding these strategies can help us reduce STDs and address the challenges of health care access that existed before.”

And now for some good news during STD Awareness Week: A vaccine already in use for the bacterium that causes meningitis might provide over 30% protection against gonorrhea in young people, according to research published in the Lancet Infectious Diseases. This research is especially promising because cases of multidrug-resistant gonorrhea have been increasing globally in recent years.

And in related news, Florida health officials are warning people about a deadly outbreak of meningococcal disease in 2021. For details, see “21 Sick or Dead in Meningitis Outbreak. Do You Need to Get Vaccinated?

For a collection of STI articles, click #Sexually Transmitted Infection. You’ll find headlines such as “In a First, the FDA Approves a Condom for Anal Sex” and “California Requires Health Plans to Cover At-Home Tests for HIV and STIs.”