Your ZIP code can influence how easily you find a doctor, get tested, or receive treatment. It can also shape your chances of encountering a sexually transmitted infection.
But when a city appears on a list of places with high STD rates, the numbers tell only part of the story. Behind those statistics are questions about healthcare access, prevention, stigma, and whether people can get treatment before an infection spreads.
Public health professionals generally use the term sexually transmitted infections, or STIs, because someone can have an infection without symptoms. That distinction matters: feeling healthy does not necessarily mean someone is infection-free.
The list below comes from Innerbody Research’s 2025 analysis of 2023 CDC data, which combines reported chlamydia, gonorrhea, syphilis, and HIV cases. It describes metropolitan areas, which may extend beyond city boundaries. It is an independent analysis of CDC data, rather than an official CDC ranking of cities.
These figures are reported cases per 100,000 residents, not the percentage of residents with an STD. One person can have more than one infection. The ranking also does not capture every STI, including HPV and herpes. Chlamydia and gonorrhea account for most reported cases in all 10 areas.
Newer national figures provide additional context: CDC’s provisional 2024 data show a decline in the combined number of reported chlamydia, gonorrhea, and syphilis cases. However, national improvement does not mean every community experienced the same progress, and those provisional figures do not establish an updated city ranking.
Infections driving the burden: Chlamydia and gonorrhea, with syphilis also a significant concern.
San Francisco demonstrates why an older ranking should not be treated as a permanent label. Local prevention efforts have produced evidence of improvement.
Why rates may be high: Transmission within affected sexual networks and differences in access to effective prevention may contribute. However, the ranking cannot determine the causes or separate transmission patterns from differences in case detection.
A study of San Francisco found substantial declines in reported chlamydia and early syphilis among men who have sex with men and transgender women after the city introduced guidelines for doxycycline postexposure prophylaxis, or doxy PEP. Gonorrhea did not show the same decline during the study period. The findings suggest that targeted prevention can change a community’s trajectory.
Infections driving the burden: Chlamydia and gonorrhea, with syphilis and HIV additional priorities.
Baton Rouge’s concerns extend beyond its combined STI ranking. Louisiana’s fourth-quarter 2024 HIV and syphilis report identifies the Baton Rouge metropolitan area as having a particularly high HIV diagnosis rate compared with other large metropolitan areas.
Why rates may be high: When infections are already common in a community, gaps in testing, prevention, or treatment can sustain transmission. Stigma and unstable access to healthcare are possible contributors, but the available ranking does not isolate their local effects.
Louisiana’s STI/HIV/Hepatitis Program emphasizes timely medical treatment and supportive social services, recognizing that a diagnosis must be followed by accessible, ongoing care.
Infections driving the burden: Chlamydia and gonorrhea, alongside syphilis and HIV.
The St. Louis metropolitan ranking describes a broader region than the city itself. Prevention therefore requires access to testing and treatment across multiple communities.
Why rates may be high: Transportation, housing stability, and access to affordable healthcare can affect whether someone receives consistent care. St. Louis’ HIV service system explicitly includes help with transportation, housing, mental health care, and other needs—services that acknowledge how everyday circumstances influence treatment access. This does not establish how much those circumstances explain the STI ranking.
The city’s Health Stop center offers confidential HIV and STI testing at no cost, providing an entry point for residents who might otherwise delay testing.
Infections driving the burden: Chlamydia and gonorrhea, with syphilis and HIV contributing to the combined total.
D.C. Health describes the District as facing overlapping epidemics involving HIV, STIs, hepatitis, and tuberculosis. However, the metro-area ranking includes communities beyond the District itself, so it should not be interpreted as a rate for D.C. residents alone.
Why rates may be high: A major consideration is how much infection already exists within connected groups of sexual partners. When an infection is more common in a network, exposure can occur even without a large number of partners.
Unequal access to prevention and treatment may compound that risk. These are established public health mechanisms, not findings that prove why the Washington metro area holds this particular rank.
Infections driving the burden: Chlamydia and gonorrhea, with significant concerns about syphilis and HIV.
New Orleans’ health department reported that its chlamydia incidence exceeded state and national averages. Its report, based on 2018–2023 data, also highlighted increases in syphilis and new HIV diagnoses among teenagers.
Why rates may be high: Local officials identify several priorities: improving sexual health education, expanding easy-to-access testing, reducing stigma, and ensuring equitable treatment.
The city also identified missed prenatal syphilis screening as an opportunity for prevention. When syphilis during pregnancy goes untreated, it can reach the baby and cause severe complications, including stillbirth. New Orleans’ experience shows why routine sexual healthcare and prenatal care must work together.
Infections driving the burden: Chlamydia and gonorrhea, with syphilis and HIV also important.
Baltimore’s experience illustrates how sexual health overlaps with broader healthcare inequality. The city’s 2023–2024 community health needs assessment identifies income disparities and barriers to quality care among uninsured and underinsured residents.
Why rates may be high: Financial strain and uneven access to care may delay diagnosis or treatment. These are documented local healthcare challenges, although the assessment does not calculate their contribution to Baltimore’s STI ranking.
Prevention access also matters. Research involving Baltimore’s sexual health clinics identifies a need to reduce barriers to HIV preexposure prophylaxis, or PrEP, which helps prevent HIV.
Infections driving the burden: Chlamydia and gonorrhea, plus a documented local concern involving HIV and syphilis.
Memphis and surrounding Shelby County have faced overlapping HIV and syphilis challenges. CDC reports that state and county officials identified a statistically significant increase in HIV and syphilis diagnoses among young people ages 15–19 in 2024.
Why rates may be high: Local response capacity is part of the picture. CDC deployed disease intervention professionals to help Shelby County address a backlog in syphilis reporting and investigations.
That does not explain the entire metropolitan ranking, but it identifies a concrete challenge: health departments need enough staff to investigate infections, notify exposed partners, and connect people with treatment.
Infections driving the burden: Chlamydia and gonorrhea, with syphilis an additional concern.
Montgomery’s high overall ranking makes access to testing for multiple infections especially important. A person tested for one infection should not assume that every other STI was included.
Why rates may be high: The ranking cannot establish a Montgomery-specific cause. However, untreated infections, stigma, and difficulty obtaining timely care are plausible contributors based on established STI research. Those challenges can persist even when free services exist, because people must know about the services and feel comfortable using them.
Montgomery County’s Fast Track program tests for chlamydia, gonorrhea, syphilis, and HIV. Alabama’s health department also provides free STI testing and treatment through its public health services.
Infections driving the burden: Chlamydia and gonorrhea, alongside syphilis and HIV.
One local concern is reaching young people before an untreated infection causes complications or spreads. Philadelphia’s high school STI screening program brings testing and education into schools and addresses confidentiality during the testing process.
Why rates may be high: Infections without symptoms can go undetected, while uncertainty about privacy or how to access care may discourage testing. Philadelphia’s school screening and walk-in services address those gaps, although the ranking does not measure how much each factor contributes.
The city also offers confidential services for partners of people diagnosed with an STI, helping interrupt transmission beyond the initial diagnosis.
Infections driving the burden: Chlamydia and gonorrhea, with syphilis and HIV also contributing.
Detroit’s health department reports that city residents experience nearly 15,000 reported chlamydia, gonorrhea, and syphilis cases annually, along with more than 200 new HIV cases. Those city figures cover a different geographic area from the metropolitan ranking, but they reinforce the scale of the local challenge.
Why rates may be high: Delays in testing and treatment can allow infections to circulate, particularly when people have no symptoms. Cost, difficulty reaching care, and stigma are recognized contributors to STI disparities nationally; they are possible contributors here, rather than proven explanations for Detroit’s position.
Detroit’s response includes STI testing, treatment for patients and partners, and rapid HIV testing. Treating partners matters because an infection can return when only one person receives care.
Many communities experiencing a high STI burden also face longstanding inequities in healthcare access. That requires context rather than blame.
Race itself does not cause an STI. CDC identifies poverty, unequal access to healthcare, stigma, and racism as factors linked to health disparities. These conditions can influence who receives preventive care, how quickly infections are diagnosed, and whether treatment is accessible.
A person’s risk also depends partly on how common an infection is among potential partners. Someone with one partner can acquire an STI. Community statistics cannot establish an individual’s behavior, character, or infection status.
The practical response is to make confidential testing, prevention, and treatment easier to obtain—and sexual health conversations easier to have.
A city’s ranking cannot tell you whether you have an STI. Testing can.
Condoms, recommended vaccinations, conversations with partners, and timely treatment are additional tools for prevention. A clinician can also discuss whether HIV PrEP or other preventive options fit your circumstances.
High STI rates are a reason to expand care and education. For individuals, the next step can be simple: make sexual health part of routine healthcare, ask direct questions, and get tested without shame.
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