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Top 10 U.S. Cities with the Highest STI Rates
For our 8th annual study of STI rates, using the latest data published by the Centers for Disease Control and Prevention (CDC), Innerbody Research analyzed statistics on a city-by-city basis and developed our list of the Top 100 metropolitan areas with the highest STI rates. In this year's report, the metro area with the highest overall STI rate was Detroit, MI, overtaking Philadelphia, PA, which moved to 2nd. Memphis, TN, which had formerly been ranked 2nd, improved to 4th this year, while the metro area that came in 3rd last year — Jackson, MS — improved to 12th in 2025. At the same time, Montgomery, AL (formerly ranked 7th) worsened to 3rd.

In addition to ranking the 100 metro areas with the highest STI rates, below we'll provide some takeaways from our report; spotlight urban communities whose STI rates have significantly improved or declined; highlight racial disparities that emerge from the CDC data; and, for the first time in years, share analysis of some encouraging developments.

Quick takeaways​

• The South continues to struggle with high infection rates in its metro areas, though there is evidence of positive change.
• Topping our annual study for the first time is Detroit, MI.
• For the second straight year, Provo, UT, comes in 100th, with 99 metro areas having worse STI rates.
• Could the tide be starting to turn in our STI epidemic? Infection rates are near their record-high levels over the past 20 years, but unlike recent years, this year shows a slight decline of nearly 2% in the overall infection rate.
• Despite hopeful signs of improvement in overall national figures, STI rates continue to reveal disturbing disparities that deserve reflection and action, and there is significant room for improvement in all respects as our nation continues to confront the epidemic.

Notable movement or stability in rankings​

Detroit, MI, was ranked 9th worst for STI rates last year, but in this year's study, it has unfortunately earned the distinction of the metro area with the highest infection rates. In our years of conducting these studies, Detroit has never before ranked number one. This also comes during a year in which our nationwide list of the hardest-hit metro areas included almost 30% more places located in Detroit's Census-designated region (East North Central U.S., which includes the states of Michigan, Wisconsin, Illinois, Ohio, and Indiana). Motor City has confronted daunting, highly publicized challenges over the past decade and has exhibited great resilience and spirit; we hope that next year's study shows a Detroit that has rebounded and risen back upward in our rankings.

Other cities joining Detroit in our top 25 are also located in the Great Lakes region. For instance, in neighborhing Ohio, Cleveland finds itself ranked 13th, which reflects a slight worsening of relative infection rates from last year when it ranked 15th. But elsewhere in the Midwest, Minneapolis, MN, which ranked 17th last year, improved its ranking to 21st in our study this year. And Milwaukee, WI, escaped the top 25 altogether to rank 29th among U.S. metro areas.

The South, as defined by the U.S. Census Bureau, remains relatively fraught with high STI rates in its metro areas this year (more on that below).

Meanwhile, out west, our study shows evidence of improvement in metropolitan STI rates. San Francisco, CA, and Portland, OR, remain in the top 25 for the second year in a row, though their ranks have improved by a couple positions. But more broadly, fewer cities in the West are found within the top 50 worst cities for infection rates, and the total number of top 100 cities that are located in the West dropped from 31 to 25.

It's also worthwhile to call out a city for remaining remarkably stable in our study, year after year. For the second straight year, Provo, UT, has ranked 100th. And prior to that, it ranked 99th.

The South fights high infection rates​

The U.S. South — a region that is home to roughly 39% of the population — accounts for over 60% of the top 25 metropolitan areas with the highest STI rates in this year's study. But, believe it or not, that's actually a slight improvement over last year's study.

The number of Floridian cities in the top 100 has slightly increased, though Miami has improved relative to other cities, ranking 19th now instead of its previous 16th.

Gulf states, in particular, are heavily represented in our top 25 metro areas, accounting for over a third of them. Louisiana alone is home to three of the 25 cities with the highest STI rates, though Montgomery, AL, has jumped several positions and leapfrogged New Orleans, LA, to become the city with the 3rd highest rates. A look into the state-level data from the CDC reveals similar trends seen in the data for major metropolitan areas: seven of the top 10 states with the highest gonorrhea infection rates are located in the South, and the South contributes eight of the top 10 states with the highest rates of chlamydia infection.

However, some metro areas are bucking regional trends. Jackson, MS, which ranked 3rd worst in last year's study, improved its rank to 12th this year -- a dramatic turnaround for a city that has been plagued by high infection rates for several years in our annual studies. And Little Rock, AR, which had the 11th highest STI rates last year, improved its ranking significantly to 27th.

Is the tide turning in this epidemic?​

According to the latest data from the CDC, overall STI rates in the United States actually dropped by 1.8% in 2023 compared to 2022. The national infection rates had trended upward for the better part of two decades leading up to the COVID-19 pandemic. This year's updated data from the CDC gives reason for hope that concerted effort and investment may be helping turn the page at last.

• Nationally, the gonorrhea infection rate dropped by 7% compared to the previous year.
• The rate of chlamydia infection remained effectively unchanged, which still signifies a 9% drop since 2019.
• A 1% increase in overall syphilis infections represents a much slower rate of increase than the staggering 29% increase seen in the previous year-over-year analysis.

Despite the improvement, however, we continue to face an epidemic that requires renewed commitment to maintain improvement and achieve greater momentum (which is what compels us to create our annual study). While a drop of nearly 2% in the national STI rate is something to celebrate, this rate remains 90% higher than it was in 2004. What seems like a scant 1% increase overall in the syphilis infection rate still translates to the highest levels of syphilis infection in our country since 1950.

And hiding beneath that 1% statistic are alarmingly high rates of congenital syphilis. Congenital syphilis cases nationally rose only by about a tenth of the amount they had risen in prior years, yet cases among newborns did rise by 3% since 2022 and by 106% since 2019. Despite the slowing of this surge, these stratospheric rates caused 279 stillbirths and infant deaths over the past year.

And within the overall population, certain groups continue to face disproportionate challenges when it comes to curbing STI rates.

Social and racial disparities​

Across racial groups, young people and men who have sex with men (MSM) contend with higher STI rates. A staggering 48% of the total cases of chlamydia, gonorrhea, and primary and secondary syphilis occurred among young people ages 15-24.

But social and racial disparities persist; the STI burden within our cities continues to hit minority racial and ethnic groups the hardest. When comparing infection rates of White people to those of some minority racial and ethnic groups, the CDC data shows dramatic disparities.

• Non-Hispanic Black people make up 12.6% of the U.S. population but suffer 32.4% of the cases of chlamydia, gonorrhea, and primary and secondary syphilis.
• The rate of chlamydia infection in the Native Hawaiian / Pacific Islander racial group, according to the latest Census data, is over three times higher than that among White people.
• The rate of gonorrhea infections among Black / African American males is over eight times the rate among White males.
• The rate of congenital syphilis infections within the Hispanic/Latino population is more than double that of White people, and the infection rate among non-Hispanic Black people is higher still — nearly four times higher than the rate among White people.
• American Indian / Alaska Native populations face congenital syphilis rates nearly twelve times higher than those of the White population in our country.

Health leaders stress that differences in sexual behavior aren't the explanation for these differences in rates of infection. What can spell the difference between life and death, or illness and health, are timely testing and treatment — but it has to be both. Nearly 90% of newborn syphilis cases are preventable through testing and treatment during pregnancy.

Barriers to timely testing and treatment include lack of health insurance; poverty and housing issues; substance use disorder; and lack of sufficient public health infrastructure. All of these factors continue to affect minority racial and ethnic groups disproportionately.

The Rankings: Top 25 U.S. cities with the highest STI rates​

1
1. Detroit, MI
STI Cases / 100K Population1,491
HIV Cases386
Chlamydia Cases20,830
Gonorrhea Cases7,983
Syphilis Cases628

2
2. Philadelphia, PA
STI Cases / 100K Population1,459
HIV Cases652
Chlamydia Cases32,157
Gonorrhea Cases12,321
Syphilis Cases1,005

3
3. Montgomery, AL
STI Cases / 100K Population1,446
HIV Cases97
Chlamydia Cases3,363
Gonorrhea Cases1,771
Syphilis Cases204

4
4. Memphis, TN
STI Cases / 100K Population1,430
HIV Cases354
Chlamydia Cases10,525
Gonorrhea Cases4,728
Syphilis Cases356

5
5. Baltimore, MD
STI Cases / 100K Population1,370
HIV Cases302
Chlamydia Cases16,192
Gonorrhea Cases6,747
Syphilis Cases525

6
6. New Orleans, LA
STI Cases / 100K Population1,357
HIV Cases230
Chlamydia Cases9,572
Gonorrhea Cases3,966
Syphilis Cases315

7
7. Washington, DC
STI Cases / 100K Population1,334
HIV Cases593
Chlamydia Cases22,738
Gonorrhea Cases6,450
Syphilis Cases489

8
8. St. Louis, MO
STI Cases / 100K Population1,314
HIV Cases280
Chlamydia Cases16,482
Gonorrhea Cases7,857
Syphilis Cases550

9
9. Baton Rouge, LA
STI Cases / 100K Population1,296
HIV Cases175
Chlamydia Cases6,651
Gonorrhea Cases2,750
Syphilis Cases255

10
10. San Francisco, CA
STI Cases / 100K Population1,296
HIV Cases291
Chlamydia Cases9,669
Gonorrhea Cases6,307
Syphilis Cases449

11
11. Mobile, AL
STI Cases / 100K Population1,277
HIV Cases103
Chlamydia Cases3,949
Gonorrhea Cases1,700
Syphilis Cases188

12
12. Jackson, MS
STI Cases / 100K Population1,273
HIV Cases80
Chlamydia Cases3,512
Gonorrhea Cases1,885
Syphilis Cases64

13
13. Cleveland, OH
STI Cases / 100K Population1,266
HIV Cases165
Chlamydia Cases11,524
Gonorrhea Cases5,117
Syphilis Cases403

14
14. Columbia, SC
STI Cases / 100K Population1,260
HIV Cases116
Chlamydia Cases6,212
Gonorrhea Cases2,756
Syphilis Cases171

15
15. Portland, OR
STI Cases / 100K Population1,247
HIV Cases166
Chlamydia Cases9,997
Gonorrhea Cases4,126
Syphilis Cases664

16
16. Seattle, WA
STI Cases / 100K Population1,227
HIV Cases297
Chlamydia Cases9,563
Gonorrhea Cases5,344
Syphilis Cases783

17
17. Richmond, VA
STI Cases / 100K Population1,205
HIV Cases160
Chlamydia Cases7,699
Gonorrhea Cases2,770
Syphilis Cases215

18
18. Shreveport, LA
STI Cases / 100K Population1,195
HIV Cases99
Chlamydia Cases3,109
Gonorrhea Cases1,357
Syphilis Cases112

19
19. Miami, FL
STI Cases / 100K Population1,192
HIV Cases1,095
Chlamydia Cases14,240
Gonorrhea Cases6,402
Syphilis Cases746

20
20. New York, NY
STI Cases / 100K Population1,189
HIV Cases1,675
Chlamydia Cases68,766
Gonorrhea Cases30,413
Syphilis Cases2,436

 

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21
21. Minneapolis, MN
STI Cases / 100K Population1,187
HIV Cases205
Chlamydia Cases15,549
Gonorrhea Cases6,471
Syphilis Cases519

22
22. San Antonio, TX
STI Cases / 100K Population1,182
HIV Cases396
Chlamydia Cases14,191
Gonorrhea Cases6,622
Syphilis Cases578

23
23. Savannah, GA
STI Cases / 100K Population1,174
HIV Cases69
Chlamydia Cases3,322
Gonorrhea Cases1,511
Syphilis Cases87

24
24. Lexington, KY
STI Cases / 100K Population1,169
HIV Cases109
Chlamydia Cases2,919
Gonorrhea Cases1,622
Syphilis Cases223

25
25. Tampa, FL
STI Cases / 100K Population1,168
HIV Cases501
Chlamydia Cases14,969
Gonorrhea Cases6,349
Syphilis Cases876

Proposed actions to improve the national outlook​

We're often asked how metropolitan areas can take action to improve STI rates. While it’s true that we are witnessing signs of hope that better days are in front of us, we find ourselves in the midst of an epidemic. Very recent drops in infection rates haven't happened in a vacuum; they're the result of meaningful innovations in testing and treatment and massive investment in infrastructure, which collectively have formed the STI National Strategic Plan and shed light on paths for further improvements.

Continue to research and develop new methods of treatment and prevention.
Doxy PEP — a prophylactic approach using antibiotics to prevent bacterial STI after exposure — is an example of a recent innovation that has proven effective. With investment, our country can improve access among groups known to benefit from it, and further research may identify additional groups who would benefit.
Fully utilize modern, at-home STI testing capabilities.
In announcing the CDC's latest STI Surveillance Report, Dr. Bradley Stoner, MD — director of the Division of STI Prevention — identified at-home self-tests as one of the four major factors that have helped our nation begin to turn the tide.
Improve local access to STI services.
We need to further expand STI testing and treatment capabilities into more local settings in order to build momentum and further reduce infection rates.
Invest heavily in workforces to combat the epidemic.
2021's American Rescue Plan Act (ARPA) might have been aimed at COVID-19, but it funded a massive increase in disease intervention specialists (DIS). It's no coincidence that the recent reduction in STI rates comes on the heels of a multi-year investment of $200 million per year in deploying these specialists across the nation to address the needs of specific communities (often those historically underserved). This DIS program has translated to more robust testing and screening from Georgia to California. It has also enabled unprecedented partnerships with tribal communities and new levels of outreach to historically at-risk groups like MSM. Ultimately, these investments amount to putting our money where our mouth is, demonstrating that we prioritize this epidemic by investing in fighting infection. To avoid losing ground as a nation, we can renew our commitment and prevent those temporary investments from expiring.
Complacency and failure to acknowledge the actions and investments that led us here could send us spiraling back into worsening infection rates. But it’s also up to us all, as individuals, to do what we can to maintain progress.

What can we do as citizens?​

As individuals, we can help stem the tide of STIs by educating ourselves and doing our very best to test for common infections routinely and seek treatment when tests indicate an infection.

The CDC stresses, "If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure you have an open and honest conversation about your sexual history and STD testing with your doctor."

Ultimately, all of us must decide whether reports next year and the year after bring additional reductions in STI rates through a combination of renewed budget priorities, public education enhancements and community cooperation, or instead show that we have slipped backward in our fight against STIs.

How we collected data for this report​

All of the STI data found in our report — including case statistics for HIV, syphilis, gonorrhea, and chlamydia — are from the CDC's latest data release. Syphilis data includes only primary and secondary syphilis cases and does not include congenital and early latent syphilis cases. HIV cases are not reported in some cities. Statistics for other relatively common STIs, such as herpes, are not collected by the CDC at this time and hence are left out of our analysis. For more information about which statistics the CDC does and does not track, see its STI Data & Statistics page.

All estimated metro area and state population data is from the CDC and the U.S. Census Bureau.

Though Washington, DC, is technically a district, we chose to include it as a city. No statistical testing was used during the production of this research.