Honestly, walking into a doctor's office for "the talk" is never fun. It’s awkward, it’s clinical, and it’s usually the last thing anyone wants to spend their Tuesday afternoon doing. But here’s the thing—the numbers are getting weird. While the headlines for 2026 are starting to show some "glimmers of hope," as the CDC's Dr. Jonathan Mermin puts it, the map of the United States still looks like a patchwork quilt of infection hotspots.
If you look at the provisional data released late last year and moving into this winter, we’re seeing a bizarre split. Adult cases of the "big three"—chlamydia, gonorrhea, and syphilis—actually dropped by about 9% nationwide in 2024. That’s the third year in a row things have trended down. Great, right?
Well, not everywhere.
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The highest STD rates in US history were being set just a few years ago, and while the national average is cooling off, specific cities and states are still stuck in a massive surge. Plus, there is the "black mark on public health," as experts call it: congenital syphilis. Even as adult rates dip, the number of babies born with syphilis has climbed for 12 straight years, hitting nearly 4,000 cases annually. It's a total tragedy because it's 100% preventable.
The Cities Leading the List
When we talk about where the risk is highest, the South usually dominates the conversation. It’s not just a stereotype; the data from the National Notifiable Diseases Surveillance System (NNDSS) consistently puts cities in Tennessee, Mississippi, and South Carolina at the top of the pile.
Take Memphis, for example. For a while now, Memphis has held a staggering rate of over 1,460 cases per 100,000 people. To put that in perspective, that’s more than double the rate of many West Coast cities. Jackson, Mississippi, and Columbia, South Carolina, aren’t far behind.
Why these places? It isn't because people there are "wilder." It’s basically a math problem involving poverty, lack of clinics, and the shuttering of rural health centers. When you have to drive two hours to find a clinic that won’t judge you—or one that’s even open—you just don’t go. And when you don’t go, you don’t get treated. Then you pass it on. It’s a cycle that’s incredibly hard to break.
In the Northeast, Baltimore and Philadelphia remain high-risk zones. Baltimore often sees rates hovering around 1,327 per 100,000. Interestingly, while New York City has massive volume (just because there are millions of people), its rate is often lower than smaller cities in the South because the public health infrastructure there is actually pretty robust.
The Syphilis Comeback Nobody Wanted
Syphilis is the one that really keeps epidemiologists up at night. In the late 90s, we almost eliminated it. Like, it was nearly gone. Now? It’s back with a vengeance.
There’s this "syndemic" happening—basically a fancy word for when two epidemics crash into each other. In this case, it’s STDs and the drug crisis. Researchers at Johns Hopkins have pointed out that the rise in syphilis, especially among women, is heavily linked to methamphetamine and opioid use. When people are struggling with addiction, sexual safety usually isn't the first thing on their minds.
Mississippi currently holds one of the highest rates of congenital syphilis in the nation. It’s heartbreaking. We’re talking about a 700% increase over the last decade. South Dakota and New Mexico are also seeing massive spikes, often concentrated in Tribal communities where healthcare access has been systemically gutted for years.
Why Are Rates Finally Dropping (In Some Places)?
If you’re wondering why the national numbers are actually improving for the first time in twenty years, it’s likely thanks to two big things: DoxyPEP and PrEP.
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- DoxyPEP: This is basically the "morning-after pill" for bacterial STDs. You take a dose of doxycycline (an antibiotic) within 72 hours after unprotected sex. Studies show it can slash the risk of syphilis and chlamydia by about 70%. In cities like San Francisco and Seattle, where DoxyPEP was rolled out early, gonorrhea and syphilis rates among men who have sex with men (MSM) started tanking almost immediately.
- PrEP for HIV: Since people on HIV prevention meds have to get tested every three months to keep their prescription, they’re catching other infections way earlier. Early detection = less spread.
But here’s the catch. DoxyPEP isn't being handed out to everyone. If you’re a college student in a rural town or a single mom in a city with no sexual health clinic, you probably haven't even heard of it. This creates a "health gap" where the wealthy or well-connected get the newest prevention tools, and everyone else keeps getting sick.
The Reality of Testing
You’ve probably heard people say, "I don't have symptoms, so I'm fine."
That is the biggest lie in sexual health. Most chlamydia and gonorrhea cases are totally silent. You could have chlamydia for months, feel nothing, and meanwhile, it’s causing permanent scarring in your reproductive system.
The CDC's 2026 goal is to move away from "risk-based" testing and toward "routine" testing. Basically, they want doctors to stop asking, "Are you a 'high-risk' person?" and start saying, "We test everyone for this once a year, let's get it done."
State-by-State Breakdown of the Highest STD Rates
It's helpful to look at the "combined rate" (Chlamydia + Gonorrhea + Syphilis). These states consistently report the highest numbers per 100,000 residents:
- Mississippi: Often #1. High poverty and limited Medicaid expansion make it a tough environment for prevention.
- Louisiana: Consistently in the top three. Similar issues with rural healthcare access.
- Alaska: This one surprises people. But Alaska has high rates partly because they have a very young population and many isolated communities where "bringing in" a single infection can lead to an outbreak very quickly.
- South Dakota: Driven largely by outbreaks in specific rural and Tribal areas.
- South Carolina: High rates of both chlamydia and gonorrhea, particularly among 15-24 year-olds.
What You Can Actually Do
The "highest STD rates in US" doesn't have to be a permanent headline. If you're living in one of these areas, or if you're just active, the "wait and see" method is a disaster.
First, ask for a full panel. A lot of "standard" blood tests don't actually include STDs unless you specifically ask. And specifically ask for a syphilis test; it's often left off unless you have a visible sore (which many people don't).
Second, if you’re in a high-risk group or have multiple partners, ask your doctor about DoxyPEP. It’s becoming the new standard of care, and it’s a literal game-changer for preventing infections before they take hold.
Lastly, stop the stigma. Half the reason people don't get tested is they're embarrassed. But honestly? It's just bacteria. It's not a moral failing; it's a medical reality. The more we talk about it like it's a regular part of healthcare—like getting your blood pressure checked—the lower those rates will go.
Actionable Next Steps:
- Check your last results: Log into your patient portal. Did they actually test for Syphilis and HIV, or just Chlamydia?
- Find a "No-Cost" Clinic: Use the CDC’s GetTested search tool to find clinics that offer sliding-scale or free testing in your zip code.
- Discuss DoxyPEP: If you're frequently worried about exposure, bring up "Doxycycline Post-Exposure Prophylaxis" at your next check-up.
- At-Home Testing: If the clinic is too far or too awkward, look into validated at-home kits like those from Everlywell or Nurx, which are increasingly covered by insurance.