People living below the Mason-Dixon line have the highest risk of contracting a sexually transmitted disease
State statistics from the Centers for Disease Control and Prevention (CDC) show the top two states where residents face the highest rate of STDs are Mississippi and Louisiana.
In the state, there is one sexually transmitted disease for about every 79 people, the highest incidence in the country. Mississippi is also one of five states on the CDC’s list where STD rates exceed 1,000 cases per 100,000 persons.
In 2021, the most recent data available, 1,266 people per 100,000 had an STD.
Falling behind it is Louisiana, with a rate of 1,160 STD cases per 100,000 people.
The ranking made a regional shift in spot three, with Alaska reporting 1,091 cases.
But returned to the south for the fourth slot, with South Carolina recording 1,052 STD cases per 100,000 people.
Of the top 10 states, seven are in the southeast.
In 2021, Mississippi topped the list with a total of 1,266 STDs per 100,000 persons. Gonorrhea rates were the highest in the country with 427.7 infections per 100,000
Alaska, a largely rural state where healthcare access might be limited, had the highest rate of Chlamydia. It has a relatively young population which is, in general, more likely to have STDs
The Covid pandemic left millions of people isolated and unable to seek preventative screenings for STDs. Infections dipped early in the pandemic but rebounded by the summer
The data reinforces what public health experts have been stressing in recent years: America is in the midst of an epidemic of sexually transmitted diseases.
Federal disease surveillance data shows every state in the US between 2017 and 2021 has seen a spike in cases of syphilis, a disease that can lead to organ damage, and gonorrhea, which can cause infertility.
A total of 2.5 million STDs were reported in the US in 2021, the most recent year for which data is available.
The STD epidemic has led to a combined rate of 763 cases per 100,000 people in the 50 states and the District of Columbia, an increase of six percent over 2020’s rate of about 722.
STD surveillance was disrupted in the early days of the Covid-19 pandemic when shelter-in-place orders were imposed on much of the US population. But rates of new diseases did not decrease overall in 2020.
The impact of disease monitoring was most acute in March and April 2020, the only time that year rates fell.
While case counts for gonorrhea and syphilis dropped below 2019 levels during that two month period, cases of both STDs surged the rest of the year.
Tracking by the CDC showed cases of gonorrhea increased 15 percent and reported cases of both early- and more advanced-stage syphilis increased 38 percent from 2019 to 2021.
In 2021, Mississippi also topped the list for highest gonorrhea rates in the country, with 427.7 infections per 100,000 people.
Cases of chlamydia, a bacterial infection, were also high at 750 per 100,000. And the cumulative number of syphilis rates that year hit 88.3 per 100,000.
Chlamydia is the most common STD in the US, followed by gonorrhea.
After Mississippi, the state with the second-highest STD rate was Louisiana. The chlamydia rate in that state was 730.1 per 100,000, while the gonorrhea rate stood at 354.5 per 100,000 residents.
Alaska had the third most STD rates overall, but according to the state’s Department of Health and Social Services, rates of gonorrhea and syphilis have been climbing there for years.
And in 2021, state health officials counted 447 cases of syphilis, a 24 percent increase over the 2020 total.
The likely contributors include a relatively young population – which makes up over 50 percent of all STD cases in the US. Much of Alaska is also remote, which limits the availability of healthcare, and the public health infrastructure is severely lacking.
After Alaska came South Carolina, which recorded 1,052 STDs per capita in 2021. It recorded the fourth-highest rates of chlamydia with 703 cases per capita.
The state had the lowest rates of syphilis on the list with 40.1 cases per capita.
In South Dakota, which rounded out the top five states, there is limited access to healthcare in rural and Tribal lands. There, syphilis has exploded by more than 1,800 percent from 41 cases in 2016 to 785 in 2021.
The rest of the top 10 states on the list, with the exception of New Mexico in ninth place, were located in the Southeast and included Alabama, Georgia, Arkansas and North Carolina.
Alabama in sixth place saw 989.6 total STDs per 100,000 persons, followed by Georgia with 987.5 per 100,000 and Arkansas with 942.4 per 100,000.
Alabama, however, had the nation’s highest rate of syphilis infections of all the states on the list at 321.3 infections for ever 100,000 people.
Georgia, meanwhile, reported 62.1 cases of syphilis per capita, while Arkansas had a rate of 79.4 per 100,000.
There are two types of syphilis infections: preventable syphilis infection is one that an adult contracts during sexual contact and a congenital infection is when a mother passes on the disease to her baby during pregnancy.
It raises an infant’s risk of bone damage, anemia, jaundice, nerve damage, and meningitis. It can be treated with antibiotics but it kills about 40 percent of babies born with it.
One possible explanation for the rise in syphilis cases is the fact many people with the disease are asymptomatic, or have no symptoms. Their lack of symptoms leads them to unknowingly pass on the disease.
About half of syphilis and chlamydia patients are asymptomatic, estimates suggest, while up to 90 percent of people with gonorrhea have no symptoms.
Rounding out the ranking in 10th place was North Carolina, with 922.2 STDs per 100,000 people. The rate of chlamydia infections was 603.3 per capita and gonorrhea rates were 271.2 cases per capita.
North Carolina had the second-lowest rate of syphilis at 47.7 infections per 100,000.
Overall, infection rates of syphilis have surged 70 percent across the US since 2017
For gonorrhea, rates are up by 25 percent
Chlamydia infections have dropped by five percent since 2017
A majority of STDs in the US occur in young people aged 15 to 24. This may be due to apprehension when it comes to discussing their sex lives with parents or doctors and the lack of informative sex education in the US.
Only 38 states and DC mandate sex education in schools, leaving roughly 11 million US public school students without it.
Twenty-nine states require sex ed programs to prioritize abstinence-before-marriage education as a means of avoiding STDs and unplanned pregnancies. This course teaches children, often in a religious context, to wait to have sex until they have entered a committed monogamous relationship.
However, teens who have made abstinence pledges have an increased risk of being exposed to human papilloma virus, and are also less likely to use safe sex methods such as condoms when they do decide to be sexually active, according to a 2016 report published in the Journal of Marriage and Family.
The authors of that report said: ‘Abstinence pledgers are more likely to receive cultural messages downplaying the effectiveness of condoms and contraceptives as well as to be exposed to the framing of premarital sexual activity as a form of failure.’