Health Insurance
STD Rates Spike By As Much As 505% Nationally Since 2000; North Dakota and Utah See the Biggest Jumps
Since 2000, the number of sexually transmitted diseases (STDs) in the U.S. has skyrocketed. The Centers for Disease Control and Prevention (CDC) points to reductions in treatment, screenings and prevention before the coronavirus pandemic. And it says STD program staff shortages have exacerbated the problem.
The latest ValuePenguin study analyzes data across five tracked STDs to show trends and patterns. The most common of the STDs we tracked, chlamydia, showed a dip during the first year of the pandemic. But preliminary 2021 data shows cases rising the following year.
Depending on your health insurance, STD preventive services might be covered. And even those without insurance coverage have numerous options available for help with STD prevention, testing and treatment.
On this page
- Key findings
- STD rates spike by as much as 505% nationally since 2000
- Chlamydia only tracked STD to see dip in rates amid start of pandemic
- North Dakota, Utah see biggest jumps in STD rates since 2000
- Delaware, D.C. see smallest jumps in STD rates since 2000
- Full rankings
- STD preventive services and health insurance: What’s covered
- Methodology
Key findings
- Population-adjusted cases of primary and secondary syphilis rose 505% between 2000 and 2020 — the biggest increase among the five sexually transmitted diseases (STDs) tracked. In that period, primary and secondary syphilis cases decreased only once year over year, in 2010. Gonorrhea saw the smallest increase in that period, though it was still 61%. Between 2000 and 2020, gonorrhea cases dropped eight times year over year.
- Chlamydia — the most common of the STDs we tracked — saw a 13% dip from 2019 to 2020 amid the beginning of the coronavirus pandemic. It was the only of the five STDs that saw rates decrease in this period. However, preliminary 2021 data shows the number of chlamydia cases is again on the rise.
- Combining the population-adjusted cases across the five STDs tracked, North Dakota and Utah saw the biggest increases since 2000. The number of STD cases per 100,000 residents increased by 369% in North Dakota and 291% in Utah. These two are among the 31 states that saw jumps of 100% or more.
- Delaware and the District of Columbia saw the smallest increases since 2000 when combining the five STDs tracked. Even at the bottom of the list, population-adjusted STD cases increased by 18% in Delaware and 39% in D.C. The District of Columbia saw the second-biggest dip between 2019 and 2020 (23%).
The STDs we tracked
According to the National Institutes of Health (NIH), sexually transmitted diseases are infections people can spread to one another through sexual contact. While sexual contact is the primary way STDs spread, the NIH says some STDs (such as HPV and herpes) can spread through skin-to-skin contact.
There are more than 20 types of sexually transmitted diseases, but ValuePenguin tracked the five STDs below based on consistent CDC data. Below is a brief definition of each.
- Chlamydia: Chlamydia is a common STD caused by bacteria called Chlamydia trachomatis that affects men and women. In women, chlamydia can result in (sometimes fatal) ectopic pregnancies and could cause permanent reproductive system damage. Chlamydia can spread through having sex (vaginal, anal or oral) with someone who has chlamydia. The STD can also pass from mother to baby during childbirth.
- Congenital syphilis: Congenital syphilis occurs when a mother with untreated (or not fully treated) syphilis passes the infection to her baby either during pregnancy or childbirth. The infection is caused by bacteria called Treponema pallidum. According to the NIH, up to half of infants infected with syphilis during pregnancy die shortly before or after birth.
- Primary and secondary syphilis: Primary and secondary syphilis are stages of the infection with Treponema pallidum when symptoms of syphilis become more noticeable. During the primary stage of syphilis, an infected person may notice (often painless) sores where the syphilis exposure occurred and should seek treatment immediately. If treatment doesn’t occur, the infection may progress to the more dangerous secondary syphilis with symptoms of sores and rashes throughout the body. Without treatment, syphilis may spread to the brain and nervous system, potentially causing muscle weakness, changes to your mental state and even dementia.
- Early non-primary, non-secondary syphilis: Early non-primary, non-secondary syphilis is an early stage of the syphilis infection. Formerly known as early latent syphilis, this stage of the STD means a person was infected with Treponema pallidum in the past 12 months and there aren’t any symptoms or signs of a primary or secondary infection when the syphilis diagnosis occurs.
- Gonorrhea: Gonorrhea is an STD common among young people. In men, the bacteria that cause gonorrhea can lead to issues with the testicles and prostate. Infected women may experience bleeding between periods, painful urination and pelvic inflammatory disease — an infection of the uterus that can lead to infertility. Gonorrhea is spread through having sex (vaginal, anal or oral) with someone infected. The STD can also pass from mother to baby during childbirth.
STD rates spike by as much as 505% nationally since 2000
The rate of primary and secondary syphilis cases in the U.S. per 100,000 residents increased by 505% over the two decades between 2000 and 2020.
In addition to the surge in primary and secondary syphilis rates, the four other STDs tracked also experienced concerning growth. Of the five tracked STDs, all had rate increases of at least 61% between 2000 and 2020.
There were a few anomalies throughout that period:
- Primary and secondary syphilis (with a 505% increase) saw one year-over-year decrease in the rate of new infections, from 2009 to 2010.
- Congenital syphilis rates rose 301%, despite nine separate year-over-year decreases throughout the two-decade period.
- Early non-primary, non-secondary syphilis increased by 285% but underwent four year-over-year decreases in 2001, 2002, 2004 and 2011.
- Chlamydia rates increased by 92%, but there was one year-over-year decrease in new infections between 2012 and 2013.
- Despite a 61% increase, year-over-year gonorrhea rates decreased eight times between 2000 and 2020.
Here’s a more detailed look at how STD rates have changed since 2000.
How STD rates have changed since 2000
Primary and secondary syphilis | Congenital syphilis | Early non-primary, non-secondary syphilis | Chlamydia | Gonorrhea | |
|---|---|---|---|---|---|
| Cases (2000) | 5,973 | 580 | 9,465 | 708,698 | 362,920 |
| Cases (2020) | 41,655 | 2,148 | 43,145 | 1,579,885 | 677,769 |
| Rate per 100,000 residents (2000) | 2.1 | 14.3 | 3.4 | 251.2 | 128.6 |
| Rate per 100,000 residents (2020) | 12.7 | 57.3 | 13.1 | 481.3 | 206.5 |
| % change in rate between 2000 and 2020 | 505% | 301% | 285% | 92% | 61% |
Source: ValuePenguin analysis of U.S. Centers for Disease Control and Prevention (CDC) data.
Numerous factors have contributed to the rapid rise in STD rates throughout the U.S., including a pre-pandemic reduction in STD prevention education and efforts. For example, a 2018 study by the Guttmacher Institute, a research and policy organization, shows a decrease in condom use among high school students between 2013 and 2017.
The Cleveland Clinic noted that antibiotic-resistant gonorrhea could play a role in certain rising STD rates. The situation, according to the CDC, is creating an "urgent public health threat."
For syphilis cases, the Cleveland Clinic points out that the STD is treatable and can be cured with penicillin. And other medications are available to those with penicillin allergies. However, practicing safe sex — the clinic says — is the best way to protect yourself.
An April 2021 statement from Raul Romaguera, the acting director for the CDC’s Division of STD Prevention, said: "Less than 20 years ago, gonorrhea rates in the U.S. were at historic lows, syphilis was close to elimination and advances in chlamydia diagnostics made it easier to detect infections. That progress has since unraveled, and our STD defenses are down. We must prioritize and focus our efforts to regain this lost ground and control the spread of STDs."
Chlamydia only tracked STD to see dip in rates amid start of pandemic
At the start of the coronavirus pandemic between 2019 and 2020, chlamydia rates in the U.S. decreased by 13% — the only of the five tracked that saw a dip in this period. The CDC says reported STD cases decreased early in 2020 but saw a resurgence by the end of the year.
Below is a look at how the five STD rates tracked changed from 2019 to 2020.
How STD rates changed from 2019 to 2020
Chlamydia | Early non-primary, non-secondary syphilis | Primary and secondary syphilis | Gonorrhea | Congenital syphilis | |
|---|---|---|---|---|---|
| Cases (2019) | 1,808,703 | 41,655 | 38,992 | 616,392 | 1,875 |
| Cases (2020) | 1,579,885 | 43,145 | 41,655 | 677,769 | 2,148 |
| Rate per 100,000 residents (2019) | 551.0 | 12.7 | 11.9 | 187.8 | 50.0 |
| Rate per 100,000 residents (2020) | 481.3 | 13.1 | 12.7 | 206.5 | 57.3 |
| % change in rate between 2019 and 2020 | -13% | 3% | 7% | 10% | 15% |
Source: ValuePenguin analysis of CDC data.
The CDC notes that chlamydia historically makes up the country’s largest proportion of reported STDs. The agency suspects the 2019-to-2020 decline in reported chlamydia cases may have been due to a reduction in STD screenings that led to fewer diagnoses rather than a legitimate decline in new chlamydia cases. These same issues may have led to the drop in reported STD cases between 2019 (2.5 million) and 2020 (2.4 million).
Examining 2021 preliminary data, STD rates for the five tracked STDs appear to be following the same upward trend. Keeping in mind that the changes aren’t final, here are the year-over-year rate increases in the five tracked STDs between 2020 and 2021:
- Primary and secondary syphilis: 25%
- Congenital syphilis: 24%
- Early non-primary, non-secondary syphilis: 17%
- Chlamydia: 3%
- Gonorrhea: 3%
North Dakota, Utah see biggest jumps in STD rates since 2000
The rate of sexually transmitted diseases rose nationwide over the past two decades. Yet certain parts of the country experienced higher rate increases than others.
North Dakota and Utah, in particular, saw the biggest increases in STD rates since 2000. The number of STD cases per 100,000 residents rose by 369% in North Dakota and 291% in Utah. Overall, 31 states saw STD increases of 100% or more. (Note: State figures combine population-adjusted cases across all five tracked STDs, while national figures look at tracked STDs individually.)
States where STD rates jumped the most since 2000
Rank | State | Rate per 100,000 residents (2000) | Rate per 100,000 residents (2019) | Rate per 100,000 residents (2020) | % change, 2000-2020 | % change, 2019-2020 |
|---|---|---|---|---|---|---|
| 1 | North Dakota | 153.3 | 706.2 | 719.7 | 369% | 2% |
| 2 | Utah | 110.5 | 452.0 | 432.3 | 291% | -4% |
| 3 | Montana | 169.2 | 611.5 | 569.9 | 237% | -7% |
| 4 | Nevada | 276.6 | 950.4 | 857.3 | 210% | -10% |
| 5 | West Virginia | 154.7 | 453.9 | 459.7 | 197% | 1% |
Source: ValuePenguin analysis of CDC data.
It’s difficult to pinpoint the causes that led to the spikes in North Dakota’s and Utah’s STD rates between 2000 and 2020.
The North Dakota Department of Health and Human Services points to large outbreaks of syphilis in nearby states as a particular struggle its residents are facing. To combat rising STD numbers, the department recommends health care providers obtain a sexual risk history for all patients, test all high-risk patients for STDs, test and treat any presumptively positive patients for primary or secondary syphilis, and treat anyone exposed to the infection. The state also recommends pregnant women be tested for syphilis at their first prenatal visit.
Meanwhile, changes in sexual and testing behaviors are possible culprits, according to the Utah Department of Health.
Delaware, D.C. see smallest jumps in STD rates since 2000
Delaware and the District of Columbia saw the smallest increases in STD rates since 2000, though they still saw jumps in the period.
States where STD rates jumped the least since 2000
Rank | State | Rate per 100,000 residents (2000) | Rate per 100,000 residents (2019) | Rate per 100,000 residents (2020) | % change, 2000-2020 | % change, 2019-2020 |
|---|---|---|---|---|---|---|
| 1 | Delaware | 586.2 | 803.6 | 689.0 | 18% | -14% |
| 2 | District of Columbia | 1,134.1 | 2,055.8 | 1,578.6 | 39% | -23% |
| 3 | Alabama | 635.5 | 981.7 | 902.8 | 42% | -8% |
| 4 | Georgia | 630.7 | 915.1 | 908.0 | 44% | -1% |
| 5 | Wisconsin | 443.0 | 660.9 | 653.7 | 48% | -1% |
| 5 | Illinois | 557.3 | 914.5 | 827.3 | 48% | -10% |
Source: ValuePenguin analysis of CDC data.
In Delaware, the Division of Public Health provides residents with testing, counseling and treatment services for various STDs, including gonorrhea, chlamydia, syphilis and other sexually transmitted infections (STIs). There are also clinics available for walk-in or call-ahead STD appointments in five cities throughout the state.
The District of Columbia also takes a proactive approach to encourage its residents to engage in STD testing and preventive measures. A newer D.C.-based initiative, GetCheckedDC, supported 2,015 at-home tests for HIV and STIs in 2020, along with nearly 600 walk-in tests for HIV, STIs and hepatitis. The program also distributed more than 3.2 million condoms and provided medical care and support services to thousands of residents.
Looking strictly at the percentage change between 2019 and 2020, D.C. saw the second-biggest dip (23%), behind Vermont at 34%. Delaware was sixth with a 14% drop.
Full rankings
Rank | State | Rate per 100,000 residents (2000) | Rate per 100,000 residents (2019) | Rate per 100,000 residents (2020) | % change, 2000-2020 | % change, 2019-2020 |
|---|---|---|---|---|---|---|
| 1 | North Dakota | 153.3 | 706.2 | 719.7 | 369% | 2% |
| 2 | Utah | 110.5 | 452.0 | 432.3 | 291% | -4% |
| 3 | Montana | 169.2 | 611.5 | 569.9 | 237% | -7% |
| 4 | Nevada | 276.6 | 950.4 | 857.3 | 210% | -10% |
| 5 | West Virginia | 154.7 | 453.9 | 459.7 | 197% | 1% |
| 6 | Idaho | 154.3 | 476.7 | 448.6 | 191% | -6% |
| 7 | Iowa | 252.7 | 686.9 | 711.8 | 182% | 4% |
| 8 | New Mexico | 362.4 | 1,070.3 | 1,012.9 | 179% | -5% |
| 9 | South Dakota | 279.4 | 783.1 | 777.8 | 178% | -1% |
| 10 | New York | 290.1 | 900.2 | 774.4 | 167% | -14% |
| 11 | Minnesota | 228.9 | 621.1 | 599.6 | 162% | -3% |
| 12 | New Hampshire | 100.2 | 317.3 | 255.7 | 155% | -19% |
Source: ValuePenguin analysis of CDC data.
STD preventive services and health insurance: What’s covered
If you’re sexually active, experts agree that regularly getting tested for STDs is essential to protect your health. Yet you may have questions about what your health insurance covers where STD testing and preventive services are concerned.
Nick VinZant, ValuePenguin health insurance expert, says STD tests are generally considered preventive care, so most insurance companies are legally required to cover STD testing.
However, it’s important to understand that your age, gender, risk factors and the type of STD test you need might play a role in coverage. Prenatal tests, for example, might have a different cost versus other types of STD testing. Cheap health insurance also might leave you responsible for a bigger out-of-pocket expense than other health insurance types.
If you’re looking for information on whether your insurance has to offer you free STD testing without cost-sharing requirements, the CDC is a resource.
"Insurance companies cover STD treatment much like any other health condition," VinZant says. "You might have a copay for office visits and medication, and your deductible will still apply."
Options for the uninsured
There are also numerous options available for people without health insurance. Your state health department may offer free STD testing, educational resources and preventive options.
"In some states," VinZant says, "they will even mail you condoms."
You can also visit the CDC’s GetTested site. This online CDC resource helps people locate free and confidential testing sites in their area for HIV, STDs and hepatitis.
Methodology
ValuePenguin researchers analyzed Centers for Disease Control and Prevention (CDC) data to estimate STD rates per 100,000 residents. Analysts looked at the following STDs:
- Chlamydia
- Congenital syphilis
- Early non-primary, non-secondary syphilis
- Primary and secondary syphilis
- Gonorrhea
Nationally, researchers calculated changes between 2000 and 2020 and 2019 and 2020 based on the individual STDs. At the state level, analysts calculated changes in the same periods but used a combined look that incorporated the five STDs tracked.
Researchers ranked the states according to the largest growth in cases between 2000 and 2020. We also calculated changes between 2019 and 2020 to present a pandemic-based look.