A new study analyzing data from the Centers for Disease Control and Prevention (CDC) finds that the D.C. metropolitan area has the ninth-highest incidence of STDs in the country.

The sixth annual study by Innerbody Research, the largest online medical and wellness testing guide, also found that three metropolitan areas surrounding D.C. also have a high incidence of STDs, with Baltimore ranking fourth overall, Norfolk coming in just behind D.C. at tenth, and Richmond placing in the top 25.

According to the study, these are the 10 U.S. cities with the highest overall STD Rates (per 100,000 population):

The study ranks all cases of four major STDs: HIV, gonorrhea, chlamydia, and syphilis, based on the rate of cases per 100,000 population.

Innerbody researchers avoided “weighting” certain diseases more than others for fear of skewing the data or appearing to make a judgment about the severity of different diseases.

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But that metric doesn’t mean a city or metro area has more of every type of STD than another.

For example, the Baltimore metropolitan area — which ranked fourth overall, with 1,327 STD cases per 100,000 people —  has fewer cases of chlamydia and syphilis than Washington, D.C. — which ranks ninth overall — but has a much higher prevalence of HIV than D.C. (both cities have similar rates of gonorrhea cases).

D.C. has a rate of 1,081 STD cases per 100,000 people, with 473 reported cases of HIV. It also has 22,829 cases of chlamydia, 6,136 cases of gonorrhea, and 1,085 cases of syphilis.

The South continues to be disproportionately represented among the metropolitan areas, with 14 of the hardest-hit 25 cities being located in the South, including three from Florida and three from South Carolina.

The biggest increases in infection rates occurred in Norfolk, Virginia; Cleveland, Ohio; Little Rock, Arkansas; Columbia, South Carolina; and Memphis, Tennessee — the latter two of which ranked third and first overall.

“Several years ago, when we were researching online STD testing, where you can order your test online and get it delivered to your home and get your results discreetly, we found there was a lot of stigma associated with STDs,” Eric Rodriguez, CEO and co-founder of Innerbody Research told Metro Weekly. “And part of what we found is that people just weren’t getting tested. So we started this annual study to raise awareness of STDs and encourage further testing.”

Rodriguez says that developing a ranking system and communicating the prevalence of STDs in a given metro area grabbed people’s attention, and helped researchers provide important information to the public in an easily digestible format.

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He notes that — like the U.S. census, which relies heavily on high participation rates — the data is likely to lead to an undercount of the actual number of STD cases due to underreporting from doctors or official government bodies like a local health department, but at least provides a picture of where things stand.

“For example, certain cities with a large homeless population or unhoused population are going to be undercounted,” he says. “We also have situations where there’s a large immigrant community, where cases are likely to be undercounted.

“And we debated internally with our statisticians about whether we should try to counter-weight that and extrapolate using other data we have to include those populations. But we decided ultimately just to stick to the CDC’s information because they try their best to get it accurate, and it’s widely considered the gold standard of data, flaws and all.”

Previous research has shown that half of all sexually active people will get at least one STD by the age of 25 — meaning awareness and education about testing and treatment are crucial to stemming any rise in STD rates. Cities or metro areas with certain characteristics can also be proactive in promoting testing and outreach. 

For example, geographic locations that have a higher proportion of younger people, who are likely to be more sexually active, tend to have higher STD rates. Additionally, cities with disadvantaged populations without regular or reliable access to health care services are more likely to have higher STD rates. 

Similarly, many of the top cities on the list of the top 100 with the highest STD rates are likely to have higher gay populations.

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There also appears to be a slight correlation between higher STD rates and the presence of college, universities, and military bases, all of which draw people from various parts of the country and the world. This increases the pool of possible sexual partners and chances for transmission — especially since not all people with STDs may be symptomatic, meaning they could unknowingly pass a disease like chlamydia to their partners.

But the most likely indicator of whether a city or metro area will have a high incidence of STDs appears to be the level of health care spending. Seventeen of the top 25 metro areas with the highest rates are in states with health care spending below the national average of $10,191 per capita.

Interestingly, the three states with the lowest health care spending per capita — Mississippi, Tennessee, and South Carolina — are home to the metro areas with the highest incidence of STD rates.

By comparison, when looking at the top 15 states with the highest per capita health care spending, only two cities in those states — Baltimore and Rochester, N.Y. — land among the top 25 cities with the highest STD rates.

Researchers also note that the correlation is not perfect, as the District of Columbia — which is not a state — has the highest health care spending per capita at $14,381, but still manages to land within the top 10 hardest-hit cities.

Rodriguez explains that while the report technically lists “cities,” the CDC collects data based on metropolitan areas, meaning that a proportion of the diagnosed cases may be coming from people who live in the suburbs or exurbs — and who may have fewer easily accessible testing or treatment options available to them.

According to 2021 data from D.C.’s HIV/AIDS, Hepatitis, STD and TB Administration, which issues an annual report tracking the number of STD cases among District residents, in 2021, there were 230 new cases of HIV; 6,920 cases of chlamydia; 4,304 cases of gonorrhea; and 178 cases of syphilis diagnosed in the District.

But looking at the data from the Innerbody study, the cases reported to HAHSTA account for 70% of all gonorrhea cases, and only 48% of HIV cases, 30% of chlamydia cases, and 16% of syphilis cases that were reported to the CDC.

Rodriguez warns people from drawing too many conclusions or inferences from the study, especially when it comes to politically-charged statements.

“This is the first time in our rankings where we’ve actually started swimming in political waters, because we always get asked questions about the ramifications,” he says. “For instance, I was just on the phone with somebody from Florida, and they were trying to spin it from a more conservative perspective, trying to say that these cities are largely run by Democratic mayors who get this health care funding and spend it on the wrong things, or illegal immigrants, or things like that. But then you talk to the Democratic-run cities and they say, ‘We are not getting the funds we need. The state controls the funds we get. We can control how we spend them, but we’re not getting nearly enough.’

“So both of those viewpoints are valid,” he continues. “But what we tried to do is just present the data that we have and let and let the readers make their own interpretations of the data, depending on what they think is more important.”

On that political front, Innerbody’s report does note that 16 of the top 20 cities with the highest STD rates are led by Democratic mayors, but only 8 of those cities are located in states with Democratic governors.

Diving deeper, when looking at the legislative branch, which actually appropriates funds to cities for health care or other forms of discretionary spending, 15 of those cities — spread across 11 states — have both legislative chambers controlled by Republicans, and, at the time the data was collected, Pennsylvania, where Philadelphia ranks #5 in the nation, had both legislative chambers controlled by Republicans, with control flipping to Democrats only last week in a series of special elections, meaning 16 of 20 cities were in states where Republicans control the purse strings, while only three cities — Washington, D.C., Baltimore, and San Francisco — were in jurisdictions under complete Democratic control.

Rodriguez says that some of the data from 2021 is likely to have been affected by the COVID-19 pandemic, especially in the latter part of the year, when lockdowns ended and people began socializing — and having sex — after months of being isolated at home.

“During the pandemic, STD rates went down, but then they started to kind of shoot up — so we’re trying to figure out what happened to cause that,” he says. “It could also be that people were as active as they’d been before the pandemic, but may have been less likely to see a doctor or get tested, which affects reporting of cases. Overall, I think COVID was a big disruptor, not only in terms of people’s actions in behaviors but in reporting as well.

“We think next year’s data release is going to show more normal rates of infection. But the overall trend, nationwide, is that STD rates are increasing,  instead of decreasing. And we’re not seeing any particular kind of technology or certain kind of interventions like PrEP affecting the rates. I think that’s just because it’s like a small drop in the bucket compared to all the different types of STDs that are out there.”

To see the full list of 100 cities in the Innerbody Research study, click here.