In 2023, the US reported about 1.65 million chlamydia cases — a rate of 492.2 per 100,000 people CDC AtlasPlus, 2023. Washington DC had the highest rate (1,228 per 100,000), followed by Louisiana (792) and Alaska (698). The lowest were Maine (217), New Hampshire (224), and Utah (227).
| Item | Value |
|---|---|
| DC | 1,228 |
| Louisiana | 792 |
| Alaska | 698 |
| Alabama | 651 |
| Georgia | 646 |
| US average | 492 |
| Utah | 227 |
| Maine | 217 |
chlamydia is the most-reported communicable disease in the country, and where you live measurably shifts your odds because of how common the infection is in the local partner pool. Below is how to read those state numbers and what they mean for how often you should get tested.
How to read chlamydia surveillance data
A state's reported rate is not the same as its true infection burden. Reported cases only count infections that got tested, diagnosed, and reported to public health. Most chlamydia causes no symptoms, so it sits undetected unless someone screens for it. The true number circulating is estimated to be far higher than what's reported.
That creates a paradox. A state with aggressive screening programs can post a higher reported rate than a state where the infection is just as common but fewer people get tested. A high number can mean lots of infection or lots of testing, and a low number can mean low burden or a state that isn't looking hard enough. Keep that ambiguity in mind for every figure below.
The 10 highest-rate states in 2023 and why
These states reported the highest chlamydia rates per 100,000 in the CDC's 2023 data:
- Washington DC — 1,228
- Louisiana — 792
- Alaska — 698
- Alabama — 651
- Georgia — 646
- Mississippi — 628
- South Carolina — 622
- North Carolina — 612
- Tennessee — 601
- Arkansas — 592
DC's rate is more than double the national figure. The top of the list shares structural features that drive transmission: concentrated urban poverty, lower rates of health insurance, and large younger sexually active populations where chlamydia clusters. These markers track healthcare access and the size of the local infection pool. The same Southern and Gulf states tend to top the gonorrhea rates by state list for the same reasons.
The 10 lowest-rate states: undertesting or true low burden?
At the other end:
- Maine — 217
- New Hampshire — 224
- Utah — 227
- Vermont — 238
- West Virginia — 248
- Wyoming — 264
- Montana — 275
These rates reflect a mix of lower transmission and lower testing coverage. Rural states with smaller, more spread-out populations and fewer clinics can undercount simply because fewer people screen. A low reported rate is partly reassuring and partly a blind spot. If you're sexually active and under 25, the screening recommendation doesn't change based on your zip code.
Who is most affected
Chlamydia is heavily concentrated in young people. Those aged 15–24 account for roughly half of all new infections despite making up a much smaller slice of the sexually active population CDC STI Surveillance, 2023. Younger cervical and urethral tissue is more susceptible, and partner turnover tends to be higher in this group.
Reported rates are far higher among Black Americans, roughly five to six times the rate among white Americans. This reflects structural inequality in healthcare access, insurance coverage, and clinic availability, not any biological difference in susceptibility. Where screening and treatment are harder to reach, infections persist and spread longer before they're caught.
Women are reported at higher rates than men — about 657 versus 328 per 100,000 — but that gap is largely an artifact of screening. Annual chlamydia screening is built into well-woman visits for sexually active women under 25, so women get tested more often. Men, screened far less, carry a larger pool of undetected infection that the surveillance numbers undercount.
What your state's rate means for your testing schedule
A higher state rate means a larger share of the available partner pool may be infected, which raises your individual risk independent of how careful you are. You can have one partner and still be exposed to whatever they brought from a wider, higher-prevalence network.
The core recommendation doesn't bend much by geography. The USPSTF gives a Grade B recommendation to screen all sexually active women 24 and under, every year, regardless of state USPSTF, 2021, and that's routinely covered by insurance at no out-of-pocket cost under the ACA. The guidance is asymmetric: a clear screen for young women, but an I-statement (insufficient evidence) for screening men, because the serious complication burden of pelvic inflammatory disease and infertility falls on women.
If you live in DC, Louisiana, Alaska, Alabama, or Georgia, the background rate alone justifies annual testing even when your perceived personal risk feels low, because the infection pool around you is larger. Testing itself is easy: a urine sample or a self-collected swab, no exam, no discomfort, results in a day or two at most clinics or mail-in labs.
How the US compares internationally
The US chlamydia rate is among the highest of high-income nations. That's partly real and partly a measurement effect. The US runs comprehensive surveillance and screening programs that find and report infections many other countries miss or underreport. A country with no national screening program will always look cleaner on paper, the same way an undertested US state looks lower than it really is.
How to act on the numbers
| If you're… | What the rate data suggests |
|---|---|
| Sexually active, under 25, any state | Annual screening regardless of your state's rate — USPSTF Grade B, insurance-covered |
| In a high-rate state (DC, LA, AK, AL, GA) | Annual testing even at low perceived risk — larger infection pool |
| In a low-rate state | Don't assume safety; low reported rates partly reflect undertesting |
| Recently treated | Retest in a few months — see chlamydia reinfection |
For the full breakdown of every infection by state, see our STD rates by state overview. Treatment specifics and partner notification belong in their own guides. Current first-line treatment is a short course of doxycycline pills, and giving partners medication to take (expedited partner therapy) measurably cuts repeat infection NEJM EPT trial.