Gonorrhea Rates by State 2023: Where Cases Are Highest

In 2023, the US reported 601,319 gonorrhea cases, a national rate of 179.5 per 100,000 CDC AtlasPlus, 2023. Rates vary enormously by place. Washington, DC tops the country at 853.3 per 100,000, followed by Alaska and Louisiana, while New Hampshire, Vermont, and Utah report the lowest rates in the nation.

Why gonorrhea rates vary so dramatically by state

A state's reported gonorrhea rate combines two tangled things: how much infection is actually circulating, and how hard the state looks for it. gonorrhea spreads through sexual networks, so where those networks are dense and partner turnover is high, the bacterium moves efficiently. DC's rate of 853.3 per 100,000 is nearly five times the US average, driven by urban density, concentrated poverty, and a high share of uninsured residents who can't easily access screening or prompt treatment.

Screening intensity matters just as much. A state that tests aggressively finds more infections and posts a higher rate, while a state that tests sparingly can look deceptively clean. Some low numbers reflect lower burden and others reflect under-detection. The same structural drivers cluster across infections: the highest-rate gonorrhea states largely overlap with the highest chlamydia rates by state and syphilis rates by state, which points to shared transmission networks rather than coincidence.

Nationally, reported gonorrhea has been falling, down from a 2021 peak of 214 per 100,000 to about 180 per 100,000 in 2023. The 2020 dip was largely an artifact of pandemic testing disruption that masked the underlying trend rather than a real drop in transmission.

The 10 highest-rate states in 2023

These jurisdictions reported the highest gonorrhea rates per 100,000 population in 2023:

1. Washington, DC — 853.3
2. Alaska — 310.9
3. Louisiana — 288.4
4. Georgia — 274.8
5. South Carolina — 272
6. Alabama — 264
7. Mississippi — 258
8. North Carolina — 248
9. Arkansas — 245
10. Tennessee — 236

The Deep South dominates this list, with Alaska and DC the notable outliers. The clustering across the Gulf states and Southeast mirrors longstanding regional patterns in poverty, uninsurance, and limited access to sexual-health care.

The 10 lowest-rate states in 2023

At the other end, these states reported the lowest gonorrhea rates:

• New Hampshire — about 40
• Vermont — about 44
• Utah — about 47
• Maine — about 52
• Idaho — about 55
• Montana — about 60
• Wyoming — about 63
• Iowa — about 75

Northern New England and the Mountain West run lowest. Read these figures with care, because low rates reflect both a smaller burden and, in some rural states, less intensive screening. A low state rate is a reason to feel less anxious, but you should still test if you have a new or multiple partners.

Antibiotic resistance: the complication that changes everything

Gonorrhea is the STI most likely to outrun our drugs. The CDC designated it an urgent antibiotic resistance threat in 2019, and the bacterium has methodically defeated nearly every antibiotic thrown at it CDC, Resistant Gonorrhea. Azithromycin was dropped from treatment because resistance climbed fast: isolates with elevated azithromycin MICs (the drug concentration needed to stop growth) rose from 0.6% in 2013 to 4.6% in 2018. That left a single ceftriaxone injection as the lone first-line regimen Clin Infect Dis, 2020.

At the state level this compounds: where rates are highest, the bacterium has the most chances to swap genes and evolve. The throat is the key danger zone. Pharyngeal (throat) gonorrhea is usually symptomless and can persist for up to 16 weeks, and the pharynx is a resistance breeding ground where gonorrhea picks up resistance genes from harmless throat bacteria living alongside it. Even fully susceptible throat infections fail ceftriaxone about 4.6% of the time, so a test-of-cure 7–14 days later is advised after treating the throat treatment-failure review.

Ceftriaxone-resistant gonorrhea is no longer hypothetical. The resistant FC428 strain emerged in Japan in 2015 and has spread internationally, against a backdrop the WHO estimates at 82 million new infections globally in 2020 WHO. For the full picture on how the injection works and what's coming next, see our explainer on gonorrhea drug resistance.

Who is most affected

Gonorrhea burden is not spread evenly across the population. The rate among Black Americans is roughly seven to eight times the rate among white Americans CDC STI Surveillance, 2023, a disparity that reflects structural inequalities in healthcare access, insurance, and poverty, not any biological difference in susceptibility. Rates among men who have sex with men also remain disproportionately high, in part because of pharyngeal and rectal infections that often go undetected.

A single urine test isn't always enough. Gonorrhea can infect the genitals, rectum, and throat, and the non-genital sites are the ones that hide symptoms and drive resistance. Anyone who has had oral or anal sex should ask for the corresponding swabs.

What your state's rate means for your testing schedule

State rates are a backdrop rather than a verdict, but they should nudge your testing cadence. If you live in DC, Alaska, Louisiana, Georgia, or Alabama, the high background rate warrants testing at least annually even with modest perceived risk. The USPSTF recommends gonorrhea screening for all sexually active women under 25 and for older women at increased risk, including those with new or multiple partners USPSTF, 2021.

Testing itself is fast and painless. A urine sample covers urogenital infection, with throat or rectal swabs added if you've had oral or anal sex, and results typically land in one to two days. If you were recently treated, a follow-up test of cure is recommended, since reinfection is common in high-rate states and resistance means clinicians want to confirm the infection actually cleared. When you're ready, you can get tested, and you can compare your state against the rest in our full STD rates by state hub.