STD Rates in Montana
CDC surveillance data for Montana covering chlamydia, gonorrhea, syphilis, and HIV — with 15-year trends, state rankings, and national comparisons.
Montana sits near the bottom of national STD rankings — 43rd out of 50 states in 2023, with a combined rate of 417.8 cases per 100,000 people. That puts it well below the national median. But the headline number obscures something worth paying attention to: syphilis, a disease that was essentially absent in Montana at the start of the century, has exploded over the past 15 years in ways that no other STD in the state comes close to matching.
Chlamydia remains the most common diagnosis, with 3,655 cases recorded in 2023 — a rate of 322.6 per 100,000. That's well below the national median of 471.3, and it's been trending downward since peaking around 2018. The long-run picture is nearly flat: the rate in 2023 is almost identical to where it stood in 2008. In a state with Montana's demographics and geography, that kind of stability over 15 years is unusual. The 2023 figure dropped another 11.4% from 2022 alone.
Gonorrhea tells a sharper story. In 2008, Montana's rate was 12.6 per 100,000 — barely a blip. By 2023, it had reached 67.7, a 437% increase over that period. It's still below the national median of 152.2, and 2023 actually brought a 42% drop from 2022's rate of 116.8. But the long arc matters: this is a disease that barely existed in measurable form in Montana two decades ago. Syphilis is even more striking. The rate went from effectively zero in the early 2000s to 27.5 per 100,000 in 2023 — nearly double the national median of 14.8. A brief dip in 2023 followed a spike to 28.9 in 2022, but at this level, syphilis is no longer a footnote in Montana's data.
HIV diagnoses in Montana have remained low through 2022, the most recent year with complete data. The state recorded just 15 new cases in 2022, a rate of 1.6 per 100,000 — among the lowest in the country. A dip to 14 cases in 2020 likely reflects pandemic-era disruptions to testing access rather than a true decline. If you're in Billings, Missoula, or Great Falls, STDTest.com can help you find nearby testing for the full range of STDs, including syphilis, which now warrants attention in Montana in a way it simply didn't a decade ago.
STD Trends in Montana
Montana's chlamydia rate has essentially gone nowhere over 15 years — 320.4 per 100,000 in 2008, 322.6 in 2023, with peaks and valleys in between. The rate has been declining since 2018, when it hit 463.6, and dropped another 11.4% in 2023 alone. At 322.6, Montana sits about 32% below the national median of 471.3, which puts it among the lower-burden states in the country.
Gonorrhea in Montana was nearly nonexistent in 2008, with a rate of just 12.6 per 100,000. By 2020 it had crossed 156 — a more than 1,100% rise in twelve years. The 2023 rate of 67.7 reflects a sharp 42% single-year drop from 2022, but the long-run gain since 2008 still stands at 437%. Montana remains below the national median of 152.2, but the trajectory over the past decade makes gonorrhea the state's fastest-moving STD by a wide margin.
Syphilis is where Montana's data takes its most unexpected turn. The rate was reported as zero for three consecutive years at the start of the century and stayed below 1.0 per 100,000 through 2016. By 2022 it had reached 28.9 — nearly double the national median of 14.8 — before edging down slightly to 27.5 in 2023. That 4.8% year-over-year decline is a small move against a backdrop of a 3,800%-plus rise since 2008.
Montana's HIV data runs through 2022 and shows a state with consistently low diagnosis counts — never exceeding 30 new cases in any year from 2017 onward. The 14 cases recorded in 2020 almost certainly reflect reduced testing access during the pandemic rather than a genuine drop in transmission. The 2021 and 2022 figures, 21 and 15 cases respectively, suggest the state remains at very low levels, though low case counts can obscure gaps in testing coverage in rural areas.
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Montana vs National Average
Comparing 2023 rates against the U.S. median across all 50 states.
| Infection | Montana | US Median | Difference |
|---|---|---|---|
| Chlamydia | 322.6 | 471.3 | 31.6% below |
| Gonorrhea | 67.7 | 152.2 | 55.5% below |
| Syphilis (P&S) | 27.5 | 14.8 | 85.8% above |
What the numbers mean — and what to do about them
Montana's 2023 numbers add up to 4,734 total chlamydia, gonorrhea, and syphilis diagnoses across a state of just over 1.1 million people. That works out to one in every 239 residents diagnosed with one of those three diseases in a single year — and that's only counting confirmed cases. Because most STDs produce no symptoms, the true number of infections circulating at any given time is considerably higher than what surveillance data captures.
The trend that matters most clinically in Montana right now is syphilis. Unlike chlamydia, which is widely screened for and often caught early, syphilis testing requires a specific blood draw that isn't always included in routine panels. The disease can remain asymptomatic for months or years while still being transmissible — and in Montana, where the rate has gone from near-zero to above the national median in under a decade, the window between infection and diagnosis is exactly where spread happens. Gonorrhea's 437% long-run rise, even with its recent dip, tells a similar story: this is a disease that was nearly absent in Montana 15 years ago and is now entrenched enough to warrant routine screening.
If you live in Billings, Missoula, or Great Falls, testing is accessible — and the case for getting a full panel, including a syphilis blood test, is stronger now than it was five years ago. Montana's syphilis rate crossed above the national median in recent years without most residents noticing, because the disease rarely announces itself. STDTest.com can show you exactly where to get tested in your city today.
WHO SHOULD GET TESTED
Any sexually active adult in Montana, but especially those in Billings, Missoula, and Great Falls, where population density makes transmission more likely. Given that Montana's syphilis rate now exceeds the national median and gonorrhea has risen sharply over 15 years, anyone with a new or multiple partners should request a full panel — chlamydia, gonorrhea, and a syphilis blood test — not just the standard swab.
HOW OFTEN
Once a year is a reasonable floor for sexually active Montanans. If you have multiple partners or a new partner, every three to six months makes more sense — particularly for syphilis, which has seen the most sustained increase of any STD in the state since 2008 and requires a separate blood draw to detect.
WHAT TO EXPECT
A full STD panel typically takes under 30 minutes and involves a urine sample or swab for chlamydia and gonorrhea, plus a blood draw for syphilis and HIV. Results usually come back within a few days. Most testing sites in Montana operate without requiring a referral, and many offer confidential or anonymous options.
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