STD Rates in North Carolina
CDC surveillance data for North Carolina covering chlamydia, gonorrhea, syphilis, and HIV — with 15-year trends, state rankings, and national comparisons.
North Carolina ranks 6th in the country for STD burden — and that ranking alone tells you something. With a combined rate of 871.0 per 100,000 people in 2023, the state sits 36% above the national median. That's not a recent development. North Carolina has been in the top tier for years, and the long-run trend lines don't show a state that's trending down.
Chlamydia accounts for most of the volume: 65,867 cases in 2023, at a rate of 607.9 per 100,000. The US median is 471.3. North Carolina is 29% above it. What makes that number harder to wave off is the trajectory — the rate has climbed nearly 50% since 2008, and after a brief plateau around 2021 and 2022, it ticked up again in 2023. It's not a spike. It's a slow, sustained elevation that never really corrected.
Gonorrhea tells a sharper story. The rate rose more than 40% between 2008 and 2023, and at 243.2 per 100,000, it's running 60% above the national median of 152.2. There was a small dip in 2022 and another in 2023 — down 2.6% year-over-year — but the rate remains near its historical peak. Syphilis is moving in the other direction, at least recently. After surging from 3.1 per 100,000 in 2008 to a peak of 23.1 in 2022 — a 640% rise over 14 years — the rate dropped to 19.9 in 2023. Whether that's the start of a real decline or just a single-year fluctuation isn't clear yet.
HIV diagnoses in North Carolina have held in a narrow band since 2017, hovering between roughly 1,076 and 1,388 new cases per year. The 2020 dip to 1,076 almost certainly reflects pandemic-related gaps in testing and care, not a true reduction. By 2022, diagnoses were back up to 1,357. If you're in Charlotte, Raleigh, Greensboro, or anywhere else in the state, STDTest.com can help you find a testing location near you.
STD Trends in North Carolina
North Carolina's chlamydia rate has never returned to anything close to the national median — it's been above 600 per 100,000 for most of the last decade. After appearing to plateau around 603 in 2021 and 2022, the rate nudged upward again in 2023 to 607.9, suggesting the ceiling isn't fixed. The long-run rise of nearly 50% since 2008 reflects both expanded testing and genuine increases in transmission.
At 243.2 per 100,000, North Carolina's gonorrhea rate is 60% above the US median of 152.2 — a gap that has widened significantly over the past 15 years. The rate has climbed more than 40% since 2008, peaking near 271 in 2020 and 2021 before easing slightly. Even with back-to-back annual declines in 2022 and 2023, the state remains one of the higher-burden states in the country.
Syphilis in North Carolina underwent a transformation over the past 15 years that few other diseases match: the rate went from 3.1 per 100,000 in 2008 to 23.1 in 2022 — a rise of roughly 640%. The 2023 rate of 19.9 marks the first meaningful decline in that run, dropping 13.9% year-over-year. The current rate still sits above the US median of 14.8, so the trend is worth watching, but the 2023 data is the first sign of potential stabilization.
North Carolina's HIV diagnosis data covers 2017 through 2022 and shows a rate that has stayed stubbornly consistent, ranging from 12.2 to 15.5 new diagnoses per 100,000 over that span. The 2020 drop to 1,076 cases and a rate of 12.2 is the clearest outlier — most public health analysts attribute dips like that to pandemic-era disruptions in testing access, not a real decline in transmission. By 2021 and 2022, the numbers had returned to pre-pandemic levels.
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North Carolina vs National Average
Comparing 2023 rates against the U.S. median across all 50 states.
| Infection | North Carolina | US Median | Difference |
|---|---|---|---|
| Chlamydia | 607.9 | 471.3 | 29% above |
| Gonorrhea | 243.2 | 152.2 | 59.8% above |
| Syphilis (P&S) | 19.9 | 14.8 | 34.5% above |
STD Rates by County
County-level data from CDC surveillance. Ranked by combined rate per 100,000.
| County | State Rank | Combined | Chlamydia | Gonorrhea | Syphilis |
|---|---|---|---|---|---|
| Edgecombe County | #1 of 100 | 2324.3 | 1507.2 | 724.9 | 92.2 |
| Vance County | #2 of 100 | 1959.7 | 1231.6 | 699.7 | 28.4 |
| Pitt County | #3 of 100 | 1766.2 | 1202.0 | 532.2 | 32.0 |
| Robeson County | #4 of 100 | 1692.9 | 1146.8 | 514.6 | 31.5 |
| Scotland County | #5 of 100 | 1640.7 | 1117.1 | 512.0 | 11.6 |
| Wilson County | #6 of 100 | 1604.5 | 1057.4 | 519.2 | 27.9 |
| Hertford County | #7 of 100 | 1578.1 | 1079.5 | 472.9 | 25.7 |
| Cumberland County | #8 of 100 | 1489.2 | 1055.1 | 400.7 | 33.4 |
| Lenoir County | #9 of 100 | 1459.2 | 912.7 | 513.7 | 32.8 |
| Anson County | #10 of 100 | 1424.8 | 1082.3 | 310.5 | 32.0 |
| Halifax County | #11 of 100 | 1393.3 | 993.7 | 372.1 | 27.5 |
| Durham County | #12 of 100 | 1373.4 | 905.3 | 440.5 | 27.6 |
| Bertie County | #13 of 100 | 1365.0 | 957.3 | 390.0 | 17.7 |
| Nash County | #14 of 100 | 1341.3 | 854.5 | 437.1 | 49.7 |
| Mecklenburg County | #15 of 100 | 1298.5 | 873.8 | 390.5 | 34.2 |
| Northampton County | #16 of 100 | 1292.2 | 909.4 | 364.9 | 17.9 |
| Washington County | #17 of 100 | 1288.1 | 896.1 | 364.0 | 28.0 |
| Richmond County | #18 of 100 | 1256.9 | 829.3 | 389.8 | 37.8 |
| Guilford County | #19 of 100 | 1253.3 | 843.8 | 381.9 | 27.6 |
| Wayne County | #20 of 100 | 1113.8 | 806.3 | 289.0 | 18.5 |
| Forsyth County | #21 of 100 | 1102.3 | 744.2 | 335.4 | 22.7 |
| Greene County | #22 of 100 | 1047.3 | 745.3 | 277.6 | 24.4 |
| Martin County | #23 of 100 | 1030.5 | 690.1 | 312.4 | 28.0 |
| Onslow County | #24 of 100 | 1020.2 | 818.5 | 192.3 | 9.4 |
| Hoke County | #25 of 100 | 1019.4 | 723.7 | 262.6 | 33.1 |
| Warren County | #26 of 100 | 1008.6 | 732.6 | 260.1 | 15.9 |
| Bladen County | #27 of 100 | 966.6 | 705.5 | 237.4 | 23.7 |
| Duplin County | #28 of 100 | 941.0 | 737.1 | 189.8 | 14.1 |
| Granville County | #29 of 100 | 871.5 | 611.0 | 238.0 | 22.5 |
| Gaston County | #30 of 100 | 868.3 | 592.2 | 249.5 | 26.6 |
| Cleveland County | #31 of 100 | 851.2 | 586.9 | 238.7 | 25.6 |
| Rowan County | #32 of 100 | 841.4 | 555.2 | 256.5 | 29.7 |
| Columbus County | #33 of 100 | 832.1 | 554.7 | 261.4 | 16.0 |
| Pasquotank County | #34 of 100 | 830.0 | 567.0 | 250.9 | 12.1 |
| Person County | #35 of 100 | 810.3 | 551.1 | 244.1 | 15.1 |
| Alamance County | #36 of 100 | 809.3 | 574.9 | 207.6 | 26.8 |
| Beaufort County | #37 of 100 | 802.6 | 564.3 | 215.8 | 22.5 |
| Sampson County | #38 of 100 | 788.6 | 617.4 | 152.7 | 18.5 |
| Wake County | #39 of 100 | 751.5 | 527.9 | 208.1 | 15.5 |
| Cabarrus County | #40 of 100 | 750.3 | 544.5 | 190.8 | 15.0 |
| Chowan County | #41 of 100 | 748.7 | 633.5 | 108.0 | 7.2 |
| Craven County | #42 of 100 | 742.2 | 550.8 | 180.7 | 10.7 |
| Harnett County | #43 of 100 | 725.2 | 510.3 | 205.0 | 9.9 |
| Jones County | #44 of 100 | 702.0 | 510.6 | 180.8 | 10.6 |
| Caswell County | #45 of 100 | 684.0 | 504.2 | 171.0 | 8.8 |
| Orange County | #46 of 100 | 670.5 | 473.4 | 183.2 | 13.9 |
| Montgomery County | #47 of 100 | 655.5 | 509.9 | 141.8 | 3.8 |
| New Hanover County | #48 of 100 | 647.3 | 484.4 | 148.2 | 14.7 |
| Johnston County | #49 of 100 | 635.7 | 450.9 | 172.8 | 12.0 |
| Franklin County | #50 of 100 | 628.5 | 453.2 | 164.9 | 10.4 |
| Jackson County | #51 of 100 | 628.1 | 507.0 | 121.1 | 0.0 |
| Lee County | #52 of 100 | 627.8 | 441.4 | 173.0 | 13.4 |
| Davidson County | #53 of 100 | 608.7 | 439.9 | 147.6 | 21.2 |
| Rockingham County | #54 of 100 | 564.2 | 382.6 | 160.0 | 21.6 |
| Iredell County | #55 of 100 | 563.8 | 411.1 | 146.7 | 6.0 |
| Pamlico County | #56 of 100 | 563.5 | 402.5 | 144.9 | 16.1 |
| Watauga County | #57 of 100 | 544.4 | 493.2 | 40.2 | 11.0 |
| Union County | #58 of 100 | 514.8 | 392.7 | 113.1 | 9.0 |
| Catawba County | #59 of 100 | 488.9 | 331.6 | 145.2 | 12.1 |
| Caldwell County | #60 of 100 | 480.3 | 362.4 | 105.5 | 12.4 |
| Stanly County | #61 of 100 | 479.5 | 379.0 | 89.8 | 10.7 |
| Rutherford County | #62 of 100 | 474.7 | 283.9 | 149.6 | 41.2 |
| Randolph County | #63 of 100 | 470.7 | 351.3 | 109.2 | 10.2 |
| Perquimans County | #64 of 100 | 456.0 | 358.8 | 89.7 | 7.5 |
| Buncombe County | #65 of 100 | 439.6 | 313.5 | 113.1 | 13.0 |
| Swain County | #66 of 100 | 431.2 | 373.7 | 50.3 | 7.2 |
| Mcdowell County | #67 of 100 | 423.3 | 282.9 | 118.1 | 22.3 |
| Moore County | #68 of 100 | 419.1 | 327.4 | 84.2 | 7.5 |
| Pender County | #69 of 100 | 392.6 | 290.4 | 93.4 | 8.8 |
| Burke County | #70 of 100 | 390.6 | 284.1 | 94.0 | 12.5 |
| Gates County | #71 of 100 | 377.1 | 309.4 | 67.7 | 0.0 |
| Brunswick County | #72 of 100 | 374.5 | 282.6 | 88.8 | 3.1 |
| Davie County | #73 of 100 | 374.4 | 262.3 | 100.9 | 11.2 |
| Yadkin County | #74 of 100 | 341.5 | 264.7 | 66.2 | 10.6 |
| Lincoln County | #75 of 100 | 340.7 | 241.4 | 89.9 | 9.4 |
| Chatham County | #76 of 100 | 329.5 | 240.1 | 83.3 | 6.1 |
| Henderson County | #77 of 100 | 323.7 | 252.5 | 59.5 | 11.7 |
| Dare County | #78 of 100 | 312.2 | 275.5 | 34.1 | 2.6 |
| Carteret County | #79 of 100 | 304.6 | 227.0 | 67.5 | 10.1 |
| Surry County | #80 of 100 | 303.7 | 212.7 | 86.8 | 4.2 |
| Wilkes County | #81 of 100 | 287.8 | 236.3 | 43.9 | 7.6 |
| Stokes County | #82 of 100 | 281.2 | 204.3 | 72.5 | 4.4 |
| Macon County | #83 of 100 | 268.1 | 223.9 | 33.8 | 10.4 |
| Tyrrell County | #84 of 100 | 260.0 | 260.0 | 0.0 | 0.0 |
| Transylvania County | #85 of 100 | 250.4 | 205.7 | 44.7 | 0.0 |
| Alexander County | #86 of 100 | 249.6 | 189.2 | 43.9 | 16.5 |
| Camden County | #87 of 100 | 242.5 | 188.6 | 35.9 | 18.0 |
| Madison County | #88 of 100 | 240.2 | 199.4 | 40.8 | 0.0 |
| Polk County | #89 of 100 | 239.3 | 174.5 | 54.8 | 10.0 |
| Hyde County | #90 of 100 | 238.7 | 173.6 | 65.1 | 0.0 |
| Currituck County | #91 of 100 | 224.8 | 177.3 | 38.0 | 9.5 |
| Haywood County | #92 of 100 | 223.9 | 195.3 | 25.4 | 3.2 |
| Mitchell County | #93 of 100 | 220.0 | 186.7 | 20.0 | 13.3 |
| Alleghany County | #94 of 100 | 211.6 | 149.9 | 61.7 | 0.0 |
| Ashe County | #95 of 100 | 207.0 | 158.9 | 33.3 | 14.8 |
| Yancey County | #96 of 100 | 184.8 | 158.4 | 15.8 | 10.6 |
| Avery County | #97 of 100 | 176.6 | 142.4 | 28.5 | 5.7 |
| Cherokee County | #98 of 100 | 170.3 | 146.9 | 6.7 | 16.7 |
| Graham County | #99 of 100 | 161.4 | 136.6 | 24.8 | 0.0 |
| Clay County | #100 of 100 | 151.7 | 134.9 | 8.4 | 8.4 |
What the numbers mean — and what to do about them
North Carolina's 2023 numbers add up to roughly 94,000 chlamydia, gonorrhea, and syphilis diagnoses combined — in a state of 10.8 million people. That's a rate of 871 cases per 100,000, which places North Carolina 6th in the country and 37% above the national median. For context: most states in the top ten are either very small or in the Deep South. North Carolina is both large and consistently ranked near the top of a list most states would rather not lead.
The trend that carries the most clinical weight is the one that's easiest to miss: chlamydia. Nearly 66,000 cases were diagnosed in 2023, but chlamydia is one of the most under-diagnosed infections in the country — most people who have it feel nothing. That gap between diagnosed and actual cases means the real number is almost certainly higher. Gonorrhea carries the same problem. North Carolina's rate has been above 200 per 100,000 for most of the last decade, and at 243.2, it's running 60% above the US median. Both infections are treatable, but only if someone gets tested first.
If you live in Charlotte, Raleigh, Greensboro, or anywhere else in the state, the practical reality is this: North Carolina has ranked in the top 10 for STD burden for years, and none of the three major disease trends show a clear downward move. Waiting for symptoms isn't a reliable strategy with these infections. STDTest.com can show you testing locations near you — because North Carolina's numbers make the case for not waiting.
WHO SHOULD GET TESTED
Sexually active adults in North Carolina face above-median rates for all three major STDs. Chlamydia and gonorrhea rates are both more than 29–60% above national medians, making routine screening important for anyone who is sexually active — not just those with symptoms or multiple partners. People under 25, men who have sex with men, and those with new partners are at particularly elevated risk given the state's persistent disease burden.
HOW OFTEN
At minimum, once a year if you're sexually active. Given that North Carolina's chlamydia rate has held above 600 per 100,000 for most of the past decade and gonorrhea remains near historic highs, every three to six months is reasonable for anyone with new or multiple partners. Syphilis rates, though down slightly in 2023, are still above the national median — so full-panel testing makes more sense here than in lower-burden states.
WHAT TO EXPECT
Most STD tests are quick — a urine sample or a swab, depending on what's being screened. Results typically come back within a few days. Many clinics in Charlotte, Raleigh, and Greensboro offer confidential testing with no requirement to involve your primary care provider. If something comes back positive, treatment for chlamydia, gonorrhea, and syphilis is straightforward — usually a single course of antibiotics.
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