STD Rates in North Dakota
CDC surveillance data for North Dakota covering chlamydia, gonorrhea, syphilis, and HIV — with 15-year trends, state rankings, and national comparisons.
North Dakota sits in the middle of the national pack — 28th out of 50 states — with a combined STD rate of 596 per 100,000 people in 2023. But the middle of the pack can be misleading. Gonorrhea and syphilis have been climbing for years, and the most recent data shows chlamydia and gonorrhea finally pulling back while syphilis accelerates. That split — some diseases falling, one rising fast — is where the real story is.
Chlamydia remains the most common STD in North Dakota by a wide margin, with 3,421 cases diagnosed in 2023 at a rate of 436.4 per 100,000. That's actually below the national median of 471.3, and it's down 8.2% from 2022. The long view is less reassuring: the rate has climbed roughly 45% since 2008, though the last two years suggest the upward trend may be flattening. Whether that's a genuine plateau or a testing artifact isn't clear yet.
Gonorrhea is where North Dakota's numbers get harder to look away from. The rate hit 147.2 per 100,000 in 2023 — down nearly 20% from the year before and now just below the national median of 152.2. That sounds like good trajectory until you consider where it started: in 2008, the gonorrhea rate was 22.3. That's a 560% increase over 15 years. The recent dip is real, but it follows years of sustained growth. Syphilis, meanwhile, moved in the opposite direction — up 51% in a single year, from 8.2 to 12.4 per 100,000. It's still below the national median of 14.8, but the pace of increase is the thing worth watching.
HIV diagnoses in North Dakota have held remarkably steady, running between 35 and 39 new cases per year from 2017 through 2022 — the most recent years with available data. The 2020 dip to 35 cases likely reflects pandemic-era disruptions to testing, not an actual change in transmission. The consistency of that number, year over year, points to a baseline that isn't shrinking. If you're in Fargo, Bismarck, or Grand Forks, STDTest.com can help you locate a testing site near you.
STD Trends in North Dakota
North Dakota's chlamydia rate has more than doubled since 2000, but the trend seems to be losing steam. After peaking at 511.5 per 100,000 in 2021, the rate fell to 475.3 in 2022 and dropped again to 436.4 in 2023 — now below the national median of 471.3 for the first time in several years. Two consecutive years of decline is notable, though the long-run rise of 45% since 2008 means the baseline is still much higher than it was a generation ago.
No STD in North Dakota has changed more sharply than gonorrhea. The rate stood at 22.3 per 100,000 in 2008; by 2021 it had reached 223.9 — a 560% increase over 13 years. The 2023 rate of 147.2 represents a real pullback and puts the state just below the national median of 152.2, but that decline follows an extraordinary run-up that makes the current number look modest only by comparison. Whether this is a lasting reversal or a temporary dip won't be clear for another year or two.
Syphilis in North Dakota was effectively absent in 2000 and stayed near zero for much of the following decade. It began climbing around 2016 and jumped 51% in 2023 alone — from 8.2 to 12.4 per 100,000. The state is still below the national median of 14.8, but the year-over-year acceleration stands out at a moment when chlamydia and gonorrhea are both declining.
HIV data for North Dakota runs through 2022, the most recent year reported by CDC surveillance. New diagnoses have been remarkably flat, ranging from 35 to 39 cases per year between 2017 and 2022, with a rate that hasn't moved much above 6.3 per 100,000. The slight dip in 2020 — 35 cases, rate of 5.5 — almost certainly reflects reduced testing access during the pandemic rather than a real change in transmission.
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North Dakota vs National Average
Comparing 2023 rates against the U.S. median across all 50 states.
| Infection | North Dakota | US Median | Difference |
|---|---|---|---|
| Chlamydia | 436.4 | 471.3 | 7.4% below |
| Gonorrhea | 147.2 | 152.2 | 3.3% below |
| Syphilis (P&S) | 12.4 | 14.8 | 16.2% below |
STD Rates by County
County-level data from CDC surveillance. Ranked by combined rate per 100,000.
| County | State Rank | Combined | Chlamydia | Gonorrhea | Syphilis |
|---|---|---|---|---|---|
| Sioux County | #1 of 51 | 3705.6 | 1894.0 | 1290.1 | 521.5 |
| Benson County | #2 of 51 | 2454.3 | 1671.0 | 783.3 | 0.0 |
| Rolette County | #3 of 51 | 2336.3 | 1313.1 | 1014.7 | 8.5 |
| Hettinger County | #4 of 51 | 1118.1 | 828.2 | 289.9 | 0.0 |
| Mountrail County | #5 of 51 | 1001.8 | 650.1 | 234.5 | 117.2 |
| Ramsey County | #6 of 51 | 793.8 | 663.0 | 122.1 | 8.7 |
| Ward County | #7 of 51 | 752.3 | 566.4 | 180.0 | 5.9 |
| Cass County | #8 of 51 | 712.4 | 540.8 | 165.5 | 6.1 |
| Burleigh County | #9 of 51 | 693.9 | 450.9 | 217.0 | 26.0 |
| Morton County | #10 of 51 | 599.0 | 410.1 | 162.3 | 26.6 |
| Grand Forks County | #11 of 51 | 536.4 | 444.2 | 89.4 | 2.8 |
| Williams County | #12 of 51 | 386.1 | 306.8 | 71.6 | 7.7 |
| Stark County | #13 of 51 | 384.8 | 321.2 | 60.6 | 3.0 |
| Mckenzie County | #14 of 51 | 378.9 | 280.7 | 91.2 | 7.0 |
| Dunn County | #15 of 51 | 373.2 | 348.3 | 0.0 | 24.9 |
| Pierce County | #16 of 51 | 333.1 | 205.0 | 102.5 | 25.6 |
| Stutsman County | #17 of 51 | 308.6 | 261.8 | 42.1 | 4.7 |
| Richland County | #18 of 51 | 308.1 | 253.7 | 42.3 | 12.1 |
| Ransom County | #19 of 51 | 303.4 | 267.7 | 35.7 | 0.0 |
| Sargent County | #20 of 51 | 291.3 | 211.9 | 79.4 | 0.0 |
| Walsh County | #21 of 51 | 291.1 | 262.0 | 29.1 | 0.0 |
| Billings County | #22 of 51 | 290.1 | 193.4 | 96.7 | 0.0 |
| Golden Valley County | #23 of 51 | 286.9 | 286.9 | 0.0 | 0.0 |
| Bowman County | #24 of 51 | 279.0 | 279.0 | 0.0 | 0.0 |
| Renville County | #25 of 51 | 263.3 | 219.4 | 43.9 | 0.0 |
| Barnes County | #26 of 51 | 242.4 | 195.8 | 46.6 | 0.0 |
| Mchenry County | #27 of 51 | 233.9 | 214.4 | 19.5 | 0.0 |
| Bottineau County | #28 of 51 | 220.6 | 173.3 | 31.5 | 15.8 |
| Mclean County | #29 of 51 | 213.6 | 122.1 | 91.5 | 0.0 |
| Traill County | #30 of 51 | 202.3 | 189.7 | 12.6 | 0.0 |
| Grant County | #31 of 51 | 180.5 | 135.4 | 45.1 | 0.0 |
| Pembina County | #32 of 51 | 165.1 | 120.1 | 30.0 | 15.0 |
| Slope County | #33 of 51 | 148.4 | 0.0 | 148.4 | 0.0 |
| Towner County | #34 of 51 | 147.8 | 147.8 | 0.0 | 0.0 |
| Dickey County | #35 of 51 | 142.9 | 142.9 | 0.0 | 0.0 |
| Divide County | #36 of 51 | 140.5 | 93.7 | 46.8 | 0.0 |
| Cavalier County | #37 of 51 | 139.0 | 139.0 | 0.0 | 0.0 |
| Kidder County | #38 of 51 | 128.1 | 128.1 | 0.0 | 0.0 |
| Emmons County | #39 of 51 | 124.1 | 93.1 | 31.0 | 0.0 |
| Wells County | #40 of 51 | 103.2 | 103.2 | 0.0 | 0.0 |
| Nelson County | #41 of 51 | 100.3 | 100.3 | 0.0 | 0.0 |
| Eddy County | #42 of 51 | 88.4 | 88.4 | 0.0 | 0.0 |
| Sheridan County | #43 of 51 | 79.0 | 79.0 | 0.0 | 0.0 |
| Lamoure County | #44 of 51 | 73.2 | 73.2 | 0.0 | 0.0 |
| Steele County | #45 of 51 | 56.1 | 56.1 | 0.0 | 0.0 |
| Logan County | #46 of 51 | 53.5 | 53.5 | 0.0 | 0.0 |
| Mercer County | #47 of 51 | 48.1 | 48.1 | 0.0 | 0.0 |
| Burke County | #48 of 51 | 46.9 | 46.9 | 0.0 | 0.0 |
| Griggs County | #49 of 51 | 44.5 | 44.5 | 0.0 | 0.0 |
| Mcintosh County | #50 of 51 | 40.2 | 40.2 | 0.0 | 0.0 |
| Foster County | #51 of 51 | 30.2 | 30.2 | 0.0 | 0.0 |
What the numbers mean — and what to do about them
In 2023, North Dakota recorded 4,672 combined diagnoses of chlamydia, gonorrhea, and syphilis — across a state of fewer than 800,000 people. That works out to roughly 1 in 168 residents diagnosed with one of these infections in a single year, and that's only counting the cases that were detected and reported. The state's combined rate of 596 per 100,000 sits just below the national median, which means North Dakota is closer to average than many people might assume.
The trend that matters most clinically is syphilis. Unlike chlamydia and gonorrhea — which are down year over year — syphilis jumped 51% in 2023, and it behaves differently from the other two. Early-stage syphilis can produce a painless sore that heals on its own, making it easy to miss. Left untreated, it progresses silently and can cause serious long-term health complications. Gonorrhea, too, is often asymptomatic, which is part of why the rate climbed so consistently for over a decade before recently declining: people who don't know they're infected can't seek treatment, and transmission continues. Testing is what breaks that chain.
If you live in Fargo, Bismarck, or Grand Forks, routine STD testing is straightforward and available at multiple locations in each city. For most people, that means a urine sample or a swab — quick, low-barrier, and confidential. North Dakota's gonorrhea rate climbed more than 500% over 15 years without most people noticing. STDTest.com can show you exactly where to get tested today.
WHO SHOULD GET TESTED
Sexually active adults in North Dakota — particularly those under 25, who account for a disproportionate share of chlamydia diagnoses statewide. Given that gonorrhea rates rose sharply for over a decade and syphilis jumped 51% in 2023, anyone with a new or multiple partners should test routinely, not just when symptoms appear. Most cases of all three diseases produce no obvious symptoms at all.
HOW OFTEN
Once a year is a reasonable floor for sexually active adults, based on North Dakota's sustained gonorrhea trend and the recent acceleration in syphilis. If you have more than one partner, or a partner whose status you don't know, testing every three to six months is appropriate. The two-year decline in chlamydia is encouraging, but the state's rates are still well above where they were a decade ago.
WHAT TO EXPECT
Standard STD testing for chlamydia, gonorrhea, and syphilis typically involves a urine sample and a blood draw — the whole process usually takes under 30 minutes at most clinics. Results are confidential. If a test comes back positive, treatment for all three infections is available and effective, and many clinics will walk you through next steps the same day.
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