STD Rates in Texas
CDC surveillance data for Texas covering chlamydia, gonorrhea, syphilis, and HIV — with 15-year trends, city-level context, and national comparisons.
Texas ranks 21st out of 50 states for combined STD burden — squarely in the upper half, with a combined rate of 683.3 per 100,000 people. That number sits about 7% above the national median. But the more telling story isn't where Texas stands today — it's how it got here, and which diseases are still climbing.
Chlamydia is Texas's highest-volume disease by far, with more than 150,000 cases reported in 2023. The rate — 491.9 per 100,000 — is above the national median of 471.3, and it's been hovering in that range since the early 2010s. The good news, such as it is: chlamydia dropped 5% from 2022 to 2023, the first meaningful pullback after years of creeping growth. The long-run picture is still up, though — the rate has risen about 18% since 2008, suggesting that plateau isn't the same as progress.
Gonorrhea is where the trend line gets harder to explain away. Texas's rate of 176.4 is 16% above the national median of 152.2 — and that's actually after a 14.6% drop from 2022 to 2023, the sharpest single-year decline of the three major STDs. The rate had surged from 118 in 2009 to nearly 219 in 2021, a 33% long-run increase. Syphilis tells a different story: the rate has risen 158% since 2008, from 5.8 to 15.0 per 100,000 — and while it ticked down slightly in 2023, it remains just above the national median of 14.8. Two diseases declining year-over-year, neither one actually low.
HIV data through 2022 shows Texas recording 4,890 new diagnoses that year — a rate of 19.8 per 100,000, the highest in the six-year window. New cases dipped sharply in 2020, likely reflecting testing disruptions during the pandemic rather than any real reduction in transmission, before rebounding strongly in 2021 and 2022. If you're in Houston, San Antonio, or Dallas — three of the largest metros in the country and among the highest-volume testing markets in the state — the data makes a straightforward case for knowing your status. STDTest.com can help you find a testing location near you.
STD Trends in Texas
Texas's chlamydia rate has been elevated for over a decade, and 2023's reading of 491.9 per 100,000 sits above the national median of 471.3 — but what's notable is how little it has moved in either direction since 2011. The rate has essentially plateaued in the 485–535 range for twelve years, suggesting a persistent baseline rather than an ongoing surge. The 5% year-over-year decline in 2023 is the first notable dip in that stretch, though a single year rarely signals a turning point.
Gonorrhea in Texas has had one of the more volatile trajectories in the state's STD data — rising 33% from 2008 to a peak of 218.9 per 100,000 in 2021, then falling back to 176.4 in 2023 after a 14.6% single-year drop. Even at its current level, the rate is 16% above the national median of 152.2, meaning Texas hasn't returned to a middling position even after two consecutive years of decline. The spike-and-partial-retreat pattern bears watching: similar patterns in other states have reversed quickly.
Syphilis has risen more sharply in Texas than either chlamydia or gonorrhea over the long run — up 158% since 2008, from a rate of 5.8 to 15.0 per 100,000 in 2023. It now sits just barely above the national median of 14.8, a threshold Texas was well below for most of the 2000s. The slight 3.2% dip from 2022 to 2023 interrupts what had been a nearly unbroken 15-year climb, but one year of modest decline doesn't rewrite a trend that long.
Texas's HIV data covers 2017 through 2022, and over that window new diagnoses have generally held in the 4,300–4,900 range per year. The 2020 figure — 3,626 cases at a rate of 15.2 — stands out as an outlier, almost certainly reflecting reduced testing access during the early pandemic rather than a genuine decline in transmission. By 2022, diagnoses had rebounded to 4,890, the highest annual count in the six-year dataset, with a rate of 19.8 per 100,000.
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Texas vs National Average
Comparing 2023 rates against the U.S. median across all 50 states.
| Infection | Texas | US Median | Difference |
|---|---|---|---|
| Chlamydia | 491.9 | 471.3 | 4.4% above |
| Gonorrhea | 176.4 | 152.2 | 15.9% above |
| Syphilis (P&S) | 15 | 14.8 | 1.4% 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 |
|---|---|---|---|---|---|
| Reeves County | #1 of 247 | 1673.7 | 1469.8 | 203.9 | 0.0 |
| Dimmit County | #2 of 247 | 1574.4 | 993.1 | 545.0 | 36.3 |
| Frio County | #3 of 247 | 1484.4 | 1267.6 | 200.1 | 16.7 |
| Potter County | #4 of 247 | 1222.9 | 839.1 | 344.5 | 39.3 |
| Dallas County | #5 of 247 | 1150.7 | 782.9 | 359.2 | 8.6 |
| Kleberg County | #6 of 247 | 1147.4 | 927.9 | 202.9 | 16.6 |
| Travis County | #7 of 247 | 1059.4 | 681.7 | 347.9 | 29.8 |
| Lubbock County | #8 of 247 | 1034.5 | 718.8 | 262.4 | 53.3 |
| Bell County | #9 of 247 | 963.6 | 708.6 | 237.5 | 17.5 |
| Nueces County | #10 of 247 | 962.6 | 675.6 | 263.4 | 23.6 |
| Zavala County | #11 of 247 | 923.6 | 569.2 | 354.4 | 0.0 |
| Harris County | #12 of 247 | 910.2 | 641.4 | 240.6 | 28.2 |
| Dawson County | #13 of 247 | 858.0 | 624.8 | 174.9 | 58.3 |
| Mclennan County | #14 of 247 | 854.4 | 637.4 | 202.5 | 14.5 |
| Brazos County | #15 of 247 | 850.4 | 614.6 | 223.1 | 12.7 |
| Tom Green County | #16 of 247 | 842.5 | 610.6 | 207.5 | 24.4 |
| Jefferson County | #17 of 247 | 840.6 | 601.6 | 222.3 | 16.7 |
| Bowie County | #18 of 247 | 807.1 | 583.5 | 207.2 | 16.4 |
| Victoria County | #19 of 247 | 778.9 | 572.7 | 193.1 | 13.1 |
| Willacy County | #20 of 247 | 778.5 | 678.7 | 94.8 | 5.0 |
| Midland County | #21 of 247 | 773.6 | 612.6 | 142.9 | 18.1 |
| Gregg County | #22 of 247 | 748.6 | 594.1 | 150.5 | 4.0 |
| Nacogdoches County | #23 of 247 | 744.9 | 607.3 | 136.1 | 1.5 |
| El Paso County | #24 of 247 | 744.4 | 588.9 | 137.5 | 18.0 |
| Tarrant County | #25 of 247 | 728.1 | 507.1 | 205.9 | 15.1 |
| Robertson County | #26 of 247 | 723.9 | 544.4 | 179.5 | 0.0 |
| Walker County | #27 of 247 | 723.5 | 563.6 | 155.0 | 4.9 |
| Ector County | #28 of 247 | 723.3 | 578.7 | 126.4 | 18.2 |
| Irion County | #29 of 247 | 710.2 | 645.6 | 64.6 | 0.0 |
| Lamar County | #30 of 247 | 702.2 | 506.6 | 183.9 | 11.7 |
| Titus County | #31 of 247 | 701.6 | 551.7 | 143.5 | 6.4 |
| Cameron County | #32 of 247 | 696.2 | 604.6 | 84.1 | 7.5 |
| Terry County | #33 of 247 | 692.8 | 519.6 | 138.6 | 34.6 |
| Smith County | #34 of 247 | 675.3 | 517.9 | 146.4 | 11.0 |
| Crosby County | #35 of 247 | 671.2 | 569.5 | 101.7 | 0.0 |
| Coryell County | #36 of 247 | 659.8 | 505.4 | 136.7 | 17.7 |
| Falls County | #37 of 247 | 647.9 | 503.3 | 138.8 | 5.8 |
| Hays County | #38 of 247 | 646.4 | 472.4 | 159.4 | 14.6 |
| Brooks County | #39 of 247 | 642.5 | 569.5 | 58.4 | 14.6 |
| Crockett County | #40 of 247 | 629.8 | 594.8 | 35.0 | 0.0 |
| Donley County | #41 of 247 | 622.3 | 404.5 | 217.8 | 0.0 |
| Runnels County | #42 of 247 | 618.1 | 374.9 | 233.1 | 10.1 |
| Camp County | #43 of 247 | 615.4 | 392.3 | 207.7 | 15.4 |
| Morris County | #44 of 247 | 613.3 | 397.8 | 190.6 | 24.9 |
| Harrison County | #45 of 247 | 605.1 | 481.0 | 119.9 | 4.2 |
| Reagan County | #46 of 247 | 604.9 | 541.2 | 63.7 | 0.0 |
| Scurry County | #47 of 247 | 598.3 | 425.6 | 135.7 | 37.0 |
| Hale County | #48 of 247 | 595.0 | 456.5 | 119.6 | 18.9 |
| Nolan County | #49 of 247 | 594.1 | 433.4 | 111.8 | 48.9 |
| Uvalde County | #50 of 247 | 593.0 | 492.8 | 100.2 | 0.0 |
| Bastrop County | #51 of 247 | 590.4 | 425.2 | 148.0 | 17.2 |
| Angelina County | #52 of 247 | 584.1 | 481.0 | 96.2 | 6.9 |
| Bexar County | #53 of 247 | 583.3 | 399.2 | 165.7 | 18.4 |
| Upton County | #54 of 247 | 579.0 | 450.3 | 96.5 | 32.2 |
| Webb County | #55 of 247 | 578.1 | 474.1 | 87.3 | 16.7 |
| Deaf Smith County | #56 of 247 | 577.8 | 506.9 | 60.0 | 10.9 |
| Shelby County | #57 of 247 | 574.8 | 454.9 | 119.9 | 0.0 |
| Edwards County | #58 of 247 | 574.3 | 502.5 | 71.8 | 0.0 |
| Erath County | #59 of 247 | 572.4 | 491.0 | 76.9 | 4.5 |
| Caldwell County | #60 of 247 | 567.6 | 449.3 | 110.3 | 8.0 |
| Kaufman County | #61 of 247 | 566.5 | 421.1 | 140.0 | 5.4 |
| Randall County | #62 of 247 | 557.8 | 412.1 | 130.9 | 14.8 |
| Washington County | #63 of 247 | 556.6 | 372.9 | 175.6 | 8.1 |
| Hudspeth County | #64 of 247 | 550.6 | 521.6 | 29.0 | 0.0 |
| San Patricio County | #65 of 247 | 542.0 | 409.0 | 120.3 | 12.7 |
| Duval County | #66 of 247 | 541.4 | 437.3 | 83.3 | 20.8 |
| Grimes County | #67 of 247 | 540.4 | 358.2 | 176.0 | 6.2 |
| Coke County | #68 of 247 | 537.0 | 477.3 | 59.7 | 0.0 |
| Lamb County | #69 of 247 | 535.0 | 369.8 | 141.6 | 23.6 |
| Cherokee County | #70 of 247 | 532.4 | 409.8 | 111.1 | 11.5 |
| Wichita County | #71 of 247 | 530.8 | 366.4 | 142.1 | 22.3 |
| Houston County | #72 of 247 | 530.2 | 403.3 | 126.9 | 0.0 |
| Howard County | #73 of 247 | 526.9 | 392.7 | 114.6 | 19.6 |
| Winkler County | #74 of 247 | 526.0 | 418.1 | 94.4 | 13.5 |
| Val Verde County | #75 of 247 | 521.8 | 400.3 | 119.4 | 2.1 |
| Brazoria County | #76 of 247 | 521.1 | 404.8 | 108.0 | 8.3 |
| Jim Wells County | #77 of 247 | 514.8 | 388.0 | 119.0 | 7.8 |
| Hockley County | #78 of 247 | 512.6 | 405.4 | 93.2 | 14.0 |
| Taylor County | #79 of 247 | 510.8 | 401.8 | 91.3 | 17.7 |
| San Augustine County | #80 of 247 | 510.6 | 408.5 | 102.1 | 0.0 |
| Milam County | #81 of 247 | 508.7 | 381.5 | 100.2 | 27.0 |
| Galveston County | #82 of 247 | 504.8 | 384.2 | 107.3 | 13.3 |
| Marion County | #83 of 247 | 491.0 | 417.9 | 73.1 | 0.0 |
| Hunt County | #84 of 247 | 490.5 | 371.4 | 112.9 | 6.2 |
| Maverick County | #85 of 247 | 488.2 | 399.9 | 88.3 | 0.0 |
| Hidalgo County | #86 of 247 | 484.3 | 392.2 | 82.8 | 9.3 |
| Rusk County | #87 of 247 | 484.2 | 376.8 | 90.4 | 17.0 |
| Live Oak County | #88 of 247 | 483.5 | 336.7 | 129.5 | 17.3 |
| Gonzales County | #89 of 247 | 481.7 | 366.3 | 105.4 | 10.0 |
| Waller County | #90 of 247 | 479.9 | 376.1 | 99.1 | 4.7 |
| Limestone County | #91 of 247 | 476.5 | 359.6 | 112.4 | 4.5 |
| Ellis County | #92 of 247 | 475.3 | 357.7 | 111.3 | 6.3 |
| Cass County | #93 of 247 | 474.6 | 303.6 | 146.6 | 24.4 |
| Bee County | #94 of 247 | 473.3 | 327.4 | 123.2 | 22.7 |
| Hopkins County | #95 of 247 | 468.9 | 377.2 | 86.5 | 5.2 |
| Matagorda County | #96 of 247 | 467.6 | 374.0 | 85.3 | 8.3 |
| Liberty County | #97 of 247 | 459.1 | 371.3 | 81.3 | 6.5 |
| Henderson County | #98 of 247 | 458.4 | 348.2 | 99.8 | 10.4 |
| Oldham County | #99 of 247 | 448.7 | 336.5 | 112.2 | 0.0 |
| Moore County | #100 of 247 | 448.4 | 405.9 | 42.5 | 0.0 |
| Wharton County | #101 of 247 | 448.1 | 354.6 | 86.3 | 7.2 |
| Wilbarger County | #102 of 247 | 447.2 | 343.4 | 95.8 | 8.0 |
| Ward County | #103 of 247 | 446.9 | 364.8 | 82.1 | 0.0 |
| Burleson County | #104 of 247 | 446.7 | 308.1 | 133.5 | 5.1 |
| Mcculloch County | #105 of 247 | 442.9 | 322.1 | 120.8 | 0.0 |
| Yoakum County | #106 of 247 | 441.9 | 334.8 | 93.7 | 13.4 |
| Williamson County | #107 of 247 | 438.8 | 319.3 | 111.9 | 7.6 |
| Anderson County | #108 of 247 | 429.6 | 330.8 | 84.9 | 13.9 |
| Andrews County | #109 of 247 | 428.6 | 364.3 | 48.2 | 16.1 |
| Fort Bend County | #110 of 247 | 426.5 | 322.8 | 97.0 | 6.7 |
| Hall County | #111 of 247 | 425.9 | 319.4 | 71.0 | 35.5 |
| Garza County | #112 of 247 | 420.6 | 287.8 | 132.8 | 0.0 |
| Briscoe County | #113 of 247 | 415.2 | 207.6 | 69.2 | 138.4 |
| Denton County | #114 of 247 | 410.8 | 304.2 | 105.2 | 1.4 |
| Orange County | #115 of 247 | 408.2 | 305.6 | 89.8 | 12.8 |
| Lee County | #116 of 247 | 405.7 | 328.9 | 71.3 | 5.5 |
| Ochiltree County | #117 of 247 | 401.9 | 350.4 | 51.5 | 0.0 |
| Atascosa County | #118 of 247 | 397.8 | 299.3 | 86.9 | 11.6 |
| Pecos County | #119 of 247 | 396.6 | 300.9 | 88.9 | 6.8 |
| Austin County | #120 of 247 | 394.6 | 312.5 | 78.9 | 3.2 |
| Castro County | #121 of 247 | 387.5 | 359.8 | 27.7 | 0.0 |
| La Salle County | #122 of 247 | 382.5 | 290.7 | 91.8 | 0.0 |
| Franklin County | #123 of 247 | 381.9 | 316.7 | 46.6 | 18.6 |
| Guadalupe County | #124 of 247 | 381.5 | 270.1 | 102.9 | 8.5 |
| Hill County | #125 of 247 | 378.0 | 286.1 | 73.5 | 18.4 |
| Grayson County | #126 of 247 | 377.7 | 295.4 | 73.5 | 8.8 |
| Red River County | #127 of 247 | 376.8 | 256.9 | 102.8 | 17.1 |
| Calhoun County | #128 of 247 | 375.8 | 299.6 | 71.1 | 5.1 |
| Navarro County | #129 of 247 | 373.9 | 273.2 | 89.9 | 10.8 |
| Jasper County | #130 of 247 | 370.1 | 256.9 | 104.0 | 9.2 |
| Presidio County | #131 of 247 | 362.4 | 327.9 | 34.5 | 0.0 |
| Delta County | #132 of 247 | 362.3 | 289.9 | 54.3 | 18.1 |
| Fisher County | #133 of 247 | 360.0 | 249.2 | 83.1 | 27.7 |
| Bailey County | #134 of 247 | 359.8 | 299.8 | 45.0 | 15.0 |
| Dallam County | #135 of 247 | 359.2 | 331.6 | 27.6 | 0.0 |
| Lampasas County | #136 of 247 | 356.8 | 253.6 | 86.0 | 17.2 |
| Hutchinson County | #137 of 247 | 349.4 | 304.5 | 39.9 | 5.0 |
| Collin County | #137 of 247 | 349.4 | 256.8 | 86.3 | 6.3 |
| Panola County | #139 of 247 | 345.9 | 258.3 | 87.6 | 0.0 |
| Gray County | #140 of 247 | 344.3 | 277.3 | 57.4 | 9.6 |
| Madison County | #141 of 247 | 342.0 | 276.5 | 65.5 | 0.0 |
| Montgomery County | #142 of 247 | 341.1 | 265.7 | 71.0 | 4.4 |
| Brown County | #143 of 247 | 335.8 | 276.4 | 56.8 | 2.6 |
| Concho County | #144 of 247 | 333.6 | 273.0 | 30.3 | 30.3 |
| Cooke County | #145 of 247 | 333.5 | 267.2 | 61.7 | 4.6 |
| Colorado County | #146 of 247 | 331.5 | 274.7 | 56.8 | 0.0 |
| Aransas County | #147 of 247 | 331.0 | 264.0 | 63.1 | 3.9 |
| Trinity County | #148 of 247 | 330.4 | 260.1 | 63.3 | 7.0 |
| Johnson County | #149 of 247 | 330.2 | 256.3 | 69.0 | 4.9 |
| Burnet County | #150 of 247 | 329.7 | 279.7 | 40.7 | 9.3 |
| Armstrong County | #151 of 247 | 327.5 | 327.5 | 0.0 | 0.0 |
| Freestone County | #152 of 247 | 318.0 | 200.6 | 107.6 | 9.8 |
| Jim Hogg County | #153 of 247 | 317.8 | 211.9 | 105.9 | 0.0 |
| Swisher County | #154 of 247 | 316.3 | 215.7 | 100.6 | 0.0 |
| Refugio County | #155 of 247 | 315.0 | 270.0 | 30.0 | 15.0 |
| Palo Pinto County | #156 of 247 | 312.7 | 245.4 | 63.9 | 3.4 |
| Rockwall County | #157 of 247 | 312.3 | 224.7 | 85.3 | 2.3 |
| Collingsworth County | #158 of 247 | 312.1 | 273.1 | 39.0 | 0.0 |
| Upshur County | #159 of 247 | 311.9 | 233.4 | 71.6 | 6.9 |
| Cottle County | #160 of 247 | 309.1 | 309.1 | 0.0 | 0.0 |
| Mitchell County | #161 of 247 | 308.5 | 253.4 | 22.0 | 33.1 |
| Menard County | #162 of 247 | 306.4 | 153.2 | 153.2 | 0.0 |
| Chambers County | #163 of 247 | 306.3 | 237.6 | 63.1 | 5.6 |
| Karnes County | #163 of 247 | 306.3 | 239.7 | 53.3 | 13.3 |
| Callahan County | #165 of 247 | 306.1 | 236.5 | 62.6 | 7.0 |
| Crane County | #165 of 247 | 306.1 | 284.2 | 21.9 | 0.0 |
| Mason County | #167 of 247 | 305.2 | 228.9 | 50.9 | 25.4 |
| Leon County | #168 of 247 | 302.3 | 254.0 | 42.3 | 6.0 |
| Newton County | #169 of 247 | 299.0 | 249.2 | 49.8 | 0.0 |
| Comanche County | #170 of 247 | 298.9 | 249.1 | 49.8 | 0.0 |
| Sherman County | #171 of 247 | 298.7 | 298.7 | 0.0 | 0.0 |
| Goliad County | #172 of 247 | 294.0 | 252.0 | 42.0 | 0.0 |
| Medina County | #173 of 247 | 293.8 | 219.0 | 67.5 | 7.3 |
| Kimble County | #174 of 247 | 292.6 | 202.6 | 67.5 | 22.5 |
| Starr County | #175 of 247 | 291.2 | 248.7 | 31.9 | 10.6 |
| Terrell County | #176 of 247 | 291.1 | 291.1 | 0.0 | 0.0 |
| Jackson County | #177 of 247 | 289.1 | 236.5 | 46.0 | 6.6 |
| Martin County | #178 of 247 | 287.5 | 249.2 | 38.3 | 0.0 |
| Fayette County | #179 of 247 | 286.6 | 212.0 | 66.7 | 7.9 |
| Sterling County | #180 of 247 | 286.3 | 286.3 | 0.0 | 0.0 |
| Rains County | #181 of 247 | 284.9 | 231.0 | 53.9 | 0.0 |
| Childress County | #182 of 247 | 279.9 | 250.4 | 29.5 | 0.0 |
| Wood County | #183 of 247 | 275.5 | 204.5 | 66.8 | 4.2 |
| San Saba County | #184 of 247 | 273.7 | 205.3 | 34.2 | 34.2 |
| Culberson County | #185 of 247 | 273.2 | 227.7 | 45.5 | 0.0 |
| Lavaca County | #186 of 247 | 272.3 | 218.8 | 53.5 | 0.0 |
| Wheeler County | #187 of 247 | 270.6 | 229.0 | 41.6 | 0.0 |
| Glasscock County | #188 of 247 | 262.9 | 175.3 | 87.6 | 0.0 |
| Gaines County | #189 of 247 | 262.0 | 217.6 | 31.1 | 13.3 |
| San Jacinto County | #190 of 247 | 259.2 | 179.7 | 79.5 | 0.0 |
| Polk County | #191 of 247 | 254.7 | 201.2 | 49.8 | 3.7 |
| Gillespie County | #192 of 247 | 252.4 | 212.7 | 36.1 | 3.6 |
| Dewitt County | #193 of 247 | 250.9 | 200.7 | 45.2 | 5.0 |
| Comal County | #194 of 247 | 250.0 | 191.3 | 51.0 | 7.7 |
| Zapata County | #195 of 247 | 247.5 | 203.8 | 36.4 | 7.3 |
| Knox County | #196 of 247 | 242.3 | 212.0 | 30.3 | 0.0 |
| Tyler County | #197 of 247 | 240.4 | 191.3 | 49.1 | 0.0 |
| Eastland County | #198 of 247 | 238.4 | 210.7 | 27.7 | 0.0 |
| Jack County | #199 of 247 | 236.7 | 214.1 | 11.3 | 11.3 |
| Floyd County | #200 of 247 | 235.8 | 235.8 | 0.0 | 0.0 |
| Stephens County | #201 of 247 | 235.5 | 203.4 | 32.1 | 0.0 |
| Llano County | #202 of 247 | 231.7 | 188.0 | 30.6 | 13.1 |
| Van Zandt County | #203 of 247 | 231.3 | 179.7 | 46.9 | 4.7 |
| Baylor County | #204 of 247 | 231.1 | 144.4 | 28.9 | 57.8 |
| Hardeman County | #205 of 247 | 229.3 | 200.6 | 28.7 | 0.0 |
| Young County | #206 of 247 | 226.2 | 165.5 | 33.1 | 27.6 |
| Jones County | #207 of 247 | 225.7 | 157.0 | 49.1 | 19.6 |
| Lynn County | #207 of 247 | 225.7 | 121.5 | 86.8 | 17.4 |
| Hardin County | #209 of 247 | 224.9 | 187.1 | 30.9 | 6.9 |
| Fannin County | #210 of 247 | 223.6 | 173.0 | 47.9 | 2.7 |
| Parker County | #211 of 247 | 223.1 | 171.8 | 48.4 | 2.9 |
| Shackelford County | #212 of 247 | 216.8 | 154.8 | 31.0 | 31.0 |
| Kendall County | #213 of 247 | 213.7 | 164.2 | 45.5 | 4.0 |
| Schleicher County | #214 of 247 | 209.1 | 167.3 | 41.8 | 0.0 |
| Hood County | #215 of 247 | 208.1 | 171.2 | 33.9 | 3.0 |
| Sabine County | #216 of 247 | 207.8 | 148.4 | 49.5 | 9.9 |
| Carson County | #217 of 247 | 204.1 | 153.1 | 51.0 | 0.0 |
| Mills County | #218 of 247 | 197.9 | 197.9 | 0.0 | 0.0 |
| Parmer County | #219 of 247 | 197.6 | 176.8 | 20.8 | 0.0 |
| Hamilton County | #220 of 247 | 197.2 | 185.6 | 11.6 | 0.0 |
| Hartley County | #221 of 247 | 194.3 | 174.9 | 19.4 | 0.0 |
| Blanco County | #222 of 247 | 191.6 | 138.0 | 53.6 | 0.0 |
| Archer County | #223 of 247 | 188.4 | 155.1 | 22.2 | 11.1 |
| Wise County | #224 of 247 | 188.3 | 153.7 | 26.9 | 7.7 |
| Hemphill County | #225 of 247 | 188.2 | 156.8 | 31.4 | 0.0 |
| Brewster County | #226 of 247 | 178.7 | 157.7 | 21.0 | 0.0 |
| Kerr County | #227 of 247 | 178.1 | 128.0 | 42.7 | 7.4 |
| Wilson County | #228 of 247 | 177.1 | 125.5 | 42.4 | 9.2 |
| Mcmullen County | #229 of 247 | 176.1 | 176.1 | 0.0 | 0.0 |
| Bosque County | #230 of 247 | 168.5 | 152.7 | 15.8 | 0.0 |
| Stonewall County | #231 of 247 | 164.2 | 82.1 | 82.1 | 0.0 |
| Cochran County | #232 of 247 | 159.4 | 159.4 | 0.0 | 0.0 |
| Sutton County | #233 of 247 | 155.2 | 124.2 | 31.0 | 0.0 |
| Bandera County | #234 of 247 | 154.6 | 123.7 | 30.9 | 0.0 |
| Montague County | #235 of 247 | 143.5 | 125.0 | 18.5 | 0.0 |
| Somervell County | #236 of 247 | 141.6 | 141.6 | 0.0 | 0.0 |
| Real County | #237 of 247 | 140.2 | 140.2 | 0.0 | 0.0 |
| Clay County | #238 of 247 | 139.6 | 93.1 | 18.6 | 27.9 |
| Kent County | #239 of 247 | 136.2 | 136.2 | 0.0 | 0.0 |
| Coleman County | #240 of 247 | 127.6 | 102.0 | 12.8 | 12.8 |
| Dickens County | #241 of 247 | 116.9 | 116.9 | 0.0 | 0.0 |
| Jeff Davis County | #242 of 247 | 107.8 | 107.8 | 0.0 | 0.0 |
| Motley County | #243 of 247 | 98.0 | 98.0 | 0.0 | 0.0 |
| Kinney County | #244 of 247 | 95.3 | 63.5 | 31.8 | 0.0 |
| Haskell County | #245 of 247 | 92.8 | 55.7 | 37.1 | 0.0 |
| Foard County | #246 of 247 | 92.7 | 0.0 | 92.7 | 0.0 |
| Hansford County | #247 of 247 | 78.9 | 78.9 | 0.0 | 0.0 |
What the numbers mean — and what to do about them
In raw terms, Texas recorded more than 208,000 combined chlamydia, gonorrhea, and syphilis cases in 2023 across a population of roughly 30.5 million. That works out to a combined rate of 683.3 per 100,000 — about 7% above the national median. For a state this large, those numbers add up fast, and the case counts in major metros like Houston, Dallas, and San Antonio represent a substantial share of the total.
The trend that warrants the most attention is syphilis. A 158% increase over fifteen years isn't noise — it reflects a disease that spreads efficiently when screening gaps exist, because most people with syphilis have no symptoms and don't know they're infected. Gonorrhea has followed a similar pattern: rates surged through the 2010s, peaked in 2021, and remain above the national median even after two years of decline. When diseases are this common and this often asymptomatic, the gap between actual infection and reported cases is always wider than the data shows.
If you live in Texas — particularly in Houston, San Antonio, or Dallas, where case volumes are highest — routine testing is the practical response to what the data shows. Texas's syphilis rate has more than doubled since 2008 while most residents had no idea it was happening. STDTest.com can show you exactly where to get tested today, so you're not part of that gap.
WHO SHOULD GET TESTED
Anyone sexually active in Texas should consider routine STD screening, but the data points most clearly to adults under 25 — who account for a disproportionate share of chlamydia cases — and to anyone in Houston, Dallas, or San Antonio, where combined case volumes are highest. Given Texas's gonorrhea rate sits 16% above the national median and syphilis has risen 158% since 2008, testing isn't just for people who have symptoms. Most infections in these categories produce none.
HOW OFTEN
Once a year is a reasonable baseline for sexually active adults given Texas's above-median rates for chlamydia and gonorrhea. If you have multiple partners or have had unprotected sex, testing every three to six months is more appropriate — especially for gonorrhea and syphilis, both of which have shown sustained elevation in Texas over the past decade. HIV testing is also worth including annually given the state's 2022 rate of 19.8 per 100,000.
WHAT TO EXPECT
STD testing is fast and low-friction at most sites. Chlamydia and gonorrhea are typically detected with a urine sample or swab; syphilis and HIV require a blood draw. Results usually come back within a few days, and many clinics offer confidential or anonymous options. If something comes back positive, effective treatment exists for all three bacterial STDs — and early detection makes treatment simpler.
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