Alabama STD Rates by County: Highest, Lowest, and Syphilis Trends

Alabama’s STD rates vary dramatically by county, with Montgomery County reporting the highest rates in the state for chlamydia, gonorrhea, and syphilis in 2024, and several northern counties reporting the lowest. Montgomery’s combined rates run roughly twenty times higher than the lowest-reporting counties, and the Black Belt region that stretches across the southern midsection of the state consistently carries the heaviest burden.¹

Counties With the Highest Rates

Montgomery County led the state in 2024 with a chlamydia rate of 1,277.4 per 100,000 residents, a gonorrhea rate of 449.8, and a primary-and-secondary syphilis rate of 106.7.¹ Adding all syphilis categories together, Montgomery’s combined STD rate across the three infections exceeded 2,000 per 100,000, more than double the statewide average.

The geographic pattern is hard to miss. Counties in and around the Black Belt consistently report the highest infection rates. These counties face overlapping disadvantages: higher poverty, fewer healthcare providers, and limited access to routine screening. ADPH identifies this region as a priority area for investigation and intervention.²

Other high-rate counties in 2024 included Jefferson, which contains Birmingham, along with Tuscaloosa and Mobile. Urban counties benefit from higher screening volumes at their clinics, but their rates still run well above the state average.

Counties With the Lowest Rates

The lowest-rate counties sit in northern and eastern Alabama, where smaller populations and more limited screening infrastructure contribute to fewer reported cases. Winston County reported just 24 chlamydia cases and a single gonorrhea case in all of 2024.¹ Several counties reported zero cases of primary and secondary syphilis for the year.

Low reported rates do not necessarily mean low actual infection rates. Counties with fewer clinics and less routine screening will inevitably capture fewer cases. A county that tests infrequently may look healthy on paper while infections spread undetected. That surveillance blind spot is worth keeping in mind when comparing rural counties to urban ones with robust testing programs.

How Alabama Compares Nationally

Alabama’s county-level disparities sit on top of a statewide burden that ranks among the worst in the country. In 2023, Alabama ranked 4th among all states for chlamydia at 651.1 per 100,000, 8th for gonorrhea at 226.9, and 5th for primary and secondary syphilis at 28.6.³ For context, the national chlamydia rate was 492.2 per 100,000 and the national gonorrhea rate was 179.5. Alabama exceeded both by roughly a third.

Chlamydia accounts for the largest share of reported cases. In 2024, Alabama recorded 33,261 chlamydia cases, 11,592 gonorrhea cases, and 1,596 primary and secondary syphilis cases.¹

The Syphilis Trend Behind the County Numbers

The infection driving the most concern among Alabama public health officials right now is syphilis. The state reported 523 primary and secondary syphilis cases in 2020.⁴ By 2024, that number had tripled to 1,596, climbing year over year through 1,190 cases in 2022 and 1,406 in 2023.¹

Rising adult syphilis translates directly into more congenital syphilis, which occurs when a pregnant person transmits the infection to their baby and can cause stillbirth, bone deformities, and neurological damage. Alabama reported 41 congenital syphilis cases in 2023 at a rate of 70.5 per 100,000 live births.³ Alabama law responds to this risk by requiring practitioners to test pregnant women for syphilis at the initial prenatal visit, again during the third trimester, and at labor and delivery.⁵

Untreated chlamydia and gonorrhea carry their own long-term costs. Roughly 10 to 15 percent of women with untreated chlamydia will develop pelvic inflammatory disease, and the resulting scarring can lead to infertility, sometimes without any obvious symptoms along the way.⁶ Every county-level disparity is ultimately a story about testing access and follow-through.

Where to Get Tested for Free in Any Alabama County

ADPH operates free, confidential STD clinics through county health departments in all 67 counties. These clinics provide testing and treatment for chlamydia, gonorrhea, syphilis, trichomoniasis, and HIV at no cost, along with counseling and partner notification services.⁷ For residents in low-reporting rural counties, where private testing options may be limited, the county health department is often the most accessible route to screening.

ADPH also mails home specimen collection kits that test for chlamydia, gonorrhea, syphilis, and HIV. Residents can request one kit every three months by creating an account through the ADPH online portal, completing a risk assessment, and selecting from available test combinations.⁸ A third kit option that includes creatinine testing is available for individuals enrolled in PrEP.

Private lab testing typically runs $150 to $400 out of pocket for a comprehensive panel. Under the Affordable Care Act, non-grandfathered private health insurance plans must cover certain STD screenings without cost-sharing when ordered consistent with U.S. Preventive Services Task Force recommendations, including chlamydia and gonorrhea testing for sexually active women under 25, syphilis screening for individuals at increased risk, and syphilis screening for all pregnant women.⁹

How Often You Should Get Tested

Screening frequency depends on age, sex, and sexual activity. CDC guidelines recommend the following for the infections most common in Alabama:¹⁰

Chlamydia and gonorrhea: annual screening for sexually active women under 25 and for older women at increased risk. Men who have sex with men should be screened at least annually, and every three to six months if at higher risk.
Syphilis: screening for anyone at increased risk, including individuals with a history of incarceration, those who engage in transactional sex, and men who have sex with men. MSM should be screened at least annually and more frequently if at higher risk.
HIV: at least annual screening for people living with HIV, and at least one lifetime test for everyone aged 13 to 64.

Alabama’s high syphilis rates mean that risk-based screening applies broadly across the state, not just in Montgomery and the Black Belt.

Minors Can Consent to Testing on Their Own

Alabama law allows any minor to consent to STD testing and treatment without parental permission or notification. Under Alabama Code Section 22-8-6, a minor can independently consent to services that determine the presence of or treat sexually transmitted infections, reportable diseases, drug dependency, alcohol toxicity, or pregnancy.¹¹ No other person’s consent is required. Fear of parental involvement is one of the most common reasons teenagers delay testing, and Alabama’s rates among young people make early detection especially important.

1
Alabama Department of Public Health. Alabama Sexually Transmitted Diseases Report January 2021 to March 2025
2
Alabama Department of Public Health. Sexually Transmitted Infections
3
Centers for Disease Control and Prevention. 2023 STI Surveillance State Ranking Tables
4
Alabama Department of Public Health. Sexually Transmitted Diseases Annual Report 2020
5
Alabama Administrative Code. Alabama Administrative Code 420-4-1-.11 – Testing of Pregnant Women for Sexually Transmitted Diseases
6
Centers for Disease Control and Prevention. Infertility and STDs
7
Alabama Department of Public Health. Get Tested
8
Alabama Department of Public Health. Home Testing
9
Centers for Disease Control and Prevention. STD Preventive Service Coverage Tables
10
Centers for Disease Control and Prevention. STI Screening Recommendations
11
Alabama Legislature. Alabama Code 22-8-6 – Consent of Any Minor as to Certain Conditions