Counties with the highest STI rates in North Dakota

Sexually transmitted infections are on the rise, putting more people at risk as they spread. Chlamydia rates have nearly doubled since 2000, while the rate of gonorrhea went up by 50% over the same period. The Centers for Disease Control and Prevention reports that syphilis rates are reaching levels last seen in the 1950s.

But some regions of the U.S. are seeing higher rates than others.

Stacker used CDC data to look at which counties reported the highest rate of sexually transmitted infections in North Dakota. Counties are ranked by the rate of chlamydia infections, the most prominent STI at the national level, with gonorrhea and then syphilis rates serving as tiebreakers. This story focuses on bacterial infections, which can be cured, rather than viral infections such as HIV and herpes. At the county level, 2021 cases are the most recent available from the CDC, but state and national-level data for 2022 are also included. This story focuses on sexual transmissions and does not include congenital syphilis cases that were inherited from the mother.

Condoms are the most effective way to prevent the spread of STIs for people with multiple sexual partners, but research has found a decreasing rate of condom use among straight, bisexual, and gay male populations.

During the HIV/AIDS epidemic throughout the 1980s and 1990s, public health efforts advocating for condom use helped curb the spread of the virus. Today, however, condoms are no longer the only tool. Pills such as PrEP lower the risk of contracting HIV from sex by as much as 99%.

While more recent data is not available, the latest CDC survey from 2011-2015 showed less than half of unmarried men used condoms during the last time they had sex.

Among high school students having sex, the share using condoms has fallen from 60% in 2011 to 52% in 2021. While one-third of sexually active students used hormonal birth control, only 10% used both condoms and birth control. Methods like the pill and IUDs are effective at preventing pregnancy but do not stop the spread of STIs.

Chlamydia, gonorrhea, and syphilis are technically bacterial infections—meaning they can be cured with antibiotics—but they can still have lasting health impacts, including pelvic inflammatory disease and infertility. These risks are heightened when left untreated, which many STIs are as they don't obviously present themselves.

The CDC recommends annual testing for cisgender women, transgender men, and gender-nonconforming people with cervixes. It also recommends annual testing for males with male sexual partners. People in these groups who frequently have sex with anonymous partners should be tested every three to six months. Anyone with symptoms should always get tested according to the guidelines.

The CDC says there is little evidence that screening among straight men lowers the spread, and the agency's limited budget is put towards programs benefiting the most at-risk groups. However, some public health groups advocate for testing among all people regardless of sex and sexual orientation.

Data from the National Survey of Family Growth shows men on average have more opposite-sex sexual partners than women, and some argue that catching STIs throughout a sexual network rather than just for the most at-risk groups could curb their spread.

Soon, a pill may also help counter the spread of STIs. DoxyPEP can be taken 24 to 72 hours after unprotected sex and stops an STI before it becomes spreadable and symptomatic. The CDC has shared proposed guidelines recommending it for men who have sex with men and transgender women. The drug was originally approved for treating inhalation of anthrax, and doctors can prescribe it for off-label use.

Read on to see how STI infection rates in North Dakota compare nationally, and the top counties.

You may also like: Average North Dakota mortgage debt increased to $198,464 in 2024

Emma Rubin // Stacker

1 / 51

State-level statistics

- Chlamydia cases: 475.3 per 100K (#25 nationally, 3,704 cases)
- Gonorrhea cases: 183.0 per 100K (#22 nationally, 1,426 cases)
- Primary and secondary syphilis cases: 8.2 per 100K (#43 nationally, 64 cases)

SevenMaps // Shutterstock

2 / 51

#50. Steele County

- Chlamydia cases: 55.2 per 100K people (1 case)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Cammie Czuchnicki // Shutterstock

3 / 51

#49. Emmons County

- Chlamydia cases: 61.1 per 100K people (2 cases)
- Gonorrhea cases: 61.1 per 100K people (2 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

4 / 51

#48. Wells County

- Chlamydia cases: 76.8 per 100K people (3 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Jacob Boomsma // Shutterstock

5 / 51

#47. Dickey County

- Chlamydia cases: 81.7 per 100K people (4 cases)
- Gonorrhea cases: 61.3 per 100K people (3 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: Coldest Decembers in North Dakota since 1895

dedio // Shutterstock

6 / 51

#46. Cavalier County

- Chlamydia cases: 81.9 per 100K people (3 cases)
- Gonorrhea cases: 27.3 per 100K people (1 case)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

northlight // Shutterstock

7 / 51

#45. Kidder County

- Chlamydia cases: 84.4 per 100K people (2 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

8 / 51

#44. Griggs County

- Chlamydia cases: 87.7 per 100K people (2 cases)
- Gonorrhea cases: 43.8 per 100K people (1 case)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Charissa Enget // Shutterstock

9 / 51

#43. Burke County

- Chlamydia cases: 92.7 per 100K people (2 cases)
- Gonorrhea cases: 92.7 per 100K people (2 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Dirk Wierenga // Shutterstock

10 / 51

#42. Nelson County

- Chlamydia cases: 98.2 per 100K people (3 cases)
- Gonorrhea cases: 32.7 per 100K people (1 case)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: Hottest Marches in North Dakota since 1895

SevenMaps // Shutterstock

11 / 51

#41. Lamoure County

- Chlamydia cases: 98.4 per 100K people (4 cases)
- Gonorrhea cases: 49.2 per 100K people (2 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

12 / 51

#40. Logan County

- Chlamydia cases: 106.2 per 100K people (2 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

northlight // Shutterstock

13 / 51

#39. Mercer County

- Chlamydia cases: 120.1 per 100K people (10 cases)
- Gonorrhea cases: 96.1 per 100K people (8 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Zack Frank // Shutterstock

14 / 51

#38. Eddy County

- Chlamydia cases: 128.4 per 100K people (3 cases)
- Gonorrhea cases: 128.4 per 100K people (3 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Dirk Wierenga // Shutterstock

15 / 51

#37. Mchenry County

- Chlamydia cases: 133.4 per 100K people (7 cases)
- Gonorrhea cases: 38.1 per 100K people (2 cases)
- Syphilis cases (non-congenital): 19.1 per 100K people (1 case)
--- Primary and secondary syphilis: 19.1 per 100K people (1 case)
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: Cities with the most UFO sightings in North Dakota

SevenMaps // Shutterstock

16 / 51

#36. Foster County

- Chlamydia cases: 148.6 per 100K people (5 cases)
- Gonorrhea cases: 118.9 per 100K people (4 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Danita Delimont // Shutterstock

17 / 51

#35. Ransom County

- Chlamydia cases: 158.6 per 100K people (9 cases)
- Gonorrhea cases: 17.6 per 100K people (1 case)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Roadwardbound // Shutterstock

18 / 51

#34. Grant County

- Chlamydia cases: 172.2 per 100K people (4 cases)
- Gonorrhea cases: 172.2 per 100K people (4 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

19 / 51

#33. Renville County

- Chlamydia cases: 176.5 per 100K people (4 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

20 / 51

#32. Divide County

- Chlamydia cases: 182.8 per 100K people (4 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: See how popular pumpkin spice is in North Dakota

Bob Pool // Shutterstock

21 / 51

#31. Pembina County

- Chlamydia cases: 192.1 per 100K people (13 cases)
- Gonorrhea cases: 14.8 per 100K people (1 case)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

22 / 51

#30. Mcintosh County

- Chlamydia cases: 199.0 per 100K people (5 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Smpalmero // Shutterstock

23 / 51

#29. Mclean County

- Chlamydia cases: 204.2 per 100K people (20 cases)
- Gonorrhea cases: 81.7 per 100K people (8 cases)
- Syphilis cases (non-congenital): 10.2 per 100K people (1 case)
--- Primary and secondary syphilis: 10.2 per 100K people (1 case)
--- Nonprimary and nonsecondary early syphilis: 0 cases

Randall Runtsch // Shutterstock

24 / 51

#28. Billings County

- Chlamydia cases: 209.4 per 100K people (2 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

northlight // Shutterstock

25 / 51

#27. Adams County

- Chlamydia cases: 230.7 per 100K people (5 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: Cities with the fastest-growing home prices in North Dakota

SevenMaps // Shutterstock

26 / 51

#26. Sheridan County

- Chlamydia cases: 236.6 per 100K people (3 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Traveller70 // Shutterstock

27 / 51

#25. Dunn County

- Chlamydia cases: 247.8 per 100K people (10 cases)
- Gonorrhea cases: 24.8 per 100K people (1 case)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

StompingGirl // Shutterstock

28 / 51

#24. Sargent County

- Chlamydia cases: 261.2 per 100K people (10 cases)
- Gonorrhea cases: 0 cases
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

29 / 51

#23. Traill County

- Chlamydia cases: 262.4 per 100K people (21 case)
- Gonorrhea cases: 50.0 per 100K people (4 cases)
- Syphilis cases (non-congenital): 12.5 per 100K people (1 case)
--- Primary and secondary syphilis: 12.5 per 100K people (1 case)
--- Nonprimary and nonsecondary early syphilis: 0 cases

Canva

30 / 51

#22. Walsh County

- Chlamydia cases: 267.5 per 100K people (28 cases)
- Gonorrhea cases: 28.7 per 100K people (3 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: Fastest-growing jobs in North Dakota

Canva

31 / 51

#21. Pierce County

- Chlamydia cases: 278.3 per 100K people (11 case)
- Gonorrhea cases: 151.8 per 100K people (6 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Canva

32 / 51

#20. Barnes County

- Chlamydia cases: 296.1 per 100K people (32 cases)
- Gonorrhea cases: 46.3 per 100K people (5 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Bob Pool // Shutterstock

33 / 51

#19. Morton County

- Chlamydia cases: 330.2 per 100K people (111 case)
- Gonorrhea cases: 178.5 per 100K people (60 cases)
- Syphilis cases (non-congenital): 14.9 per 100K people (5 cases)
--- Primary and secondary syphilis: 14.9 per 100K people (5 cases)
--- Nonprimary and nonsecondary early syphilis: 0 cases

Tanyarmorgan2436 // Shutterstock

34 / 51

#18. Mckenzie County

- Chlamydia cases: 332.9 per 100K people (46 cases)
- Gonorrhea cases: 115.8 per 100K people (16 cases)
- Syphilis cases (non-congenital): 7.2 per 100K people (1 case)
--- Primary and secondary syphilis: 7.2 per 100K people (1 case)
--- Nonprimary and nonsecondary early syphilis: 0 cases

Canva

35 / 51

#17. Richland County

- Chlamydia cases: 350.2 per 100K people (58 cases)
- Gonorrhea cases: 175.1 per 100K people (29 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: Hottest Februarys in North Dakota since 1895

Cavan-Images // Shutterstock

36 / 51

#16. Stark County

- Chlamydia cases: 372.2 per 100K people (123 cases)
- Gonorrhea cases: 63.5 per 100K people (21 case)
- Syphilis cases (non-congenital): 21.2 per 100K people (7 cases)
--- Primary and secondary syphilis: 18.2 per 100K people (6 cases)
--- Nonprimary and nonsecondary early syphilis: 3.0 per 100K people (1 case)

SevenMaps // Shutterstock

37 / 51

#15. Towner County

- Chlamydia cases: 373.8 per 100K people (8 cases)
- Gonorrhea cases: 280.4 per 100K people (6 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

38 / 51

#14. Bottineau County

- Chlamydia cases: 391.2 per 100K people (25 cases)
- Gonorrhea cases: 46.9 per 100K people (3 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Canva

39 / 51

#13. Williams County

- Chlamydia cases: 400.2 per 100K people (154 cases)
- Gonorrhea cases: 122.1 per 100K people (47 cases)
- Syphilis cases (non-congenital): 15.6 per 100K people (6 cases)
--- Primary and secondary syphilis: 10.4 per 100K people (4 cases)
--- Nonprimary and nonsecondary early syphilis: 5.2 per 100K people (2 cases)

Jacob Boomsma // Shutterstock

40 / 51

#12. Stutsman County

- Chlamydia cases: 477.4 per 100K people (103 cases)
- Gonorrhea cases: 166.9 per 100K people (36 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

You may also like: The scoop on North Dakota's ice cream preferences, according to Instacart

Joseph Sohm // Shutterstock

41 / 51

#11. Burleigh County

- Chlamydia cases: 511.5 per 100K people (506 cases)
- Gonorrhea cases: 184.0 per 100K people (182 cases)
- Syphilis cases (non-congenital): 14.2 per 100K people (14 cases)
--- Primary and secondary syphilis: 12.1 per 100K people (12 cases)
--- Nonprimary and nonsecondary early syphilis: 2.0 per 100K people (2 cases)

Yosoyana // Shutterstock

42 / 51

#10. Ward County

- Chlamydia cases: 525.5 per 100K people (363 cases)
- Gonorrhea cases: 227.3 per 100K people (157 cases)
- Syphilis cases (non-congenital): 11.6 per 100K people (8 cases)
--- Primary and secondary syphilis: 7.2 per 100K people (5 cases)
--- Nonprimary and nonsecondary early syphilis: 4.3 per 100K people (3 cases)

Scott Cummings // Shutterstock

43 / 51

#9. Golden Valley County

- Chlamydia cases: 565.0 per 100K people (10 cases)
- Gonorrhea cases: 226.0 per 100K people (4 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Guy William // Shutterstock

44 / 51

#8. Cass County

- Chlamydia cases: 611.1 per 100K people (1,140 cases)
- Gonorrhea cases: 249.8 per 100K people (466 cases)
- Syphilis cases (non-congenital): 8.6 per 100K people (16 cases)
--- Primary and secondary syphilis: 4.3 per 100K people (8 cases)
--- Nonprimary and nonsecondary early syphilis: 4.3 per 100K people (8 cases)

Jacob Boomsma // Shutterstock

45 / 51

#7. Grand Forks County

- Chlamydia cases: 676.7 per 100K people (492 cases)
- Gonorrhea cases: 258.6 per 100K people (188 cases)
- Syphilis cases (non-congenital): 6.9 per 100K people (5 cases)
--- Primary and secondary syphilis: 5.5 per 100K people (4 cases)
--- Nonprimary and nonsecondary early syphilis: 1.4 per 100K people (1 case)

You may also like: Highest-rated things to do in North Dakota by visitors

Kit Leong // Shutterstock

46 / 51

#6. Mountrail County

- Chlamydia cases: 710.1 per 100K people (68 cases)
- Gonorrhea cases: 386.4 per 100K people (37 cases)
- Syphilis cases (non-congenital): 41.8 per 100K people (4 cases)
--- Primary and secondary syphilis: 10.4 per 100K people (1 case)
--- Nonprimary and nonsecondary early syphilis: 31.3 per 100K people (3 cases)

northlight // Shutterstock

47 / 51

#5. Hettinger County

- Chlamydia cases: 740.7 per 100K people (18 cases)
- Gonorrhea cases: 535.0 per 100K people (13 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Michael Coddington // Shutterstock

48 / 51

#4. Ramsey County

- Chlamydia cases: 838.2 per 100K people (97 cases)
- Gonorrhea cases: 527.1 per 100K people (61 case)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

Joseph Sohm // Shutterstock

49 / 51

#3. Sioux County

- Chlamydia cases: 1,658.6 per 100K people (62 cases)
- Gonorrhea cases: 1,498.1 per 100K people (56 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

SevenMaps // Shutterstock

50 / 51

#2. Rolette County

- Chlamydia cases: 1,801.1 per 100K people (217 cases)
- Gonorrhea cases: 1,485.7 per 100K people (179 cases)
- Syphilis cases (non-congenital): 16.6 per 100K people (2 cases)
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 16.6 per 100K people (2 cases)

You may also like: Most expensive homes for sale in North Dakota

SevenMaps // Shutterstock

51 / 51

#1. Benson County

- Chlamydia cases: 2,186.3 per 100K people (127 cases)
- Gonorrhea cases: 1,893.6 per 100K people (110 cases)
- Syphilis cases (non-congenital): 0 cases
--- Primary and secondary syphilis: 0 cases
--- Nonprimary and nonsecondary early syphilis: 0 cases

This story features data reporting and writing by Emma Rubin and is part of a series utilizing data automation across 49 states.