Where in Texas are STI risks the highest?

Key Takeaways

• Syphilis rates nearly doubled from 9.7 to 18.8 cases per 100,000 between 2017 and 2022 in Texas.
• Gonorrhea increased by about 21%, from 206 to 249.4 cases per 100,000 over the same period.
• Texas’s STI Risk Score is 45 (4th highest in the U.S.).
• Frio County’s risk score (33.54) is over ten times higher than Loving County (risk score: 3.27).

Sexually transmitted infections (STIs) remain a significant public health challenge in Texas. A new report by LabCafe examines trends in reportable bacterial STIs, assessing Texas’s statewide risk profile.

Trends in Reportable Bacterial STIs (2017–2022).

• Chlamydia dipped in 2018–19, rebounded post-pandemic, and now sits at 626 per 100,000 (still below its 2017 peak).
• Gonorrhea climbed sharply during the pandemic year (2020 +30%), eased back slightly in 2022 yet remains 21% above 2017.
• Primary & Secondary Syphilis shows the steepest escalation, nearly doubling since 2019 and posting 18.8 per 100,000 in 2022; these early stages are highly contagious and marked by sores and rash.
• HIV diagnoses fell markedly in 2020 (−17.8%), then bounced back to just above 2017 levels by 2022.

Current Statewide Outlook (2022)

LabCafe calculated two separate STI-Risk Scores—one calculated at the state level and one at the county level—but both use the same variables, combining local STI infection burden rates (such as chlamydia, gonorrhea, syphilis, and new HIV diagnoses) and socio-economic vulnerability factors (like poverty, low education, and lack of insurance) to assess risk consistently across different geographic scales.

• Texas’s STI Risk Score is 45 (on a 0–100 scale), ranking 4th highest among U.S. states.
• The infection burden is higher than average (about 34.5),  ranking 13th highest among U.S. states.
• Texas is ranking 2nd for the socio-economic strain indicator (about 66.5), reflecting challenges like poverty, uninsured rates, and housing instability.
• These structural vulnerabilities, combined with moderately high disease rates, elevate Texas’s overall STI risk profile.

County-Level Risk Variation (2022)

Highest-risk counties:

1. Frio County (risk score: 33.54)
2. Dimmit County (24.86)
3. Reeves County (21.83)
4. Willacy County (21.44)
5. Potter County (20.55)

Lowest-risk counties:

1. Loving County (risk score: 3.27)
2. Borden County (5.24)
3. Roberts County (5.52)
4. Somervell County (5.53)
5. Kendall County (5.62)

Results by County

Implications

• Rising STI rates—especially for syphilis and gonorrhea—demand renewed prevention efforts.
• The gap between the highest- and lowest-risk counties is about tenfold, illustrating how unevenly STI risk is distributed across Texas.
• Targeted interventions in the highest-risk counties could yield a significant impact, while low-risk counties provide models for effective prevention.

Methodology

Data sources

• U.S. figures came from the CDC’s 2023 STI  surveillance tables. Each line gives one pathogen-specific rate (chlamydia, gonorrhea, primary & secondary syphilis, or new HIV diagnoses) for a state or territory.
• County-level microdata:CDC NCHHSTP Atlas.

County risk score 

• Gather four pathogen rates per county (chlamydia, gonorrhea, primary + secondary syphilis, new HIV) and four ACS percentages (poverty, no-HS diploma, uninsured, vacant housing).
• Min-max scale each variable to 0–100 so the lowest county becomes 0 and the highest becomes 100.
• Infection burden = average of the four scaled pathogen measures.
   Socio-economic strain = average of the four scaled structural measures.
• Combine with a 2-to-1 weight:
   Risk=0.67×Burden+0.33×StrainRisk=0.67×Burden+0.33×Strain
• National mean ≈ 9.9; scores above that signal elevated exposure or barriers to care.

State risk score 

• Gather four pathogen rates per state(chlamydia, gonorrhea, primary + secondary syphilis, new HIV) and four ACS percentages (poverty, no-HS diploma, uninsured, vacant housing).
• Min-max scale each variable to 0–100 so the lowest county becomes 0 and the highest becomes 100.
• Infection burden = average of the four scaled pathogen measures.
   Socio-economic strain = average of the four scaled structural measures.
• Combine with a 2-to-1 weight:
   Risk=0.67×Burden+0.33×StrainRisk=0.67×Burden+0.33×Strain