The Rising Tide of STIs in Georgia: A County-by-County Look at a Growing Public Health Concern

Georgia doesn't have a quiet sexual health story. The state recorded the 4th-highest overall STD rate in the entire country in 2023, and it's been in the national top five for chlamydia and gonorrhea for years running. But the number that gets the least attention is the one that should worry Georgians most: syphilis cases jumped over 11% in a single year, and babies born with the infection — congenital syphilis, almost always preventable with a simple prenatal blood test — rose more than 25% in that same stretch. This report walks through what the Georgia Department of Public Health's own data says about Atlanta, Savannah, Augusta, and Athens, and — because numbers alone don't explain why a state's trendline moves — what's actually driving the people and places behind them.

Common STIs and HIV in Georgia

Four conditions make up almost every conversation about sexual health in this state.

• Chlamydia is Georgia's most-reported infection by a wide margin — the state ranked 5th highest in the country for it in 2023, and most people who have it never notice a single symptom.
• Gonorrhea runs even hotter here — Georgia ranked 3rd highest nationally in 2023, behind only a couple of other states.
• Syphilis is the infection actually accelerating in Georgia right now, and its cruelest form isn't in an adult at all — it's congenital syphilis, passed from an untreated mother to her baby.
• HIV in Georgia is, more than in almost any other state, a story about one metro area — Atlanta carries a share of the state's burden that's wildly out of proportion to its population.

Statewide Trends: What Changed in a Single Year (2022–2023)

Georgia's health department doesn't publish a perfectly clean five-year rate table the way some states do, so the most reliable comparison is the most recent one: 2022 against 2023. Chlamydia actually eased slightly, down 1.9%. Gonorrhea dropped too, down 3.6%. Neither is cause for celebration — both rates are still among the highest in the nation — but neither is the real story either. Syphilis is. All-stage syphilis cases climbed 11.2% in a single year, and congenital syphilis, the version that actually kills or disables infants, jumped over 25%. Georgia's primary and secondary syphilis rate (the newest, most infectious stage) held essentially flat at 20 per 100,000 — which means the growth is coming from cases that have already been circulating undetected for a while, exactly the pattern you'd expect when testing and prenatal screening aren't catching infections early enough.

Zoom out further and the longer trend is worse than any single year suggests. Georgia's combined STD case count hit 106,467 in 2021 alone — a 54% increase from a decade earlier — and the CDC has placed Georgia in the national top 10 for chlamydia, gonorrhea, or syphilis in nearly every surveillance report released since 2019.

HIV in Georgia: Atlanta Carries the Weight

Georgia had 65,195 people living with diagnosed HIV in 2023 — a rate of 591 per 100,000 — and ranked 5th among all states for the sheer number of new diagnoses that year, behind only Texas, California, Florida, and New York. The imbalance inside that number is the real story: the Atlanta metro area alone accounts for 66% of every new HIV diagnosis in Georgia and 69% of everyone living with the virus statewide, and within that metro, Fulton and DeKalb counties together make up 63% of new diagnoses. Black cisgender men who have sex with men accounted for 40% of all new HIV diagnoses in the state in 2023 — the single largest share of any group, which is why Georgia's "Ending the HIV Epidemic" efforts are concentrated so heavily on outreach and PrEP access in that community specifically.

One honest caveat worth including: this is not a new outbreak. New HIV diagnosis rates in both Fulton and DeKalb counties have actually been trending downward since 2018, and Fulton's own health board found no evidence of a resurgence as of 2023 — the burden is just old, large, and heavily concentrated rather than freshly exploding. That distinction matters, but it doesn't change the bottom line: Atlanta's rate of people living with HIV is still estimated at roughly 1 in every 51 residents, among the highest of any metro area in the country. Augusta tells a similar story on a smaller scale — Richmond County alone reported 1,626 residents living with HIV, a rate of 945 per 100,000, among the highest of any county in the state. Anyone concerned about their own exposure can look into PrEP and PEP, both available in Georgia without a positive test first.

Atlanta, Savannah, Augusta & Athens Compared

County-level data tells a more complicated story than "it's all about Atlanta." Here's how Georgia's major cities compared in the most recent available county breakdown:

*Cases per 100,000 residents. County syphilis figures reflect non-congenital syphilis. Richmond County's syphilis rate wasn't broken out separately in available reporting, but its combined rate across all three STIs — 1,884 per 100,000 — was the highest of any county in Georgia. Sources: Georgia DPH, CDC AtlasPlus, Coastal Health District.

A few things stand out once you look past the four biggest names. Clayton County — smaller and less talked-about than its Fulton and DeKalb neighbors — actually posted the 2nd-highest chlamydia rate of any Atlanta-area county at 996.4 per 100,000. DeKalb County reported more total gonorrhea and syphilis cases than Gwinnett County despite Gwinnett having the larger population, and Cobb County out-reported Gwinnett on gonorrhea too. And nationally, Savannah actually lands higher than Atlanta on at least one independent city-level STI ranking — proof that this isn't purely a big-metro story.

Behavior, Stigma & Culture: What's Actually Driving Georgia's Numbers

It's tempting to reach for simple explanations — but Emory University researchers who built a predictive model specifically to understand Georgia's HIV disparities found something more useful than a stereotype: sociostructural factors and healthcare access predicted who acquires HIV far better than race or individual behavior did. In their words, the goal was partly to "dispel misconceptions of race... as a behavioral risk factor for HIV." That finding should reframe how anyone reads the rest of this section.

• Stigma is the barrier researchers hear about most. Emory interviews with young adults living with HIV in Atlanta found that stigma — sometimes layered with racism, homophobia, or family and community judgment — consistently delayed testing, caused people to isolate, and made some avoid healthcare altogether, even for unrelated conditions.
• Georgia hasn't expanded Medicaid. It's one of just 10 states that hasn't, relying instead on a limited work-requirement program ("Pathways to Coverage") that has enrolled a small fraction of the Georgians it was designed to cover. Fewer insured residents means fewer people getting routine screenings before an infection becomes a crisis.
• Rural Georgia is genuinely underserved. A 2025 Satcher Health Leadership Institute/Emory study found real, measurable gaps in HIV care access and treatment adherence between rural and urban Georgians, driven by distance to specialists, thinner support systems, and more acute stigma in small communities where confidentiality feels harder to count on.
• Sex education is inconsistent. Georgia leaves most curriculum decisions to local school districts, and where sex ed is taught at all, state law requires an abstinence-focused approach — which leaves a lot of young, sexually active Georgians without a clear picture of transmission risk or confidential testing options.
• Dating apps changed how people meet partners. That shift is driving infection patterns nationally, Georgia included — we go into the specifics in our piece on dating apps and STD risk.
• MSM-focused epidemiology, reported plainly. The Georgia DPH's own data shows men who have sex with men account for more than half of new HIV infections statewide and carry disproportionately high syphilis rates — which is precisely why the state's prevention dollars increasingly target PrEP access and outreach in that community rather than the general population.

None of this is about any single group's "culture" causing disease. It's a state with a large, young, diverse population; a healthcare system with real coverage gaps; and a geography where urban infrastructure and rural isolation sit twenty miles apart from each other. That combination, researchers say, explains Georgia's numbers far better than any individual behavior does.

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