The rates in St. Louis are among the highest because St. Louis and Baltimore are the only cities reporting numbers as independent cities rather than as a county, explained Dr. Hilary Reno, assistant professor at Washington University School of Medicine and medical director of the St. Louis County Sexual Health Clinic.

“It is my professional opinion that it’s irrelevant and inaccurate, but it’s what everybody pays attention to,” Reno said.

As a metropolitan area, St. Louis and its surrounding 14 counties ranks 16th for chlamydia, 12th for gonorrhea and 25th for syphilis.

Those numbers are still alarming, Reno said.

She echoes what the CDC says are factors behind the rising rates: Drug use, poverty, stigma and unstable housing, which can reduce access care; decreased condom use among vulnerable groups; and budget cuts that have resulted in clinic closures and poor follow-up care.

“We have come across this problem where people aren’t quite sure where to go for sexual health care,” Reno said. She recently found that 50% of patients treated in emergency rooms at Barnes-Jewish, St. Louis Children’s and Christian hospitals had free testing clinics closer to them.