Sexually transmitted disease cases for chlamydia, gonorrhea, and syphilis in Alabama are nearly double the national average based on population, county health records show.



Montgomery and Dallas counties have four times the national rate for the diseases, according to an average of five years of county data AL.com obtained from the Alabama Department of Public Health. Several other Black Belt counties also experience elevated levels, including Hale, Greene, and Wilcox.

Jefferson, Alabama's most populous county, has roughly 2.7 times the U.S. incidence of those sexually transmitted diseases. Mobile has a similar rate of incidence.



Lawrence Robey, Madison County's health officer, has practiced internal medicine for 33 years. He has tried to reduce the state's STD rates for most of his career.



"STD rates have always been high in the south," Robey said. "It continues to feed from one generation to the next."



The statewide rate of incidence is about 1.8 times the nationwide rate, with roughly 1,000 cases per 100,000 people (U.S. rate: 577 per 100,000). More often than not, it's the poorer counties that suffer the most, Robey said.



"I hate to sit here and put everything off on money," Robey said. "It's often a common denominator."

On average, residents in poorer communities are at greater risk to contract and transmit STDs because of substandard public education and transportation as well as smaller tax bases to pay for medical centers and physicians, Robey said. Likewise, wealthier counties in northern Alabama often have average or below average STD incidence.



"Add these together and there are social determinants working against people getting proper healthcare," Robey said.

STDs in Alabama counties

The map below charts the incidence of gonorrhea, chlamydia, and syphilis in each Alabama county compared to the U.S. rate. Counties shaded green have incidence below the national rate, while counties shaded red have incidence much higher than the national rate. Click each county to see how its STD rate compares to the U.S. For example, in Bibb County, the incidence rate is about equal to the U.S. rate, while in Montgomery County, STD incidence is four times the national rate.

For example, the average household in Madison County, which borders Tennessee, earned $58,242 and 9.1 percent of its families lived in poverty in 2012, census figures show. Madison County has about 1.5 times the national STD incidence.

The average Montgomery County household earned $44,401 and about 16.3 percent of all families there lived in poverty in 2012, according to census figures. Montgomery County has about 4.2 times the national STD incidence.

"While we now know how to prevent STDs, getting people to change their behaviors is very difficult," Robey said.

County STD rate compared with U.S. Montgomery 4x Dallas 4x Hale 3.8x Greene 3.8x Wilcox 3.7x Jefferson 2.7x Mobile 2.5x Russell 2.4x Tuscaloosa 2.1x Madison 1.5x Lee 1.4x Baldwin 0.9x Limestone 0.8x Shelby 0.6x Blount 0.4x

Symptoms of STDs

Chlamydia and gonorrhea can cause swollen genitals, painful urination, and abnormal discharge among other symptoms, according to the Center for Disease Control. If left untreated, the diseases can cause scarring of Fallopian tubes, infertility and pregnancy outside the womb.

Syphilis in its first two stages can cause lesions, rashes, sore throat, hair loss, weight loss and fever, according to the CDC. Symptoms of late stage syphilis – which may occur 10-30 years after the initial infection – include paralysis, numbness, blindness, dementia and even complications that lead to death.



All three diseases can be treated with antibiotics; however, permanent damage caused by the diseases before they are treated cannot be undone, the CDC states. If untreated in pregnant mothers, the diseases can also be transferred to babies during childbirth.



The Alabama Department of Public Health has not seen any cases of antibiotic-resistant strands of these STDS that have appeared elsewhere in the world, said Anthony Merriweather, the director of the department's STD division.

He said easiest way to reduce the spread of STDs is to use condoms and dental dams, and maintain monogamous sexual relationships. He encouraged people to be open with their partners about their past sexual history prior to having sex.

"The main important thing is to remain open and honest," Merriweather said.

Depending where you live, it might not be that easy.

"You have to openly talk about human sexuality," Robey said. "That's still a taboo topic in many parts of the county."

AL.com reporter Alex Walsh contributed to this story.