Estimating state-level chlamydia and gonorrhea incidence and prevalence among women living in the United States during 2019-2023: mathematical modeling analysis

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Abstract Background Estimates of chlamydia and gonorrhea prevalence and incidence have typically focused on national-level epidemiology. Disaggregated estimates are useful for local public health decision making. Methods We developed a Bayesian hierarchical modeling framework to estimate the incidence and prevalence of chlamydia and gonorrhea for women in the United States. The model was calibrated to indicators from different data sources, including state and age-specific laboratory test positivity (data pooled over 2019–2023), and diagnosis rates (average of 2019-2023). At the national level, we calibrated to chlamydia prevalence and test coverage. We used the model to estimate state-level and national-level prevalence, incidence, and screening rates among women by state and age (15-24, 25-34, 35-44, 45-54, ≥55 years). Results For women aged 15–24 years, national-level chlamydia prevalence was estimated at 4.6% (95% uncertainty interval: 4.2-4.9%), gonorrhea prevalence was 0.4% (0.4–0.5%), and testing coverage was 33.4% (33.2–33.7.0%). Across states, corresponding chlamydia incidence estimates were 1.9-3.1 times as high as observed diagnosis rates; gonorrhea incidence estimates were 3.3-4.7 times as high as diagnosis rates. Chlamydia prevalence in women aged 15–24 years ranged 2.3%- 7.8% across states, and chlamydia incidence ranged 2.8%-12.4%. Gonorrhea prevalence ranged 0.09%-1%, and gonorrhea incidence ranged 0.5%-6.0%. Conclusions This study presents a new analytic framework for estimating incidence and prevalence at the state level. By integrating laboratory, diagnosis, and survey data, we provide more granular, actionable estimates of STI burden.

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