Quick Answer: North Carolina ranks 6th in the U.S. for gonorrhea and 7th for chlamydia, with young adults and marginalized communities most affected by silent, untreated infections.
When “No Symptoms” Still Means Risk
Imagine waking up after a weekend party. You scroll your phone with a headache, not from the night before but from the gnawing question that sits heavy in your stomach: “Could I have caught something?” You feel fine, your body isn’t screaming at you, but you can’t shake the thought. That’s the cruel trick of chlamydia and gonorrhea; they don’t always come with flashing warning signs. In fact, most people in North Carolina who tested positive never had the textbook discharge or painful urination they had been told to expect.
Jamie, 22, a college student in Raleigh, had what he thought was just a seasonal sore throat. When a friend pushed him to get checked, the test came back positive for gonorrhea of the throat.
“I laughed at first, because I didn’t even know that was a thing,” he told me. “Then it sank in. I could’ve passed it to someone else without ever knowing.”
His story is common, and it shows how invisibility fuels spread. The infection doesn’t need your symptoms to survive; it only needs your silence.
By the numbers, North Carolina reported over 65,800 chlamydia cases and 26,300 gonorrhea cases in 2023. Nearly half of those cases belonged to people under 25. It’s not just a “youth problem,” but the reality is that the transition years; college, new jobs, first apartments; are when testing often falls off the radar. People assume no pain means no infection. In truth, “no symptoms” is one of the most dangerous symptoms of all.
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The Numbers Behind the Headlines
Every year, the CDC releases rankings that can feel like a scoreboard no state wants to lead. In 2023, North Carolina ranked 7th in the nation for chlamydia and 6th for gonorrhea. These aren’t abstract positions; they translate into crowded clinics, late-night Google searches, and anxious text messages after hookups. They also reveal who carries the heaviest weight. Almost 80 percent of cases in the state were found among people between 15 and 29 years old. That means the same demographic juggling exams, rent checks, and first real relationships is also navigating the greatest STD burden.
It's easy to think of these numbers as just geography, as if living in North Carolina makes you more likely to get an STD. The truth has many layers. The rate of gonorrhea in Mecklenburg County, where Charlotte is located, is almost four times higher than in rural counties. In Durham, almost 70% of reported gonorrhea cases in 2023 were among Black residents. This is because of systemic problems, not because of individual choices. When you look at numbers next to real-life experiences, you can see how race, education, and access to care all affect where the infections settle.
Renee, 19, remembers sitting in her car outside a testing center in Fayetteville, crying before she even went inside.
“It wasn’t even about being sick,” she explained. “It was about what people would think of me if they knew why I was there.”
Stigma becomes another symptom; an invisible one that keeps people from walking through the door until it’s too late. This is how a state ends up topping charts: not because people are reckless, but because silence, shame, and structural barriers work together to keep infections alive and moving.
Where the Burden Falls Heaviest
Step inside a public clinic in Durham on a weekday afternoon. The waiting room is crowded, quiet except for the shuffle of papers and the occasional cough. Most of the faces are young, many of them students. The reality is clear: in 2023, more than half of chlamydia cases and nearly 70 percent of gonorrhea cases in Durham County were among Black residents. These numbers don’t reflect reckless behavior; they reflect layers of inequity; housing instability, patchy healthcare coverage, and the absence of comprehensive sex education in many schools.
Disparities are not limited to race alone. Poverty pulls hard at the strings of health outcomes. Neighborhoods with the lowest incomes often show the highest infection rates. If you can’t afford a car, the closest clinic might be a bus ride away that eats up half your workday. If you don’t have insurance, the fear of a bill can keep you from walking in at all. These are not excuses; they’re barriers. And while the virus or bacteria doesn’t discriminate, access to diagnosis and treatment often does.
Marcus, 27, grew up in a small town outside Greensboro. “We didn’t talk about sex in my family, and the school was abstinence-only,” he recalled. “By the time I got tested in college, I’d already had gonorrhea and didn’t even know it.” His story underlines how information; or the lack of it; becomes a public health determinant. A generation raised on silence is now dealing with the fallout in clinics across North Carolina.
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The Hotspots: Cities That Carry the Weight
If you zoom in on the state map, three counties glow brighter than the rest: Mecklenburg, Cumberland, and Durham. In Mecklenburg County, where Charlotte’s nightlife hums with possibility, the STD rate hovers among the highest in the nation. Cumberland, with its large military presence, shows spikes in cases year after year. Durham, a hub for universities, reflects the risks of concentrated youth populations. Each county tells a slightly different story, but together they explain why North Carolina refuses to fall from the top of the charts.
In Charlotte, a 21-year-old named Tasha described how she and her friends use group chats to talk about everything; except testing.
“We’ll share memes, hookups, even birth control tips,” she laughed nervously, “but nobody wants to be the one to ask, ‘When’s the last time you got checked?’”
That silence leaves space for infections to keep moving under the radar. The hookup culture itself isn’t the problem; the absence of routine, shame-free testing is.
Walk a few hours east to Fayetteville and you’ll hear soldiers quietly admit to clinic staff that they “just don’t feel right” after a deployment. Military life adds another layer: long separations, frequent relocations, and cultures of toughness that discourage seeking care. Cumberland County’s numbers reflect this reality. In Durham, the story loops back to students balancing new freedom with limited knowledge about risk. The common thread across these settings is that desire and connection are not the enemies; it’s the lack of accessible testing, open dialogue, and safety nets that makes infections thrive.
Lifestyle, Love, and the Risk We Don’t See
Picture a Friday night in Chapel Hill. Bars overflow with students, music rattles windows, laughter spills into the street. In the swirl of first kisses and messy goodbyes, no one is thinking about gonorrhea. But weeks later, someone might notice a burning sensation when they pee or nothing at all. The invisible infections hitch rides in these moments of connection, blending intimacy with risk. It’s not a morality tale; it’s biology intersecting with human behavior.
North Carolina’s surge is not about “bad choices.” It’s about normal, everyday experiences of people navigating dating apps, campus life, and relationships where conversations about protection don’t always happen. It’s about the gap between knowing condoms reduce risk and actually using them every time. And it’s about how quickly routine testing gets pushed to the bottom of a to-do list already full of classes, bills, or family responsibilities.
Ana, 24, put it simply after her diagnosis:
“I wasn’t sleeping around. I was dating one person, and I still ended up with chlamydia. Nobody warned me it could be that invisible.”
Her voice carries what statistics can’t capture; the shock, the confusion, the frustration of realizing prevention isn’t always straightforward. Lifestyle factors don’t explain away the crisis, but they illustrate how infection slips in through the cracks of everyday life, unannounced and unjudged.
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When Delay Becomes Dangerous
There’s a saying among clinicians: the most dangerous STD is the one you don’t know you have. In North Carolina, that’s not just a phrase; it’s the lived reality for thousands of people each year. Chlamydia left untreated can scar the reproductive system, leading to infertility in women and chronic pain in men. Gonorrhea doesn’t wait politely either; it can spread to the bloodstream, a rare but life-threatening complication. Every day that passes without diagnosis gives the infection a chance to move deeper into the body.
Kiana, 29, didn’t think much of the occasional cramps she felt between periods. “I chalked it up to stress,” she said. By the time she was tested, her doctor told her she had pelvic inflammatory disease caused by untreated chlamydia. She now faces difficulty conceiving.
“It’s not the sex that hurt me,” she said, her voice heavy. “It’s the silence. Nobody told me how high the risk was where I live.”
Her story underlines the cruel irony: what feels like nothing can, over time, steal something irreplaceable.
The Stigma That Keeps People Away
In Fayetteville, a 19-year-old sat in his car outside a health department clinic, scrolling Instagram while trying to work up the nerve to walk in. “I kept thinking someone from my high school would see me,” he later admitted. This kind of fear isn’t uncommon. In many communities across North Carolina, the shame of being “seen” at a clinic outweighs the fear of the infection itself. That stigma feeds the cycle: people stay away, infections spread, numbers climb.
Stigma doesn’t only come from peers. Some patients describe feeling judged by providers, especially in small towns where privacy feels impossible. One young woman in Johnston County whispered that she drove two counties over to get tested because, “My aunt works at the front desk here. Everyone would know my business.” When access to care comes wrapped in fear, avoidance becomes the default. The result? Rising rates, undiagnosed cases, and a crisis that grows in the shadows.
It’s worth saying plainly: testing is not an admission of guilt, recklessness, or shame. It is healthcare, as ordinary and necessary as checking your blood pressure. Until more people in North Carolina hear and believe that, stigma will continue to act as one of the most powerful drivers of this epidemic.
Taking Back Control: The Power of Testing
Imagine the weight that lifts the moment you finally know your status. For Diego, 25, it was like unclenching a fist he hadn’t realized he’d been holding for months.
“I thought I had something, then I thought maybe I didn’t. My brain wouldn’t shut up,”
When his at-home kit arrived, he swabbed, sealed, and mailed it off within ten minutes. A few days later, the results came back negative. “It was like breathing again,” he laughed. Testing, for him, was not just about medical clarity; it was about emotional relief.
For others, a positive result still carries empowerment. One woman in Charlotte described the way knowing allowed her to take antibiotics quickly, tell her partner honestly, and move forward without the constant guessing. “I wasn’t ruined,” she explained. “I was just informed.” That subtle shift; from dread to knowledge; can change the entire trajectory of an infection and a relationship. In a state where silence fuels spread, testing is more than prevention; it’s liberation.
If you’re in North Carolina, testing options range from county health departments to discreet at-home kits delivered to your door. The key is not where you test, but that you do. Peace of mind, treatment when needed, and protection for your partners all begin with one step: finding out.
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FAQs
1. Can you get chlamydia without symptoms?
Yes. Most people with chlamydia don’t show obvious signs, which is why it spreads so easily in North Carolina and beyond.
2. Is gonorrhea common in North Carolina?
Very. The state ranks 6th nationally, with more than 26,000 cases reported in 2023.
3. Can untreated chlamydia cause infertility?
Yes. Left untreated, chlamydia can cause pelvic inflammatory disease, scarring, and long-term fertility issues.
4. What age group is most affected by STDs in NC?
People between 15 and 29 carry the highest burden of chlamydia and gonorrhea infections.
5. Are certain counties more affected than others?
Yes. Mecklenburg, Durham, and Cumberland counties report some of the highest rates in the state.
6. How does stigma impact STD rates?
Stigma discourages people from seeking testing, which allows infections to spread silently and unchecked.
7. What’s the safest way to test for STDs?
Both clinic-based and at-home tests are effective. The safest way is the one you’re most likely to actually use.
8. Can you get gonorrhea in the throat?
Yes. Oral sex can transmit gonorrhea, which may show up as a sore throat or no symptoms at all.
9. I tested positive, what happens now?
Most STDs are treatable with antibiotics. Take your results to a doctor and ask for a prescription.
10. How often should you get tested?
If you’re sexually active, especially under 30, annual testing; or more often with new partners; is strongly recommended.
You Deserve Answers, Not Assumptions
North Carolina’s position near the top of the nation’s STD charts is not about shame; it’s about systemic barriers, missed conversations, and infections that thrive in silence. Behind every statistic is someone who thought they were safe, someone who mistook a small symptom for nothing, someone who stayed quiet out of fear. The way forward isn’t judgment; it’s access, honesty, and a simple test.
If you’re reading this with a pit in your stomach, you’re not alone. Whether you’re in Charlotte, Durham, Fayetteville, or a small town with one bus line, your peace of mind matters. Peace of mind is one test away. Don’t let silence make decisions for you.
Sources
1. CDC: 2023 STD Surveillance State Ranking Tables
2. The Charlotte Post: NC Among Leading States in STDs
3. PMC: STD Disparities in Durham County
4. News & Observer: STD Hotspots in NC
