San Francisco reports sharp drop in syphilis, chlamydia and gonorrhea

San Francisco’s sexually transmitted infection numbers fell sharply in 2025, a decline health officials say is real enough to show up in clinics and policy. Reported syphilis cases dropped 24% from 2024, chlamydia fell 18% and gonorrhea fell 5%, with the steepest declines among men who have sex with men and transgender women.

The San Francisco Department of Public Health released the figures on April 13, 2026, as STI Awareness Week began, turning the update into a test of whether the city’s prevention strategy is working. By the year-end counts used in local reporting, total syphilis cases fell from 892 in 2024 to 678 in 2025. Chlamydia dropped from 4,219 to 3,467, and gonorrhea fell from 4,812 to 4,578.

Officials have tied much of the shift to doxy-PEP, the post-exposure antibiotic regimen that San Francisco became the first health department in the country to recommend in October 2022. The city says bacterial STI rates had climbed every year from 2014 to 2018, then fell sharply in 2020 during COVID-related disruptions to care before beginning to decline again after the doxy-PEP guidance was released. SFDPH’s own data page says 2024 chlamydia diagnoses were at their lowest level since 2006, and early syphilis diagnoses were at their lowest since 2007, aside from the pandemic year of 2020.

The new numbers also show where the gains have and have not landed. Reported male rectal chlamydia cases fell from 825 in 2024 to 510 in 2025, while male rectal gonorrhea was essentially flat, 1,691 last year and 1,688 this year. Congenital syphilis edged down from three cases in 2024 to two in 2025. That pattern matters because it suggests prevention is having a stronger effect on some infections than others, especially chlamydia and syphilis.

Dr. Stephanie Cohen has said the decline is due in large part to San Francisco’s doxy-PEP rollout, while Health Officer Dr. Susan Philip has urged residents to keep testing and Director of Health Daniel Tsai has called STI prevention a key priority. A 2024 citywide analysis found that by November 2023, about 13 months after the guidance was released, chlamydia and early syphilis among men who have sex with men and transgender women had dropped about 49% and 51% below modeled projections, while gonorrhea ran 25% above those projections. Studies cited by the San Francisco AIDS Foundation later found sustained declines in chlamydia and syphilis among doxy-PEP users, with less effect on gonorrhea.

The question now is durability. San Francisco’s progress has depended on outreach, testing, treatment and prevention tools that reach people at highest risk. If clinic access narrows or prevention budgets slip, the city could quickly lose ground in the same neighborhoods and communities where the gains were most pronounced.