A long-term study of the scleractinian coral Acropora palmata in the US Virgin Islands (USVI) showed that diseases, particularly white pox, are limiting the recovery of this threatened species. Colonies of A. palmata in Haulover Bay, within Virgin Islands National Park, St. John, were examined monthly in situ for signs of disease and other stressors from January 2003 through December 2009. During the study, 89.9 % of the colonies (n = 69) exhibited disease, including white pox (87 %), white band (13 %), and unknown (9 %). Monthly disease prevalence ranged from 0 to 57 %, and disease was the most significant cause of complete colony mortality (n = 17). A positive correlation was found between water temperature and disease prevalence, but not incidence. Annual average disease prevalence and incidence remained constant during the study. Colonies generally showed an increase in the estimated amount of total living tissue from growth, but 25 (36.2 %) of the colonies died. Acropora palmata bleached in the USVI for the first time during the 2005 Caribbean bleaching event. Only one of the 23 colonies that bleached appeared to die directly from bleaching. In 2005, corals that bleached had greater disease prevalence than those that did not bleach. Just over half (52 %) of the colonies incurred some physical damage. Monitoring of fragments (broken branches) that were generated by physical damage through June 2007 showed that 46.1 % died and 28.4 % remained alive; the fragments that attached to the substrate survived longer than those that did not. Recent surveys showed an increase in the total number of colonies within the reef area, formed from both asexual and sexual reproduction. Genotype analysis of 48 of the originally monitored corals indicated that 43 grew from sexual recruits supporting the conclusion that both asexual and sexual reproduction are contributing to an increase in colony density at this site.