The Association between Type 2 Diabetes and Sexually Transmitted Infections in the United States, NHANES 2007-2014 Open Access

Abstract

Diabetes (DM) and sexually transmitted infections (STIs) are both growing problems in the United States, with prevalences of 22 million and 110 million, respectively. The immunopathology of DM and the propensity towards infection make it very likely that these mounting burdens will begin to overlap, resulting in a higher burden of STIs among those with diabetes. We performed a cross-sectional analysis of 2007-2014 National Health and Nutrition Examination Survey (NHANES) data to determine the association between DM and STI. After exclusions, the study population consisted of 16,696 individuals. DM, the exposure, was determined by a combination of glycohemoglobin testing and self-report. STI status was determined by self-reporting any of: chlamydia (last 12 months), gonorrhea (last 12 months), herpes (ever), and human papillomavirus (HPV) (ever). Results were produced using univariate and multivariate logistic regression models. With few exceptions, the odds of being STI positive among people with diabetes were consistently lower than those of people without diabetes. Notably, the odds of having herpes among people with diabetes were 0.48 times those of people without diabetes, adjusting for age, race, sex, risky sexual behavior, HIV, sexual orientation, health insurance coverage, and BMI (95%CI: 0.25-0.90). Interestingly, when herpes laboratory testing was used as the outcome, the odds of having herpes among people with diabetes was 1.79 (95%CI: 1.34-2.38) times that of people without diabetes, adjusting for the same covariates. Using self-report as a proxy for symptomatic disease, the discrepancy in the self-report versus laboratory test modeling results may indicate that although people with diabetes have significantly higher odds of being herpes positive upon testing, they have lower odds of being symptomatic.

Table of Contents

Table of Contents

1. Chapter I: Background and Literature Review - 1
2. Chapter II: Manuscript - 13
3. Chapter III: Public Health Implications and Future Directions - 24
4. Tables and Figures - 25
5. Bibliography - 35

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Herpes Diabetes NHANES STI
Committee Chair / Thesis Advisor	Ali, Mohammed K, Emory University
Committee Members	Magee, Matthew, Georgia State University
Partnering Agencies	Emory University schools, faculty or affiliated programs University, college or educational institution (other than Emory)

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