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
- Chapter I: Background and Literature Review -
1
- Chapter II: Manuscript - 13
- Chapter III: Public Health Implications and Future
Directions - 24
- Tables and Figures - 25
- Bibliography - 35
About this Master's Thesis
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