Diabetes x STDs

Based on the WHO diagnostic criteria, diabetes mellitus is defined as a fasting serum glucose level equal to or more than 7 mmol/L or 126 mg/dl. In diabetes, a person has chronically high sugar levels in the bloodstream due to a defect or reduced insulin production.

Diabetes is infamously associated with long-term health complications such as increased risk of heart attack, stroke, kidney disease, nerve complications, blindness, poor wound healing, various disabilities, and even death. According to the International Diabetes Federation, 1 in 10 people lives with diabetes worldwide. Based on the National Population Health Survey 2022 Singapore, the prevalence of diabetes (between the age group 18 to 75) in Singaporean is 8.5%.  

The question is, is there a link between diabetes and STDs?

In this article, we aim to discuss the correlation and overlapping symptoms of both medical conditions.

Correlation of Diabetes and STDs

A person with diabetes tends to have a weaker general immune system, and this predisposes the person towards various forms of infections, including sexually transmitted diseases (STDs).

Interestingly, an untreated STD, just like any form of infection, may increase the blood sugar level in a diabetic person. This can create a vicious cycle for a diabetic patient with STDs- predisposition to high risks of infection and is more complicated to treat.

There is no direct causative effect between diabetes and STDs. Diabetes does not cause STDs, and vice versa. Both conditions are due to completely different underlying physiology. STDs are due to sex and infection. Diabetes is due to the ineffective breakdown of sugar by insulin in the body, leading to a long-term hyperglycaemic state in the circulation.

It is imperative to note that STDs, as the name has suggested, sexually transmitted diseases, are transmitted through sexual encounters. STDs occur due to exposure to unsafe unprotected oral, vaginal, or anal intercourse. A person with diabetes without a history of sexual encounters is, hence, unlikely to acquire an STD.

Nonetheless, people tend to be confused by both medical conditions, as their presentations are similar, and we strive to iron them out in simpler terms.

Overlapping Symptoms of Diabetes and STDs

Genital itching

In both diabetes and STDs, a patient (both men and women) can present with itching over the genital region.

In diabetes, chronic high blood sugar and a low immune system cause a person to have a poorer skin barrier, which increases the risk of fungal and bacterial infection. Itching can be a symptom of a skin infection.

On the other hand, STDs such as Chlamydia, Gonorrhoea, Trichomoniasis, Mycoplasma Genitalium, HPV/warts, and Herpes Simplex Virus infection can present with itching over the genital region.

A new skin rash

A rash over the genital region is always a concern of a possible STD. STDs such as herpes infection and HPV infection can present with a rash and are commonly mistaken as eczema or sensitive skin.

A rash over the lower pelvic, groin, or even anal region can also be non-STD related. In the case of diabetes, a combination of a weakened immune system and environmental factors such as increased sweating/ hygiene/ humidity of surroundings, one can present with a bacterial or fungal-related skin infection over the moist area below.

Furthermore, patients with diabetes may be more commonly seen with skin tags. Skin tags are small appendages, stalk-like skin bumps that can be confused with STD skin bumps such as HPV viral warts.

Unusual vaginal discharge

Abnormal vaginal discharge is characterised by unusual excessive volume (compared to baseline), colours such as yellow to green or greyish in appearance, and foul-smelling vaginal discharge. There can be occasional associated painful urinary symptoms, lower pelvic pain or, in more severe cases, even fever.

This abnormal symptom invariably always rings a red flag alarm on a possible underlying STD (as long as there is a sexual history involved). Bacterial STDs such as Chlamydia, Gonorrhoea, Trichomoniasis, Ureaplasma spp, Mycoplasma spp, etc, are common culprits that are involved in the abnormal symptoms.

Nonetheless, abnormal vaginal discharge can be seen more frequently in diabetic patients due to recurring fungal/yeast infections.

Painful urination

Urinary tract infection is frequently seen in a person with diabetes due to high blood sugar levels in the body. Confusingly, in bacterial STDs, one can present with similar symptoms such as urinary tract infection- painful urination, discharge from the urethral, burning sensation upon peeing, urinary urgency, etc.

In a person with a urinary tract infection that is not caused by an STD, the urinary tract is infected due to migration or contamination of the bacteria from the surrounding genital region. In the case of diabetes- it is due to an underlying poor immune system, poor skin integrity, and a higher risk of general infection.

In STDs, the causative bacteria, such as chlamydia and gonorrhoea, come from an external source- such as an infected sexual partner.

Painful intercourse

Pain during intercourse should not be ignored. Reversible and manageable causes such as STDs or diabetes should be addressed to avoid irrevocable complications such as chronic discomfort and infertility.

As diabetes can affect the blood vessels and nerve supplies of the body, in females, it can be associated with vaginal dryness due to reduced lubrication as a result of diabetic neuropathy. In diabetic males, the blood flow to the penis can be impaired, leading to sexual dysfunction. In both circumstances, sex can be painful and uncomfortable.

Painful sex can be an indicator of an untreated STD. Over time, an undiagnosed STD can cause chronic inflammation and scarring of the reproductive organs and chronic pain during intercourse. STDs are important to treat, not just to address sexual discomfort but, more importantly, to prevent the infection from causing scarring and eventual infertility.

Pregnancy complications

High-risk pregnancies are commonly seen in a person with diabetes or untreated STDs.

In diabetes, the pregnant mother is at higher risk of miscarriage, pre-term labour, stillbirth, and serious birth defects in babies (congenital heart, brain, and spine defects).

Vertical transmission of STDs from mother to unborn foetus is possible. Infections such as HIV, hepatitis, syphilis, chlamydia and gonorrhoea can be passed on to the foetus during pregnancy. STDs in newborns can be associated with neurological defects, meningitis, blindness, deafness, chronic infection in the babies, failure to thrive, or even death. STDs are one of the preventable causes in newborns if screening and early treatment are offered to pregnant mothers.

Pearls for the day:

1.  Diabetes and STDs are two medical conditions of different entities and underlying causes.

2.  A person can have both diabetes and STDs.

3.  A person with underlying diabetes can be more susceptible to STDs.

4.  Diabetes clinical presentation can be similar to STD symptoms, though the treatment for both are completely different.

5.  As diabetes and STD presentations can be confusing, a review with your healthcare professional can be beneficial to diagnose the symptoms correctly.

6.  Both diabetes and STDs can be screened accurately, and there are effective treatment options in managing both conditions to minimise long-term complications.

References

1. https://idf.org/about-diabetes/diabetes-facts-figures/ 
2. https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/nphs-2022-survey-report-(final).pdf?sfvrsn=afbe8f91_0
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8. Tsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. Am J Obstet Gynecol. 2017 Jan;216(1):1-9. 
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