As a man who has sex with men and who came of age during the height of the HIV epidemic in the 1980s, Phil thought a lot about how to reduce the risk of contracting a sexually transmitted disease (STD). He learned that some forms of sexual activity had more risk than others, and tried to follow medical advice to stay healthy.
But because Phil (last name withheld for privacy) had been diagnosed with type 1 diabetes (T1D) as a child, he still had questions about what was considered healthy and what wasn’t. For example, he had been taught that manual sex, or any sexual activity involving the hands, such as fingering or a hand job, was generally considered one of the healthier activities on the spectrum of risk. But he wasn’t sure if this held true for people with T1D, who often prick their fingers multiple times a day to check their blood sugar levels. He asked his endocrinologist if the pinprick wounds could pose a risk.
“My doctor’s thought was that it was possible, but it was low-risk unless the skin opening was fresh,” Phil said.
Despite the relatively low risk, Phil opted to not check his blood sugar levels before engaging in certain types of sexual activity. He knew that healthcare providers often advised checking blood sugar levels before sex to avoid hypoglycemia, but he was too concerned about upping his risk of contracting an STD, now often referred to as an STI (sexually transmitted infection).
“Out of an abundance of caution, unless I felt really high or really low, I did not do a fingerstick,” he said. He now uses a continuous glucose monitor (CGM).
In recent years, health officials have been sounding the alarm that not enough people are being as vigilant about STIs as Phil was during the first wave of the HIV epidemic, and that behavior has led to a rise in reported cases. In 2018, there were a record 2.4 million reported cases of STIs in the United States, according to
This rise in cases comes in spite of adult Americans having sex less frequently than in the past, according to University of Chicago survey data. This rise likely comes from a variety of societal factors, including a rise in injectable drug use, poverty, and housing issues in the United States. Also, when Americans are having sex, they are, on average, engaging in riskier behavior per sexual encounter than in the past, according to Gail Bolan, the director of the CDC’s Division of STD Prevention.
This trend is not confined to the young, according to Janis Roszler and Donna Rice, two diabetes care and education specialists who authored the book “Sex and Diabetes: For Him and For Her.” As it has become more accepted for older adults to have an active sex life, more are cutting corners about using condoms, too.
“They are sexually active, but don’t always use condoms because they aren’t worried about getting pregnant. They still need to wear them,” said Roszler.
While people with T1D are typically more vigilant than the average population about maintaining their daily health, they are not immune from making risky choices when it comes to STIs. A
These statistics, as well as a survey of the most common search terms associated with STIs, show that education on sexual health may be falling short. Some of the most common search terms about STIs and T1D — including the perennial favorite “Can I get type 1 diabetes from sex?” — show that there is confusion among many with T1D, and those who love them, about their sexual health.
(By the way, the answer is no, you cannot get type 1 diabetes from having sex with someone who has it.)
We queried two leading physicians and two diabetes care and education specialists to provide a brief overview of some of the common questions and concerns about STDs/STIs and T1D.
As noted, the terms STD and STI are often used interchangeably these days to refer to one of several transmissions often spread through a variety of sexual contact. This can include vaginal, anal, and oral sex, as well as skin-to-skin contact.
Such contact, however, is not the only way to contract these illnesses. Shared use of needles or medical equipment is also a culprit of the rise in STI cases in the United States. Such shared use is not always for the purpose of recreational drug use — there have been several instances when patients with diabetes were warned to be screened after hospitals incorrectly reused insulin pens.
Here are some of the more common forms of STIs:
The most commonly reported STI, chlamydia is caused by bacteria. It is easily treated with antibiotics, if diagnosed promptly. Symptoms can include:
- pain or discomfort during sex or urination
- green or yellow discharge from the penis or vagina
- pain in the lower abdomen
- infections of the urethra, prostate gland, or testicles
- pelvic inflammatory disease
If a newborn contracts chlamydia from a mother, it can cause serious complications, including pneumonia, eye infections, and blindness.
Some with chlamydia are asymptomatic, and the symptoms that show can vary with the severity of the case, said Dr. Andrea Chisolm, a board-certified OB-GYN at Cody Regional Health in Wyoming. This is true of many STIs, she said.
“Chlamydia may not give you any symptoms at all,” Dr. Chisolm said. “Other STI symptoms may be subtle and easily ignored or confused for a yeast infection or urinary tract infection.”
Also known as “The Clap,” gonorrhea may not cause notable symptoms, or it may cause many of the same symptoms as chlamydia. There are a few differences, however, including that the color of discharge may be different, there may be a feeling of needing to urinate frequently, and it can cause a sore throat. This STI also can be dangerous to newborns.
HIV is a well-known virus that, if left untreated, can damage and disable the immune system, leaving the body defenseless against other viruses, bacteria, and some forms of cancer. In the early stages, HIV can be mistaken for symptoms of the flu. In later stages, a person with HIV may not show symptoms or may show signs of recurrent fatigue, fever, headaches, and stomach issues.
Many people are living long, normal lives with HIV with current treatments (often a cocktail of different drugs). In addition, we’ve reached a point where experts agree an HIV-positive person with an undetectable viral load cannot pass on the virus through unprotected sex.
A historically infamous STI, syphilis can often go unnoticed in early stages and appears in mid-term stages as a small sore that can show up around the genitals, anus, or mouth. Later signs include flu-like symptoms, joint pain, hair loss, and weight loss. If left untreated, it can lead to debilitating symptoms and death.
In 1932, 399 African-Americans were left untreated for syphilis, without evidence of their consent, in an
HPV (human papillomavirus)
A virus that can often be carried asymptomatically, HPV can also present as warts on the genitals, mouth, or throat. While most cases of HPV can clear up without treatment, others can lead to various forms of oral, genital, and rectal cancer. There is a vaccine available to shield against some of the most serious HPV strains.
Herpes (herpes simplex)
There are two strains of herpes — one largely responsible for oral herpes, and another that is more often responsible for cases of genital herpes. The most common symptom of this virus is regular flare-ups of sores on either the mouth or genital area. If passed on to newborns, herpes can cause serious and life-threatening complications.
Other STIs can include pubic lice (“crabs”), trichomoniasis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, and scabies. Some bloodborne pathogens, including hepatitis, can also be spread during sexual activity.
While manual sex is considered a lower-risk sexual activity, it is not risk-free. It is extremely rare to contract an STI while receiving a hand job, but in some instances, an STI may be transmitted when giving a hand job or during fingering if genital discharge or ejaculatory liquid carrying an STI comes in contact with an open wound.
As stated above, that’s unlikely to be a problem with the small, quickly closed wounds of diabetes fingerpricks, but it may be more likely with the slow-healing cuts and skin infections that can be more frequently found on the hands and feet of people with T1D. Sexual partners of people with diabetes might want to consider waiting until any small cuts or wounds on the genitals heal before having sex to reduce the risk of contracting an STI.
Let’s be clear that diabetes cannot cause an STI. However, there is some evidence that an STI might increase the risk of a future type 2 diabetes diagnosis. Researchers at the University of California Los Angeles (UCLA) have discovered, for example, that a history of chlamydia transmissions can increase the risk of a type 2 diagnosis by as much as 82 percent. In addition, Spanish researchers have found evidence that exposure to chlamydia and herpes can increase insulin sensitivity in middle-aged men.
There appears to be little research focusing on establishing a link between T1D risk and STI exposure, however.
Unfortunately, people with T1D may have more trouble fighting off transmissions than those without diabetes, “especially when their blood sugar level is not managed well,” Rice said.
Dr. Yogish C. Kudva, a Mayo Clinic endocrinologist and diabetes researcher, further confirms that people with T1D will likely have more trouble fighting off certain sexually passed fungal transmissions.
If you do contract an STI, your T1D body will react much as it does to most bacteria, meaning your blood sugar levels will tend to run higher than usual, and your risk of diabetic ketoacidosis (DKA) will increase. If you have prolonged bouts of unexplained high blood sugar levels, you should discuss the matter with your healthcare provider, as it might be a sign of an undiagnosed case.
“How hard it will be to control your blood sugar typically correlates with how sick you are,” said Dr. Chisholm. “For instance, if you had chlamydia cervicitis, your sugars may be a bit off, but if you had Pelvic Inflammatory Disease (PID), a more severe infection caused by chlamydia, it’s likely your glucose levels would skyrocket.”
Most STIs are treatable with antibiotics or antifungal medications. The effect of these medications on your blood sugar levels will vary, but the healthcare providers surveyed for this article agreed that many medications used to treat STIs will lower blood sugar levels — therefore increasing the risk of hypoglycemia (dangerously low blood sugar).
This creates an especially difficult situation for a person with T1D: The STI itself can raise blood sugars, while the treatment drugs have a lowering effect. Naturally, it will be important to check your blood sugar levels more frequently than usual if you have an STI and are receiving treatment, as levels may be quite volatile.
There are three ways for anyone — living with T1D or not — to lower their risk of contracting an STI: barrier methods such as condoms or dental dams, communication, and testing.
“I can’t stress enough the importance of condom use, especially in the prevention of chlamydia and gonorrhea,” said Dr. Chisholm. “Unfortunately, condoms do not as effectively prevent genital herpes, genital warts, or syphilis, as these STI can be spread by skin-to-skin contact. I also would highly encourage STI testing when you are with a new partner. If you have multiple partners or engage in higher-risk sexual practices, I would recommend more frequent STI testing.”
If you engage in oral sex, it’s also highly recommended to use a dental dam — a thin, flexible piece of latex that protects against direct mouth-to-genital or mouth-to-anus contact during oral sex. This reduces STI risk while still allowing for clitoral or anal stimulation.
Finally, communication among partners is key to safety. Many people with T1D have learned to talk openly with their long-term partners about how the chronic condition might impact sex. This may provide a head start over others in having conversations about STI risk.
In addition, it’s important that people with T1D monitor blood sugar levels closely and discuss any abnormal blood sugar trends with their healthcare providers, as any pronounced change may indicate a hidden transmission, according to Roszler and Rice.
Don’t be shy, and trust in your provider, Rice said. “All endocrinologists should be able to discuss this topic.”
A few additional resources to learn more: