Overlooked STI Screening in Women with Diabetes and Practical Steps to Rebalance Visit Priorities

Despite strong recommendations for universal STI screening in younger, sexually active populations, data comparing STI screening rates in women with vs without diabetes are strikingly sparse. Most existing research and clinical practice patterns implicitly frame diabetes as a condition of older adults, which can lead to systematic neglect of sexual health needs in younger patients with diabetes and prediabetes. This oversight is increasingly problematic as epidemiologic trends show rising prevalence of type 2 diabetes and prediabetes in adolescents and young adults, and ongoing burden of type 1 diabetes in this age group.

The absence of comparative STI screening data for women with diabetes suggests a broader lack of appreciation for the intersection between chronic disease management and sexual and reproductive health. In routine visits, clinicians understandably prioritize what appears most urgent—preventing hospitalizations, managing hyperglycemia, adjusting insulin or other medications, and troubleshooting diet and self-management barriers. When 20–30 minutes are consumed by intensive diabetes management, screening for STIs, contraceptive counseling, and broader preventive topics can easily be deferred or omitted altogether, especially in the absence of prompts or clear expectations.

In this discussion, Lauren Wisk, PhD, highlights that primary care physicians seeing reproductive-age women with diabetes can take immediate, practical steps to rebalance visit priorities. She recommends explicitly establishing at the outset of each visit whether the primary focus will be diabetes management, general preventive care, or both—while clarifying who is responsible for each domain across the care team. In the video, Wisk suggests strategies such as scheduling more frequent follow-up visits when a single appointment cannot reasonably accommodate both complex diabetes care and comprehensive preventive services, thereby reducing the risk that critical sexual and reproductive health needs—such as STI screening—remain chronically unaddressed.