Can I have developed erectile dysfunction (ED), low libido, and testicular atrophy from unprotected oral sex, possibly due to a sexually transmitted infection (STI)?

STI Transmission via Oral Sex and Your Symptoms

Your symptoms of low libido, erectile dysfunction, and testicular atrophy are unlikely to be caused by an STI from oral sex alone, and you need urgent hormonal evaluation to identify the actual cause, which is most likely hypogonadism or another endocrine disorder. 1, 2

Why STIs Are Unlikely to Explain Your Symptoms

While oral sex can transmit certain STIs (gonorrhea, chlamydia, syphilis, herpes), these infections do not typically cause the triad of symptoms you're experiencing 3:

• Gonorrhea and chlamydia from oral sex primarily cause pharyngeal infections that are usually asymptomatic or cause mild throat symptoms—not systemic sexual dysfunction 3
• Testicular atrophy is not a recognized manifestation of common STIs transmitted through oral sex 3, 2
• The combination of low libido, ED, and testicular atrophy strongly suggests hormonal dysfunction (hypogonadism), not infection 1, 2, 4

What's Actually Causing Your Symptoms

The constellation of low libido, erectile dysfunction, and testicular atrophy is the classic presentation of hypogonadism (low testosterone) 1, 2:

• Testicular atrophy on physical examination is a specific physical finding that suggests hormonal abnormality and warrants immediate testosterone measurement 3, 2
• Approximately 15-36% of men presenting with sexual dysfunction have undiagnosed hypogonadism 3, 2, 4
• Decreased libido is the primary symptom that distinguishes hormonal causes from other etiologies of ED 1, 4

Immediate Diagnostic Steps Required

You need the following blood tests drawn between 8-10 AM on two separate occasions 1, 5:

1. Morning total testosterone (must be <300 ng/dL on two occasions to confirm hypogonadism) 1, 5
2. Free testosterone or androgen index (total testosterone/SHBG ratio), as this prevents unnecessary investigation in up to 50% of men with borderline total testosterone 1, 2
3. LH and FSH levels to distinguish primary (testicular) from secondary (pituitary/hypothalamic) hypogonadism 1, 5
4. Prolactin level, as elevated prolactin universally causes reduced libido and should be measured when loss of libido is the primary complaint 1, 2

Should You Still Get STI Testing?

Yes, but for different reasons 3:

• Screen for gonorrhea, chlamydia, and syphilis as routine sexual health maintenance, not because they explain your symptoms 3
• If you have any oral symptoms, genital lesions, or discharge, these infections should be treated 3
• HIV testing should be performed if you're in a high-prevalence area or have other risk factors 3

Critical Pitfall to Avoid

Do not accept symptomatic ED treatment (like Viagra) without first investigating the hormonal cause of your symptoms 3, 1:

• PDE5 inhibitors (sildenafil, tadalafil) require a minimal level of testosterone to work effectively 3, 6, 7
• Approximately 36% of men seeking consultation for sexual dysfunction have hypogonadism that must be addressed first 2, 4
• Treating ED without correcting underlying hypogonadism leads to treatment failure 3, 6

Expected Treatment Path If Hypogonadism Is Confirmed

If your testosterone is confirmed low (<300 ng/dL on two occasions) with symptoms 1, 5:

• Testosterone replacement therapy (transdermal gel or intramuscular injection) produces small but significant improvements in sexual function and libido 1, 5
• Treatment should target mid-normal testosterone levels (500-600 ng/dL) 5
• Expect improvement in 2-3 months, with reevaluation at 12 months 5

Bottom Line

Your symptoms point to a hormonal problem, not an infection from oral sex. Get your testosterone, LH, FSH, and prolactin checked immediately—this is the most likely explanation for your constellation of symptoms. STI screening is still appropriate for sexual health maintenance, but it won't explain testicular atrophy and the specific pattern of sexual dysfunction you're experiencing.