Can I have contracted a sexually transmitted infection (STI), such as gonorrhea, chlamydia, or syphilis, from unprotected oral sex, resulting in erectile dysfunction (ED), low libido, and testicular atrophy?

Can Unprotected Oral Sex Cause ED, Low Libido, and Testicular Atrophy?

Yes, you could have contracted a sexually transmitted infection from unprotected oral sex, but STIs alone do not typically cause the triad of erectile dysfunction, low libido, and testicular atrophy—these symptoms more strongly suggest hypogonadism (low testosterone), which requires immediate endocrine evaluation. 1

Why STI Testing is Still Essential

You absolutely need comprehensive STI screening because:

• Gonorrhea and chlamydia readily transmit through oral-genital contact and can infect both the genital tract and oropharynx 2, 3
• Syphilis, HIV, herpes simplex virus (HSV), and human papillomavirus (HPV) all transmit through unprotected oral sex 3, 4
• Most extragenital gonorrhea and chlamydia infections are asymptomatic (53-100% have no symptoms), meaning you could be infected without knowing it 4
• The presence of bacterial STIs increases inflammation and can affect overall health, though they don't directly cause the specific symptoms you describe 5

What Testing You Need Immediately

STI Screening Panel:

• Urethral nucleic acid amplification test (NAAT) for gonorrhea and chlamydia with sensitivities of 86-100% 4
• Pharyngeal (throat) testing for gonorrhea if you received oral sex, as recommended by CDC guidelines 2
• Syphilis serology (treponemal and nontreponemal antibody testing) 4
• HIV testing with repeat testing at 3 and 6 months if initial test is negative 2

Endocrine Evaluation (More Likely Culprit):

• Morning serum total testosterone level is essential given your symptoms of ED, low libido, and testicular atrophy 2, 1
• Free testosterone measurement if total testosterone is borderline, as this saves unnecessary evaluation in 50% of cases 1
• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) if testosterone is low, to determine if this is testicular failure versus pituitary/hypothalamic dysfunction 2
• Prolactin level only if testosterone is low and/or you have decreased libido 1

Why Your Symptoms Point to Hypogonadism, Not STIs

The combination of ED, low libido, and testicular atrophy is the classic presentation of hypogonadism (low testosterone), which occurs in approximately 15.6% of men presenting with sexual dysfunction 1. Here's the critical distinction:

• STIs cause localized genital symptoms (discharge, pain, ulcers) or systemic infection signs, but do not directly cause testicular atrophy 2, 4
• Epididymitis from gonorrhea/chlamydia causes acute testicular pain and swelling, not gradual atrophy 2
• Testicular atrophy specifically indicates chronic testosterone deficiency affecting testicular tissue 1
• A history of decreased libido and testicular atrophy cannot predict which patients have STIs, but strongly predicts hypogonadism 1

Critical Clinical Pitfall to Avoid

Do not assume your symptoms are "just" from an STI and delay endocrine evaluation. Studies show that patient-reported decreased libido and physical examination findings of testicular atrophy cannot reliably predict hypogonadism, meaning you need objective laboratory testing regardless of how you feel 1. Hypogonadism requires specific hormone replacement therapy that STI treatment will not address 2.

The Oral Sex Connection: What You Actually Risked

While oral sex doesn't cause your current symptoms, you did expose yourself to:

• Gonorrhea and chlamydia with high transmission rates through oral-genital contact 2, 3
• HPV transmission (7% point prevalence of oral HPV), which increases oropharyngeal cancer risk, especially in men 3
• Syphilis, HIV, and HSV all transmit through oral-genital contact 3, 4
• The CDC recommends barrier methods (condoms/dental dams) for every act of oral sex to prevent these infections 3

Immediate Action Plan

1. Schedule urgent appointment for morning testosterone testing (must be done in morning due to diurnal variation) 2, 1
2. Get comprehensive STI screening including urethral and pharyngeal sites 2, 4
3. If testosterone is low on two separate measurements, proceed with LH/FSH testing to determine cause 2, 1
4. Repeat HIV testing at 3 and 6 months even if initial test is negative, as seroconversion takes time 2
5. Notify your partner so they can receive STI screening and treatment if needed 2, 5

Treatment Implications

• If STIs are detected: Ceftriaxone 250mg IM plus doxycycline 100mg twice daily for 10 days treats gonorrhea and chlamydia effectively 2, 4
• If hypogonadism is confirmed: Testosterone replacement therapy addresses ED, libido, and may prevent further testicular atrophy 2
• Both conditions may coexist, requiring treatment of infections plus hormone replacement 2

The bottom line: Get both STI screening and testosterone testing immediately—your symptoms suggest a hormone problem, but you still need STI evaluation given your unprotected oral sex exposure. 2, 1