SARS-CoV-2 in semen of patients with COVID-19?

May 9, 2020: SARS-CoV-2, the virus that causes COVID-19, may be present in the semen of patients with COVID-19, both recovering and those with acute disease, according to a small study published in online today at JAMA network open.

However, several experts caution that the researchers only analyzed the viral components and that the findings do not demonstrate infectivity. “I am not aware of any reports of sexually transmitted infection, so the risk here, even if the study is verified on a larger scale, is very limited,” said Ian Jones, PhD, professor of virology, University of Reading, UK . .

Other experts point out that the published article is short on information on methodology and context. “I’m not saying they’re wrong, but they’re shy about the details,” said Maureen Ferran, PhD, associate professor of biology, Rochester Institute of Technology, New York. She notes that although the authors say they used the reverse transcription polymerase chain reaction (RT-PCR) to detect viral RNA from nasal swabs to confirm infection, they do not say what they did to detect the virus in semen. , leaving readers to assume that I also used RT-PCR to analyze those samples.

A spokesperson for the Jamaica the press office has clarified that the authors used RT-PCR to detect viral RNA in semen; the authors did not respond to multiple requests for comment by email.

“It is peer-reviewed, but everyone is trying to get everything out so fast that some things are hurting,” Ferran continued. She noted that she was surprised that the authors did not mention other studies that showed conflicting results.

In the recently reported study, SARS-CoV-2 was detected in semen of 6 (15.8%) of 38 evaluated patients. All patients had confirmed COVID-19.

The finding may have implications for the prevention and control of COVID-19, say the study authors, led by Diangeng Li, PhD, of the General Hospital of the Chinese People’s Liberation Army, Beijing, China.

“Due to imperfect testis / vas deferens / epididymis barriers, SARS-CoV-2 could be seeded in the male reproductive tract, especially in the presence of local systemic inflammation,” the authors write.

“Even if the virus cannot replicate in the male reproductive system, it can persist, possibly as a result of privileged testicle immunity,” Li and colleagues wrote.

If additional research shows that SARS-CoV-2 is sexually transmitted, then this may be critical in preventing transmission, they point out. “Withdrawal or condom use could be considered as a preventive means for these patients,” they suggest.

Commenting on the study, Allan Pacey, PhD, FRCOG, professor of andrology at the University of Sheffield, UK, acknowledges that this opens up the possibility that a route of infection may be through sexual contact, although this has not been confirmed.

He said Medscape Medical News Although the results seem solid, they disagree with a recent study published in Fertility and sterility who found no evidence of the virus in semen in a similar number of men (n = 34), suggesting the need for more research. “From my own experience … I can confirm that there are a number of methodological challenges to overcome in order to truly establish the source of a virus or bacteria infection within the male reproductive tract, and furthermore that any DNA / RNA represents enough viruses or bacteria to they are enough to cause infection by sexual contact. “

However, he added, “We should not be surprised if the virus that causes COVID-19 is found in some men’s semen, as this has been shown with many other viruses, such as Ebola and Zika.”

This point was repeated by Walter D. Cardona Maya, PhD, microbiologist and expert in semen evaluation at the University of Antioquia, Medellín, Colombia. “[T]”His SARS-CoV-2 infection is very similar to other viral infections that could be transmitted through semen and therefore during sexual intercourse,” he said. Medscape Medical News.

He added that similar results were reported in 2003 for SARS-CoV, the virus that causes severe acute respiratory syndrome. Based on this study and other articles, taken as a whole, “the evidence shows that with regard to asymptomatic patients with COVID-19, it is very important to consider this alternative route of infection. The possibility of transferring the virus through couples , and perhaps with an effect on fertility and offspring, should be evaluated, “he said. Cardona Maya recently wrote a comment, SARS-CoV-2 and Testis: Similarity to Other Viruses and Routes of Infection, which discusses this in more detail.

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Viral presence in semen

It is not uncommon to find viruses in semen, and it could be more common than is currently understood, Li and colleagues say in the new study. To date, 27 viruses have been associated with viremia in human semen. “It should not be assumed that traditional non-sexually transmitted viruses are totally absent in genital secretions,” they write.

The researchers started the observational study after recognizing that little was known about SARS-CoV-2 in semen. The virus has been detected in feces, the gastrointestinal tract, saliva, and urine samples.

To address this research gap, men with laboratory-confirmed COVID-19 who were in treatment at Shangqiu Municipal Hospital, China were asked to provide a semen sample for the SARS-CoV-2 test. Of the 50 patients, 38 were able to provide a viable sample.

The authors note that the SARS-CoV-2 viral RNA was present in recovering patients as well as in those with acute infections. They report that 23 of the patients who provided a semen sample had achieved clinical recovery. Of these, samples from two (8.7%) tested positive for SARS-CoV-2. Of the 15 participants with acute disease, samples from four patients (26.7%) were positive for SARS-CoV-2.

The authors write that “there was no significant difference between negative and positive test results for patients by age, history of urogenital disease, days from onset, days from hospitalization, or days from clinical recovery.”

They add that avoiding contact with the patient’s saliva and blood may not be enough, because the fact that SARS-CoV-2 survived in the semen of a recovering patient suggests that the virus is likely to infect others.

Conflicting studies highlighting the need for more work

Several groups have observed that the testes have a high expression of the angiotensin-converting enzyme receptor 2 (ACE2), which the virus uses for cell entry. A study, published on a prepress server on April 17 but not peer-reviewed, showed that virus clearance is delayed in men. The authors, led by Aditi Shastri, MBBS, of New York City’s Albert Einstein College of Medicine, wrote: “High expression of ACE2 in the testes increases the possibility that testicular viral reservoirs may play a role in Viral persistence in men and should be further investigated. “

In contrast, an observational study of 12 recovering patients, none of whom had severe COVID-19 pneumonia, found that all patients tested negative for SARS-Cov-2 RNA in semen samples. Another 67-year-old deceased patient tested negative for viral RNA on a testicular biopsy. The study, published as a letter in Reproduction biology, concluded that no viral RNA was found in the semen or testicular biopsy sample, but that more work was needed to confirm the finding.

The study authors have not included relevant financial relationships. Pacey is chairman of the advisory committee for the UK’s National External Quality Assurance Schemes in Andrology, editor in chief of Human fertility, and trustee of the Progress Educational Trust (all unpaid). He has recently done work for the World Health Organization, the British Broadcasting Corporation and Purple Orchid Pharma (consultancy paid with all funds going to the University of Sheffield) and is co-applicant for a research grant from the Medical Research Council . The other commenters have disclosed no relevant financial conflicts.

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