Chinese researchers who tested the sperm of men infected with COVID-19 found a minority had the new coronavirus in their semen, opening up a small chance the disease could be sexually transmitted, The Guardian reports scientists have said. A study by doctors at China’s Shangqiu Municipal Hospital of 38 men hospitalised with the disease found that six of them (16%), tested positive for SARS-CoV-2 in their semen.
The researchers said that while the findings were preliminary, and based on only a small number of infected men, more research is needed to see whether sexual transmission might play a role in the COVID-19 pandemic. “Further studies are required with respect to the detailed information about virus shedding, survival time and concentration in semen,” the team wrote.
Independent experts are quoted in the report as saying that the findings were interesting but should be viewed with caution and in the context of other small studies that have not found the new coronavirus in sperm. A previous small study of 12 COVID-19 patients in China in February and March found that all of them tested negative for SARS-CoV-2 in semen samples.
Allan Pacey, a professor of andrology at Sheffield University in the UK, said the studies should not be seen as conclusive, as there were some technical difficulties in testing semen for viruses. He said the presence of SARS-CoV-2 in sperm did not show whether it is active and capable of causing infection. “However, we should not be surprised if the virus which causes COVID-19 is found in the semen of some men, since this has been shown with many other viruses such as Ebola and Zika,” he said.
Sheena Lewis, a professor of reproductive medicine at Queen’s University Belfast, stressed that this was a “very small study” and said its findings were in keeping with other small studies showing low or no SARS-CoV-2 in tests of semen samples.
Abstract
Introduction: In December 2019, an outbreak of pneumonia associated with coronavirus disease 2019 (COVID-19) occurred in Wuhan, China, and rapidly spread to other parts of China and overseas.1 It has been confirmed that COVID-19 has the characteristic of human-to-human transmission, mainly through respiratory droplets and contact. Other routes require further verification. The virus responsible for COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in stool, gastrointestinal tract, saliva, and urine samples.2 However, little is known about SARS-CoV-2 in semen.
Methods: This cohort study was performed after patients gave written informed consent for research purposes, and in compliance with the Helsinki Declaration3 with the approval of the ethics committee of Shangqiu Municipal Hospital, Shangqiu, China. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
We identified all male patients with laboratory-confirmed COVID-19 aged 15 years and older between January 26, 2020, and February 16, 2020, in Shangqiu Municipal Hospital, which is the only designated hospital for the treatment of COVID-19 in Shangqiu, in the east of Henan province. Following guidance from the World Health Organization,4 laboratory confirmation for COVID-19 was defined as positive result for SARS-CoV-2 in real-time reverse transcriptase–polymerase chain reaction assay of nasal and pharyngeal swabs.1 Enrolled patients were asked to provide a semen sample for SARS-CoV-2 testing.
Groups were compared using the t test, χ2 test, or Mann-Whitney or Kruskal-Wallis test. All statistical analyses were performed using SPSS statistical software version 19 (IBM). P values were 2-tailed, and P < .05 was considered to indicate significant differences.
Results: Among 50 patients identified, 12 patients were unable to provide a semen specimen because of erectile dysfunction, being in a comatose state, or dying prior to recruitment; therefore, a total of 38 patients were enrolled for semen testing. Of these 38 participants who provided a semen specimen, 23 participants (60.5%) had achieved clinical recovery and 15 participants (39.5%) were at the acute stage of infection. Results of semen testing found that 6 patients (15.8%) had results positive for SARS-CoV-2, including 4 of 15 patients (26.7%) who were at the acute stage of infection and 2 of 23 patients (8.7%) who were recovering, which is particularly noteworthy. But there was no significant difference between negative and positive test results for patients by age, urogenital disease history, days since onset, days since hospitalization, or days since clinical recovery. The clinical characteristics of patients with positive test results for SARS-CoV-2 in semen are shown in the Table.
Discussion: In this cohort study, we found that SARS-CoV-2 can be present in the semen of patients with COVID-19, and SARS-CoV-2 may still be detected in the semen of recovering patients. Owing to the imperfect blood-testes/deferens/epididymis barriers, SARS-CoV-2 might be seeded to the male reproductive tract, especially in the presence of systemic local inflammation. Even if the virus cannot replicate in the male reproductive system, it may persist, possibly resulting from the privileged immunity of testes. So far, researchers have found 27 viruses associated with viremia in human semen. But the presence of viruses in semen may be more common than currently understood, and traditional non–sexually transmitted viruses should not be assumed to be totally absent in genital secretions.5,6 Studies on viral detection and semen persistence are beneficial to clinical practice and public health, especially concerning viruses that could cause high mortality or morbidity, such as SARS-CoV-2.
Authors
Diangeng Li; Meiling Jin; Pengtao Bao; Weiguo Zhao; Shixi Zhang
[link url="https://www.theguardian.com/world/2020/may/07/covid-19-found-in-semen-of-infected-men-say-chinese-doctors"]Full report in The Guardian[/link]
[link url="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765654?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=050720"]JAMA research letter[/link]