Evaluation of SARS-CoV-2 in semen, seminal plasma, and spermatozoa pellet of COVID-19 patients in the acute stage of infection

Abstract

To date, there is limited information about the presence of SARS-CoV-2 in semen especially in the acute phase of the infection. While available data from cohort studies including a total of 342 patients in the acute or recovery phase of the infection are reassuring, one study mentioned detecting virus in the semen of 6/38 COVID-19 patients. Here we assessed SARS-CoV-2 presence in the semen of COVID-19 positive patients in the acute stage of infection, within 24 hours of the positive nasopharyngeal swabs. Semen, seminal plasma and spermatozoa pellet were screened for SARS-CoV-2 and manual or airborne contamination during semen sampling. Among the 32 COVID-19 volunteers, the median interval from the onset of symptoms to semen collection was 4 days [IQR: 0–8]. Only one presented positive SARS-CoV-2 PCR in semen and seminal plasma fractions, although the spermatozoa pellet was negative. Viral cultures were all negative. We observed slightly higher concentrations of bacterial DNA in the SARS-CoV-2 positive specimen than in all negative samples. The bacteria identified neither confirm nor rule out contamination by oropharyngeal secretions during collection. SARS-CoV-2 was rarely present in semen during the acute phase of the disease. This very rare situation could be connected to oral or manual contamination during semen collection. The possible presence of SARS-CoV-2 in semen calls for nasopharyngeal viral testing and strict hygiene protocols during semen collection before assisted reproductive attempts.

Could SARS‐CoV‐2 infection affect male fertility and sexuality?

“…To date, there are only two studies that found SARS‐CoV‐2 in semen specimens. These patients were in acute stage of infection or recovering from severe disease [21, 22]. However, another study analyzing semen samples obtained in acute stage of the infection did not detect SARS‐CoV‐2 in semen [23].…”

“…Hormonal levels restored after treatment [33] Semen of COVID-19 patients No detection of SARS-CoV-2 RNA in the semen of COVID-19 patients, including semen samples from two patients with an acute COVID-19 infection. Subjects with a moderate infection showed an impairment of sperm quality [24] Semen of COVID-19 patients SARS-CoV-2 was not detected in semen sample of patients in the acute phase of the infection [23] Semen of COVID-19 patients SARS-CoV-2 was detected in semen sample of patients in the acute phase of the infection or recovering from severe disease [21] Semen of patients recovering from COVID-19 SARS-CoV-2 was detected in semen sample of just 1 out of 32 patients [22] Blood from COVID-19 patients Lower total testosterone (TT), calculated free T (cFT), were found in the transferred to intensive care unit (ICU)/deceased patients [18] Semen of patients affected by COVID-19…”

SARS-CoV-2 Can Infect Human Embryos

“…Numerous studies have failed to identify virus in male and female reproductive organs of infected patients [45][46][47]. However, a more recent study detected the virus in vaginal swabs of two out of 35 women with COVID-19 [21], and two groups have reported virus in semen of infected men [19,20]. For example, a study by Li and colleagues found that six of 38 male COVID-19 patients had detectable levels of SARS-CoV-2 in their semen [19].…”

“…Within the female and male reproductive systems, expression of SARS-CoV-2 entry factors is present in cells of the ovaries, uterus, vagina, testis, and prostate [7,[15][16][17][18]. Some studies showed detectable virus in the semen of infected males [19,20] and vaginal secretions of infected females [21].…”

SARS-CoV-2 can infect human embryos

“…Within the female and male reproductive systems, expression of SARS-CoV-2 entry factors is present in cells of the ovaries, uterus, vagina, testis, and prostate 7 , 15 – 18 . Some studies showed detectable virus in the semen of infected males 19 , 20 and vaginal secretions of infected females 21 .…”