Novel Investigation of SARS-CoV-2 in COVID-19 Survivors’ Semen in Surabaya, Indonesia

Abstract

The emergence and the widespread of Coronavirus disease 2019 (COVID-19) demands an accurate detection method to establish a diagnosis. Real-time polymerase chain reaction (real-time PCR) is accounted for the perfect point of reference in detecting this virus. The notion that this virus also invades the male reproductive tract requires further investigation to prove the presence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the semen. This investigation was designed to detect SARS-CoV-2 in COVID-19 survivors semen. This study design was a cross-sectional examination and conducted between November 2020 and March 2021 in the Andrology Unit of Dr. Soetomo General Hospital and Professor Nidom Foundation, both located in the City of Surabaya, Indonesia. The sample was 34 male participants aged above 18 years old and had been confirmed COVID-19 by nasopharyngeal swab PCR test. Part of the semen was taken for real-time PCR testing with the QuantStudio 5 Applied Biosystem (AB) PCR machine and the kits utilized were the STANDARD M nCOV Real-Time Detection Kit and mBioCov-19 RT-PCR Kit. Furthermore, the mean of participants ages was 35.74 years old with 25% of them had had a history of primary infertility and 21.8% of secondary infertility. From the real-time PCR COVID-19 of the semen examination, this investigation found that 27 participants had been negatives (74.4%), six inconclusive (17.6%), and one positive (3%) of SARS CoV-2. In summary, SARS-CoV-2 could be found in the semen of COVID-19 survivors. This should be a concern for the potential impact of COVID-19 in male fertility and the possibility of transmission reproductively.

Viral shedding of SARS-CoV-2 in body fluids associated with sexual activity: a systematic review and meta-analysis

“…The presence of SARS-CoV-2 in semen was assessed by 30 studies (16 cohort, 8 cross-sectional and 6 case series), including 888 patients (1428 specimens). Six studies reported the presence of SARS-CoV-2 in semen (n=14 patients),24–29 but only one followed patients until a negative result was obtained 25…”

long-term impact of COVID-19 infection on semen quality of the COVID-19 survivors

“…24 Statistical analysis was performed globally and within each group, respectively, if sufficient. Semen volume, pH, sperm concentration, total, progressive, non-progressive, and immotile motility percentage, morphology percentage, leukocyte, erythrocyte, and immature sperm cells parameters obtained from the current semen analysis were to be statistically compared with individual previous results, which were obtained by Supardi, et al 20 All statistical analyses were performed using SPSS version 25.0. Normality test was based on the result of the Shapiro-Wilk Test.…”

“…19 Similar result was found in a prior study conducted in Surabaya, that from 34 men diagnosed with infertility in the resolution phase of COVID-19 infection, one of them showed positive results in seminal SARS-CoV-2 PCR, after 121 days since diagnosis of COVID-19 based on nasopharyngeal PCR swab. 20 Longer-term effects of COVID-19 on males have also been reported in several case reports. A 36 years-old man with no history of any kind of infertility pre-COVID-19 was diagnosed with oligoasthenoteratozoospermia one month post-COVID-19, only improving after four months post-COVID-19 without reaching pre-COVID-19 semen analysis values.…”

“…COVID-19 survivors previously evaluated by semen analysis were included in this follow-up study. All patients were outpatients treated in the Andrology Unit of Dr. Soetomo General Hospital and Professor Nidom Foundation, both located in Surabaya, Indonesia, and recently diagnosed with infertility based on the semen analysis by the time of the resolution of COVID-19 symptoms by Supardi, et al 20 Inclusion criteria for the subjects are patients aged >18 years old, had a history of resolved COVID-19 infection with previous evidence of laboratory-confirmed positive SARS-CoV-2 nasopharyngeal PCR swab result and had a previous history of infertility after COVID-19 infection based on the evidence of the semen analysis within 6 months or longer. Patients with any history of primary or secondary infertility before COVID-19 infection, history of testicular infection or malignancy, and patients currently using hormonal drugs which could affect spermatogenesis are excluded.…”

“…The sampling was performed 2 times for each participant. The baseline sampling, which was already performed before by Supardi, et al 20 , was performed immediately by the time of resolution of COVID-19 symptoms. The follow-up sampling was performed within 6 months or more from the previous baseline sampling.…”