Review of COVID‐19 and male genital tract

Abstract

COVID‐19 pandemic leads to health challenges globally, and its diverse aspects need to be uncovered. Multi‐organ injuries have been reported by describing potential SARS‐CoV‐2 entrance routes: ACE2 and TMPRSS2. Since these cell surface receptors’ expression has been disclosed within the male reproductive system, its susceptibility to being infected by SARS‐CoV‐2 has been summarised through this literature review. Expression of ACE2 and TMPRSS2 at RNA or protein level has been reported across various investigations indicates that the male genitalia potentially is vulnerable to SARS‐CoV‐2 infection. Presence of SARS‐CoV‐2 within semen samples and following direct viral damage, secondary inflammatory response causing orchitis or testicular discomfort and finally the amount of viral load leading testicular damage and immune response activation are among probable underlying mechanisms. Therefore, genital examination and laboratory tests should be considered to address the male reproductive tract complications and fertility issues.

The Effect of COVID-19 Infection on Sperm Quality and Male Fertility

“…On the other hand, TMPRSS2 can break down ACE2 into amino acids 697 to 716 and facilitate the entry of the COVID-19 virus. The ACE2 gap is expected to reduce sperm viability and function following exposure to the virus, leading to loss of fertility (35). Our results are similar to some recent reports describing viral infections negatively affect semen parameters, including the semen volume, number of spermatozoa, and sperm total motility.…”

Male infertility and COVID-19: Is there a relationship?

“…The importance of viral infections associated with the male reproductive system has been highlighted in several studies, leading to the detection of more than 30 viruses that spread in the semen, such as mumps, human immunodeficiency, hepatitis and zika that cross the blood-testicular barrier, causing as orchitis, epididymitis and changes in sperm count or semen quality as a whole (Sheikhzadeh et al, 2021;Vishvkarma et al, 2020).…”

“…When we observe the ACE2 cell receptor and the viral nucleocapsid protein in tissue samples, we can observe that positive areas are mainly distributed in the cytoplasm of epithelial cells and the cilia of the gastrointestinal glandular epithelial cells . ACE acts to catalyze the conversion of angiotensin I to angiotensin II (ANG II), and ACE2 is responsible for the generation of angiotensin 1-7 (ANG 1-7) from angiotensin II (Younis et al, 2020;Illiano et al,2020;Dutta et al, 2021;Sheikhzadeh et al, 2021).…”

“…While ANG II exerts deleterious effects via type 1 angiotensin II receptors, the ANG 1-7 receptor axis causes benefits, balancing and salutary actions on vital organs, such as vasodilation, anti-inflammatory, anti-fibrotic, diuretic action and natriuretic. ACE2 is widely expressed in the heart, kidneys, lungs, intestines, liver and testicles (Younis et al, 2020;Illiano et al,2020;Dutta et al, 2021;Sheikhzadeh et al, 2021).…”

“…The cells with greater expression of ACE2 function as a key receptor for Sars-CoV-2, therefore favoring a greater predisposition to infection by COVID-19 (Illiano et al, 2020 ;Sheikhzadeh et al ., 2021).The innovation in male fertility research is because the testicular Leydig and Sertoli cells have one of the largest amounts of ACE2 among the various tissues of the body, combined with the property of being the meeting point of most testicular mRNAs, mainly in Leydig cells (Younis et al, 2020;Vishvkarma et al, 2020). SARS-CoV-2 activates sensitive pathways through an inflammatory response with the release of cytokines, C reactive protein (CRP), interleukin 6, procalcitonin and ferritin.…”