SARS‐CoV‐2 and its relationship with the genitourinary tract: Implications for male reproductive health in the context of COVID‐19 pandemic

Abstract

Background The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, named coronavirus disease 19 (COVID‐19), is not the first well‐known spillover of an animal originated virus to infect humans. However, one of the few to make such a fast jump in a powerful evolutionary shortcut. The incredible pattern of aggressiveness worldwide since the beginning of the outbreak is that up to 20% of those infected need hospitalization and 5% evolve to critical conditions, not limited to respiratory‐related issues, but rather to systemic involvement. Objective This study aims to summarize the current knowledge about the effects of SARS‐CoV‐2 infection on the male genitourinary tract. Materials and methods A narrative review was carried out to identify articles on the SARS‐CoV‐2 infection on the male genitourinary system. Results Considerations were made about the molecular characteristics of SARS‐CoV‐2 and immune response to coronavirus. We discussed the influence of the virus on the urinary system, potential mechanisms of COVID‐19‐ related acute kidney injury (AKI), and the role of cytokine release syndrome on the renal pathophysiology of the disease. In the male reproductive tract, it was discussed the testis' vulnerability to SARS‐CoV‐2 invasion and the possible adverse effects on its function and the seminal findings of COVID‐19. Discussion and conclusion During the COVID‐19 pandemic, an international coordinated scientific effort must arise to understand the role of the urogenital system in the SARS‐CoV‐2 infection in the clinical setting.

Radiological patterns of incidental epididymitis in mild‐to‐moderate COVID‐19 patients revealed by colour Doppler ultrasound

“…Nonetheless, a viral translocation between the testis and epididymis has been detailed in very few experimental animal models, such as a micro‐RNA targeted Zika virus clones in mice (Tsetsarkin et al., 2018) and simian immunodeficiency virus (SIV) infected monkeys (Houzet et al., 2018). For SARS‐CoV‐2 infection, probably an indirect deleterious effect mediated by cytokines could act on the epididymis, similarly as it has been hypothesised for the testis (Hallak et al., 2021).…”

“…An ongoing debate regarding the potential deleterious SARS‐CoV‐2 effects on the male reproductive tract had encouraged the intensive investigation of the viral action upon testicular and epididymal physiology (Hallak et al., 2021), since this organ precisely displays the highest ACE2 expression, according to data gathered from the Genotype‐Tissue Expression (GTEx) project (Baughn et al., 2020). Therefore, subclinical or even asymptomatic testicular manifestations are potential and realistic concerns as scientific and medical communities have not yet had the time to gather more information on the consequences of the reproductive, sexual and hormonal status of mildly affected and under‐evaluated individuals.…”

“…The male reproductive tract is gaining increasing attention as a primary target‐organ system for infection, as the testicles widely express the angiotensin‐converting enzyme 2 (ACE2), the viral entry receptor, whose co‐expression with the viral priming transmembrane protease serine 2 (TMPRSS2) mediate SARS‐CoV‐2 cell invasion (Chen et al., 2020; Hallak et al., 2021). Scrotal clinical manifestations during the acute stage of the infection usually range from a prevalent asymptomatic scenario to an unusually mild local discomfort (Pan et al.…”

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): a Systemic Infection

“…There is no evidence of sexual transmission of SARS-CoV-2, but the consequences regarding male fertility as well as female fertility and perinatal outcomes are not evident at the moment. Nevertheless, it should be a topic of further study and discussion ( 396 , 405 – 408 ).…”

SARS-CoV-2 and Multi-Organ damage – What men's health specialists should know about the COVID-19 pathophysiology

“…SARS-CoV-2 belongs to the genus Betacoronavirus, which also involves two other zoonotic coronaviruses that provoked epidemics of Severe Acute Respiratory Syndrome (SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in 2012 (11). The Coronavirus family infects humans and other vertebrates and causes deleterious effects on the respiratory, cardiovascular, gastrointestinal, central nervous system, and genitourinary tract (12)(13)(14). Studies suggest that severity and mortality of COVID-19 are substantially higher in men than women, drawing fully attention to all Men Health's care professionals (15).…”