Viral pathogenesis of SARS-CoV-2 infection and male reproductive health

Abstract

Coronavirus disease 2019 (COVID-19) has emerged as a new public health crisis, threatening almost all aspects of human life. Originating in bats, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted to humans through unknown intermediate hosts, where it is primarily known to cause pneumonia-like complications in the respiratory system. Organ-to-organ transmission has not been ruled out, thereby raising the possibility of the impact of SARS-CoV-2 infection on multiple organ systems. The male reproductive system has been hypothesized to be a potential target of SARS-CoV-2 infection, which is supported by some preliminary evidence. This may pose a global threat to male fertility potential, as men are more prone to SARS-CoV-2 infection than women, especially those of reproductive age. Preliminary reports have also indicated the possibility of sexual transmission of SARS-CoV-2. It may cause severe complications in infected couples. This review focuses on the pathophysiology of potential SARS-CoV-2 infection in the reproductive organs of males along with their invasion mechanisms. The risks of COVID-19 on male fertility as well as the differences in vulnerability to SARS-CoV-2 infection compared with females have also been highlighted.

The Epidemic of COVID-19-Related Erectile Dysfunction: A Scoping Review and Health Care Perspective

“… √ √ Beghi et al 2020 25 Italy Narrative Review • COVID-19 is an influenza virus with neurotropic potential, presents with neurological manifestations many individuals • Postinfectious neurological complications are the result of the activation of immune mechanisms and can explain the insurgence of immune-mediated diseases √ √ Thomas & Konstantinidis 2021 26 Greece Narrative Review • The pathophysiology of ED remains a labyrinth. • Underlying mechanisms of ED may be vasculogenic, neurogenic, anatomical, hormonal, drug-induced and/or psychogenic • Neurogenic ED consists of a large cohort of ED, accounting for about 10% to 19% of all cases √ √ Wu et al 2020 27 China Narrative Review • Viral infections have detrimental impacts on neurological functions, and even to cause severe neurological damage • Coronaviruses (CoV), especially SARS-CoV-2, exhibit neurotropic properties and may cause neurological diseases √ √ Roychoudhury et al 2021 28 India Narrative Review • Preliminary findings so far suggest the possibility of both direct and indirect infection ofSARS-CoV-2 in the reproductive system of males and possible impact on general health and well-being potentially leading to infertility • Evidence indicates a possible long-term effect of the pathogenicity of SARS-CoV-2 infection on testicular tissue, which may further impact reproductive performance √ √ Lipsky & Hung 2020 3 USA Narrative Review • Plausible theories for why men respond differently to the SARS-CoV-2 infection include sex-related differences in angiotensin-converting enzyme 2 receptors, immune function, hormones, habits, and coinfection rates • Data from the CDC demonstrate disparities among racial and ethnic minorities, with mortality rates for African American and Latino men exceeding those for White or Asian males • Continuing to collect data disaggregated by sex can help us understand why men are more likely to experience severe disease √ √ Pennanen-Iire et al 2021 29 Finland Narrative Review • COVID-19 affects sexual function with implications on overall health • Increased awareness of health-...…”

“… 17 It has been theorized that that testicular damage may result following COVID-19 infection. 18 , 19 , 28 The ACE2 gene is a receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for COVID-19. High levels of ACE2 expression in testes indicate that SARS-CoV-2 might affect the testes, potentially affecting male sexual function.…”

Outbreaks of SARS-CoV-2 in naturally infected mink farms: Impact, transmission dynamics, genetic patterns, and environmental contamination

“…It has been also documented that men with COVID-19 are more at risk for worse outcomes and death, independent of age [33]. It has been also hypothesized that the male reproductive system could be a potential target of SARS-CoV-2 infection, and could also lead to infertility [34]. To our knowledge, such differences in viral load and infection outcome between male and female minks have not been documented so far.…”

Serum Albumin Levels are a Predictor of COVID-19 Patient Prognosis: Evidence from a Single Cohort in Chongqing, China

“…1,2 Additionally, the lungs are not unique targets of SARS-CoV -2 and other targets include the heart, liver, kidney and the male reproductive system. [3][4][5][6][7] These studies have suggested that COVID-19 might cause systemic disease.…”