The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was responsible for the coronavirus disease 2019 (COVID-19) pandemic in Wuhan, China, in 2019.
Study: SARS-CoV-2 Shedding in Semen and Oligozoospermia of Patient with Severe Coronavirus Disease 11 Weeks after Infection. Image Credit: LL_studio/ Shutterstock
Association of SARS-CoV-2 with long-term implications of male fertility and sexual transmission has not been reported to date. However, various other emerging pathogens such as the Ebola virus and Zika virus have undergone sexual transmission.
Angiotensin-converting enzyme-2 (ACE2) receptors essential for the entry of the virus inside host cells are abundant in the testis. Additionally, autopsy reports have indicated viral invasion of the testis. Furthermore, the presence of SARS-CoV-2 has been detected in semen from two studies during the acute phase and one study during early convalescence.
A new study published in the journal Emerging Infectious Disease reported findings of semen analysis from a prospective COVID-19 cohort study.
About the study
The study took place in March 2020 and involved participants from inpatient and outpatient settings in New York. Participants who showed positive results for SARS-CoV-2 RT-PCR or serological tests were considered to be eligible. The recruited participants had to fill out surveys that involved demographics, their COVID-19 clinical course, and underlying conditions.
Clinical samples were collected from the participants at each visit which included nasopharyngeal swab specimens, peripheral blood mononuclear cells, plasma, stool/rectal swab specimens, saliva samples, and semen.
Out of the 107 participants who enrolled for the cohort study, only seven provided semen samples. The mean age of the participants was found to be around 38.7 years. Out of the seven participants, two were Hispanic, three Caucasian, and two Black. Two of the participants had previous HIV infections, and two were reported to have a body mass index greater than 30 kg/mg2. Furthermore, one participant had a successful vasectomy and was included in the study to evaluate viral carriage in non-testes organs.
The semen was collected and assessed according to the guidelines of the World Health Organization. A total of 17 semen samples were collected from the 7 participants. The samples were frozen after collection. The samples then underwent semen analysis and quantitative RT-PCR (qRT-PCR) testing. Additionally, the cycle threshold (Ct) values were also assessed.
Furthermore, immunoassays were carried out to quantify IgA, IgG, and IgM binding against the viral spike and nucleocapsid protein. Antibody neutralization assay was carried out for measurement of neutralization at half-maximal inhibitory concentration. Also, an ELISPOT assay was done to determine the T-cell response against viral spike, matrix, nucleocapsid, and envelope proteins.
The results indicated the presence of SARS-CoV-2 RNA along with severe oligozoospermia in one participant 81 days after COVID-19 onset. The sperm count for this participant was less than one million on day 81, and no sperm motility was observed. Additionally, two other participants were found to have severe oligozoospermia, and one had mild oligozoospermia. The semen samples from the rest of the six men were negative for the qRT-PCR test.
Furthermore, sperm count recovery was observed in three participants, while two participants had decreased sperm count during later convalescence. Additionally, the humoral and cell-mediated immune responses were found to be adequate. The ELISPOT assay showed strong reactivity against the matrix protein, while half-maximal inhibitory concentration against SARS-CoV-2 trimer was found to be modest at days 72 and 78.
Although the study was quite effective in determining the presence of SARS-CoV-2 in the semen, it had certain limitations. The initial sample of semen was collected during the late convalescent phase, where a high Ct value corresponded to the presence of an inactive virus that could not detect sexual transmission.
The study's sample size was quite small and did not include pre-infection semen analysis for comparison. Therefore, the findings could not be generalized for all the male COVID-19 survivors and require further research.