Objective
SARS-CoV-2 has led to a rapidly spreading COVID-19 global pandemic. From a public health perspective, it is crucial to determine if SARS-CoV-2 is sexually transmitted and its possible effects on human reproduction.
Design
A systematic review of English publications to July 15, 2020, was conducted according to PRISMA guidelines. A search in PubMed, NIH iCite COVID-19 portfolio, Cochrane Library, and Google Scholar databases was conducted for SARS-CoV-2 and COVID-19 with fertility, reproduction, testes, seminal, prostatic and vaginal fluids, and in cervical smears. The focus of this review is sexual transmission by vaginal intercourse. Fecal-oral transmission has been discussed by others.
Materials and Methods
The search revealed 1,107 publications after removal of duplicates, which were reviewed for eligibility by examining titles and abstracts. 141 full-text articles were reviewed and evaluated by two independent reviewers. 57 studies were included in this review based on relevance, including 14 studies which tested the male and female reproductive tracts for SARS-CoV-2 RNA.
Results
COVID-19 may have detrimental effects on male reproduction by inducing orchitis and decreased testosterone levels, sperm count, and motility. No study investigated its effects on female fertility. No epidemiological investigation to date has suggested COVID-19 is a sexually transmitted disease (STD). The lack of co-expression of ACE2 receptors and the TMPRSS2 modulatory protein, needed for SARS-CoV-2 cell entry, in testicular cells, sperm, and oocytes, supports rejection of the hypothesis that gametes transmit SARS-CoV-2. 14 molecular detection studies of SARS-CoV-2 RNA in the male reproductive tract (in testicular biopsies, seminal and prostatic fluids), and the lower female reproductive tract (in vaginal fluids and cervical smears) were published. Only 1 out of 7 studies found positive SARS-CoV-2 RNA tests in seminal fluid (6 out of 143 total men). Interestingly, all seminal fluids of 7 men that demonstrated orchitis-like symptoms, identified in 2 other studies, tested negative. All 28 prostatic fluids tested negative. Only 1 out of 11 postmortem testicular biopsies tested positive, but electron microscopy found no viral particles in the testes. In women, all 35 cervical smears tested negative and only 1 case report described a positive SARS-CoV-2 RNA result in vaginal fluid (1 out of 58 total women). All together, sexual transmission of SARS-CoV-2 has not been confirmed.
Conclusions
Based on the current world published information, COVID-19 is not an STD. This information is important for clinicians, guidelines for public health, FDA guidelines for gamete and tissue donor eligibility, and for fertility treatments. Universal precautions, practiced in clinical settings and in IVF laboratories to prevent transmission of known or unknown viral infections, are adequate and sufficient at this time. We suggest that recovered patients of COVID-19, especially those with infertility, should be evaluated for their ovarian and testicular function. Prospective longitudinal follow up studies are warranted.
P-932 3:30 PM Wednesday, October 21, 2020
Footnotes
SUPPORT: Supported in part by the Institute for Human Reproduction (IHR), Chicago, IL.