COVID-19 may affect male fertility but is not sexually transmitted: a systematic review

Ilan Tur-Kaspa M.D. , Tomer Tur-Kaspa , Grace Hildebrand B.A. , David Cohen M.D.
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引用次数: 40

Abstract

Objective

To determine if SARS-CoV-2, which has led to the rapidly spreading COVID-19 global pandemic, is sexually transmitted. Since the putative receptor for the virus is identified in reproductive organs, it is also important to examine if COVID-19 may affect human fertility.

Evidence Review

A systematic review of English publications was conducted up to December 11, 2020 in PubMed, NIH iCite COVID-19 portfolio, Cochrane Library, and Google Scholar databases, searching for SARS-CoV-2 in the testes; seminal, prostatic, and vaginal fluids; and cervical smears. A total of 1,997 records were identified, duplicates were removed, and 1,490 records were reviewed for eligibility by examining titles and abstracts. Subsequently, 202 full-text relevant articles were reviewed by 2 independent reviewers. Forty-seven studies (literature reviews, editorials, and guidelines) were assessed qualitatively, and 23 studies that tested the male and female reproductive tracts of patients with COVID-19 for SARS-CoV-2 were quantitatively analyzed.

Results

No epidemiological investigations to date have described evidence suggesting that COVID-19 is an STD. While angiotensin-converting enzyme 2 receptor is found in the reproductive organs, the lack of co-expression of the TMPRSS2 modulatory protein, required for SARS-CoV-2 cell entry, in testicular cells, sperm, or oocytes, argues against the hypothesis that gametes transmit SARS-CoV-2. Molecular detection studies of SARS-CoV-2 RNA in the male and female reproductive tracts were summarized: 98.0% (293/299) of the seminal fluids, 16/17 testicular biopsies, all 89 prostatic fluids, 98.3% (57/58) of the vaginal fluids, all 35 cervical smears, and all 16 oocyte samples tested negative for SARS-CoV-2. None of the studies confirmed sexual transmission of SARS-CoV-2. Nonetheless, COVID-19 may have detrimental effects on male reproduction by inducing orchitis and/or decreasing testosterone levels, sperm counts, and motility.

Conclusion

On the basis of the current worldwide published information, COVID-19 is not an STD. This information is important for clinicians, proposed guidelines for public health, U.S. Food and Drug Administration guidelines for gamete and tissue donor eligibility, and fertility treatments. Universal precautions, currently practiced worldwide, are adequate and sufficient at this time to prevent the transmission of known or unknown viral infections. We suggest that recovered patients of COVID-19, especially those with infertility, should be evaluated for their ovarian and testicular function.

COVID-19可能影响男性生育能力,但不会通过性传播:一项系统综述
目的确定导致COVID-19全球大流行迅速蔓延的SARS-CoV-2是否通过性传播。由于在生殖器官中确定了该病毒的假定受体,因此检查COVID-19是否可能影响人类生育能力也很重要。在PubMed、NIH iCite COVID-19组合、Cochrane图书馆和Google Scholar数据库中对截至2020年12月11日的英文出版物进行了系统评价,搜索睾丸中的SARS-CoV-2;精液、前列腺液和阴道液;还有子宫颈涂片检查。共确定了1997份记录,删除了重复的记录,并通过检查标题和摘要审查了1490份记录的合格性。随后,202篇相关全文由2名独立审稿人审阅。对47项研究(文献综述、社论和指南)进行定性评估,对23项对COVID-19患者的男性和女性生殖道进行SARS-CoV-2检测的研究进行定量分析。虽然在生殖器官中发现了血管紧张素转换酶2受体,但在睾丸细胞、精子或卵母细胞中缺乏SARS-CoV-2细胞进入所需的TMPRSS2调节蛋白的共表达,这反驳了配子传播SARS-CoV-2的假设。总结了男性和女性生殖道中SARS-CoV-2 RNA的分子检测研究:98.0%(293/299)的精液,16/17的睾丸活检,所有89例前列腺液,98.3%(57/58)的阴道液,所有35例宫颈涂片和所有16例卵母细胞样本均检测出SARS-CoV-2阴性。没有一项研究证实了SARS-CoV-2的性传播。尽管如此,2019冠状病毒病可能会诱发睾丸炎和/或降低睾丸激素水平、精子数量和活力,从而对男性生殖产生不利影响。结论根据目前全球公布的信息,COVID-19不是一种性病,这一信息对临床医生、拟议的公共卫生指南、美国食品和药物管理局配子和组织供体资格指南以及生育治疗都很重要。目前在世界范围内实行的普遍预防措施,在此时足以防止已知或未知病毒感染的传播。建议对新冠肺炎恢复期患者,特别是不孕症患者进行卵巢和睾丸功能检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
F&S reviews
F&S reviews Endocrinology, Diabetes and Metabolism, Obstetrics, Gynecology and Women's Health, Urology
CiteScore
3.70
自引率
0.00%
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0
审稿时长
61 days
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