Urogenital manifestations of SARS-CoV-2, MPXV and Zika virus: A comprehensive review

The current century has been associated with the outbreaks of emerging and re-emerging viral infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), monkeypox virus (MPXV), and Zika virus (ZIKV). Although their common clinical manifestations are currently well-known, the urogenital system is gaining attention as a significant, though often underappreciated, anatomical site for emerging and re-emerging viral infections, disease development, and transmission. The present review aims to comprehensively discuss the urogenital complications linked to the infections caused by these viruses, with a primary focus on describing their suggested and established roles in the development of urogenital sequelae. It reviews various molecular and cellular mechanisms, such as direct viral pathogen cytopathic activity, virally-mediated inflammation, and the nephrotoxic side effects of specific medications, by which SARS-CoV-2, MPXV, and ZIKV may affect various parts of the urogenital system. In this context, SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) for cell entry, which is frequently present in the urogenital tissues, resulting in urogenital injuries. Zika virus exhibits a distinct tropism for the male reproductive tract, demonstrating prolonged viral persistence in semen that facilitates sexual transmission and is linked to testicular damage and adverse congenital outcomes. The present study also addresses diagnostic considerations and therapeutic strategies in the context of urogenital sequelae associated with these viruses. Understanding the intricate molecular basis of these viral-caused sequelae is crucial for improving differential diagnosis and introducing targeted therapeutic strategies.