The virus that causes COVID-19 can be found in semen, Chinese researchers report in a small study that doesn’t address whether sexual transmission is possible.
Doctors detected the virus in semen from six of 38 men hospitalized with laboratory-confirmed COVID-19. Four were still very sick with the disease while two were recovering.
The report from Shangqiu Municipal Hospital in China was published Thursday in JAMA Network Open.
There was no long-term follow-up so it is not known how long the virus may remain in semen or if men can spread it to their partners during sex.
The results contrast with a study of 34 Chinese men with COVID-19 published last month in the journal Fertility and Sterility. U.S. and Chinese researchers found no evidence of virus in semen tested between eight days and almost three months after diagnosis.
Dr. John Hotaling of the University of Utah, co-author of that report, said the new study involved much sicker men, most with active disease.
Authorities believe the coronavirus mainly spreads from droplets produced when infected people cough, which are inhaled by people nearby.
Some studies have reported finding the virus in blood, feces and tears or other fluid from COVID-19 patients with inflammation in their eyes.
Evidence suggesting that other infectious viruses including Zika and Ebola may be sexually transmitted has prompted questions about the coronavirus.
Hotaling said it’s an important public health concern but that more research is needed to provide a definitive answer.
The American Society for Reproductive Medicine said the new study shouldn’t be cause for alarm. To be safe, though, “it may be wise to avoid sexual contact with men until they are 14 days without symptoms,” Dr. Peter Schlegel, the group’s immediate past president, said in a statement.
In this cohort study, we found that SARS-CoV-2 can be present in the semen of patients with COVID-19, and SARS-CoV-2 may still be detected in the semen of recovering patients.
Owing to the imperfect blood-testes/deferens/epididymis barriers, SARS-CoV-2 might be seeded to the male reproductive tract, especially in the presence of systemic local inflammation.
Even if the virus cannot replicate in the male reproductive system, it may persist, possibly resulting from the privileged immunity of testes. So far, researchers have found 27 viruses associated with viremia in human semen.
But the presence of viruses in semen may be more common than currently understood, and traditional non–sexually transmitted viruses should not be assumed to be totally absent in genital secretions.[ Mead PS , Duggal NK , Hook SA , et al. Zika virus shedding in semen of symptomatic infected men. N Engl J Med. 2018;378(15):1377-1385. doi:10.1056/NEJMoa1711038 – Feldmann H . Virus in semen and the risk of sexual transmission. N Engl J Med. 2018;378(15):1440-1441. doi:10.1056/NEJMe1803212]
Studies on viral detection and semen persistence are beneficial to clinical practice and public health, especially concerning viruses that could cause high mortality or morbidity, such as SARS-CoV-2.
This study is limited by the small sample size and the short subsequent follow-up. Therefore, further studies are required with respect to the detailed information about virus shedding, survival time, and concentration in semen.
If it could be proved that SARS-CoV-2 can be transmitted sexually in future studies, sexual transmission might be a critical part of the prevention of transmission, especially considering the fact that SARS-CoV-2 was detected in the semen of recovering patients.
Abstinence or condom use might be considered as preventive means for these patients. In addition, it is worth noting that there is a need for studies monitoring fetal development.
Therefore, to avoid contact with the patient’s saliva and blood may not be enough, since the survival of SARS-CoV-2 in a recovering patient’s semen maintains the likelihood to infect others.
More information: Diangeng Li et al. Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019, JAMA Network Open (2020). DOI: 10.1001/jamanetworkopen.2020.8292
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