No evidence of severe acute respiratory syndrome-coronavirus 2 in semen of males recovering from coronavirus disease 2019

Abstract

Objective: To describe detection of severe acute respiratory syndrome (SARS)-coronavirus 2 (CoV-2) in seminal fluid of patients recovering from coronavirus disease 2019 (COVID-19) and to describe the expression profile of angiotensin-converting enzyme 2 (ACE2) and Transmembrane Serine Protease 2 (TMPRSS2) within the testicle.

Design: Observational, cross-sectional study.

Setting: Tertiary referral center.

Patient(s): Thirty-four adult Chinese males diagnosed with COVID-19 through confirmatory quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) from pharyngeal swab samples.

Intervention(s): None.

Main outcome measure(s): Identification of SARS-CoV-2 on qRT-PCR of single ejaculated semen samples. Semen quality was not assessed. Expression patterns of ACE2 and TMPRSS2 in the human testis are explored through previously published single-cell transcriptome datasets.

Result(s): Six patients (19%) demonstrated scrotal discomfort suggestive of viral orchitis around the time of COVID-19 confirmation. Severe acute respiratory syndrome-CoV-2 was not detected in semen after a median of 31 days (interquartile range, 29-36 days) from COVID-19 diagnosis. Single-cell transcriptome analysis demonstrates sparse expression of ACE2 and TMPRSS2, with almost no overlapping gene expression.

Conclusion(s): Severe acute respiratory syndrome-CoV-2 was not detected in the semen of patients recovering from COVID-19 1 month after COVID-19 diagnosis. Angiotensin-converting enzyme 2-mediated viral entry of SARS-CoV-2 into target host cells is unlikely to occur within the human testicle based on ACE2 and TMPRSS2 expression. The long-term effects of SARS-CoV-2 on male reproductive function remain unknown.

Keywords: COVID-19; angiotensin-converting enzyme 2; coronavirus; infertility; male; semen.

Figure 1

Expression of ACE2 and TMPRSS2 in human testicular cells using single-cell RNA-seq dataset. (A) Dimension reduction (t-SNE) analysis of single-cell transcriptome data from human testes (n = 6,490) based on data from Guo et al. (10). Each dot represents a single cell and is colored according to its cluster identity, as indicated on the figure key. (B) Expression patterns of ACE2 and TMPRSS2 projected on the t-SNE plot. Red indicates high expression, and gray indicates low or no expression, as shown on the figure key. (C) Scatter plot to show the co-expression of ACE2 (x-axis) and TMPRSS2 (y-axis) in human testicular cells.