Evaluation of SARS-CoV-2 in the Vaginal Secretions of Women with COVID-19: A Prospective Study

Abstract

Objective: We aimed to investigate the likelihood of vaginal colonization with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnant and non-pregnant women with Coronavrus Disease 2019 (COVID-19).

Materials and methods: Vaginal swabs were taken from women diagnosed with mild to moderately acute SARS-CoV-2 infection, at Wolfson Medical Center, Israel, from March 2020 through October 2020. COVID-19 was diagnosed by real-time polymerase chain reaction (RT-PCR) performed on nasopharyngeal swabs. Vaginal swabs were tested for the presence of SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR).

Results: In total, 51 women diagnosed with COVID-19 were included in the study. Of the 51 women with COVID-19 enrolled in this study, 16 (31.4%) were pregnant at enrollment and 35 (68.6%) were non-pregnant. Mean age was 43.5 ± 15.3 years (range 21-74 years). Compared to the non-pregnant group, the pregnant group was characterized by a higher white blood cell and absolute neutrophil count (p = 0.02 and p = 0.027, respectively). The non-pregnant patients were more likely to have chronic diseases (p = 0.035) and to be hospitalized (p < 0.001). Only one patient (1.9%) aged 60 years tested positive for SARS-CoV-2 in vaginal secretions. Mean gestational age at the diagnosis of COVID-19 of the pregnant group was 32.3 ± 7.8 weeks. Thirteen patients delivered during the study period; all delivered at term without obstetric complications and all neonates were healthy.

Conclusions: Detection of SARS-CoV-2 in the vaginal secretions of patients diagnosed with COVID-19 is rare. Vaginal colonization may occur during the viremia phase of the disease, although infectivity from vaginal colonization needs to be proven.

Keywords: COVID-19; SARS-CoV-2; vaginal secretions.

Figure 1

Real-time polymerase chain reaction results of the patient with positive SARS-CoV-2 in the vaginal secretions. (A) Results from nasopharyngeal swab utilizing the DiaSorin Molecular Simplexa™ COVID-19 Direct real-time RT-PCR assay, testing for genes S and Orf1b. (B) Results from the first positive vaginal swab utilizing the DiaSorin Molecular Simplexa™ COVID-19 Direct real-time RT-PCR assay, testing for genes S and Orf1b. (C) Results from the repeat vaginal swab utilizing GeneXpert^® Xpress SARS-CoV-2, testing for genes E and N2. Cycle threshold (Ct) levels are inversely proportional to the amount of mRNA of the targeted antigen. The Ct of the S gene, ORF1, and N2 in the vaginal samples was 34.6, 36.1, and 41.7, respectively (B,C). The X and Y axes represent the amount of amplified RNA and the number of cycles, respectively; the earlier the signal is detected, the lower the number of cycles and the higher the viral load. The orange line (C), sample processing control (SPC), and the purple line (B), RNA internal control (RNA IC), represent the positive controls. A positive result for the genes E and N2 is determined with values of Ct < 45 [22]. Positive results for both methods were determined according to known values [22,23]. Cycle threshold (Ct) levels are inversely proportional to the amount of mRNA of the targeted antigen. Ct of the S gene, ORF1 and N2 in the vaginal samples were 34.6, 36.1 and 41.7, respectively (B,C).