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Meta-Analysis
. 2024 Feb 21;14(2):e073084.
doi: 10.1136/bmjopen-2023-073084.

Viral shedding of SARS-CoV-2 in body fluids associated with sexual activity: a systematic review and meta-analysis

Guilherme Amaral Calvet #  1 , Edna Kara #  2 , Lianne Gonsalves  2 , Armando Humberto Seuc  3 , Raquel de Vasconcellos Carvalhaes de Oliveira  4 , Soe Soe Thwin  2 , Rodolfo Gomez Ponce de León  5 , Maité Cabrera Gámez  6 , Gilda Monteagudo Peña  6 , Bertha Victoria Rodríguez Pendás  6 , Manuel Gómez Alzugaray  6 , Gisel Ovies Carballo  6 , Duniesky Cintra Cala  7 , Patrícia Machado Quintaes Guimarães  4 , Mercedes Bonet  2 , Melanie Taylor  8 , Anna Thorson  2 , Caron Kim  2 , Moazzam Ali  2 , Nathalie Broutet  2
Affiliations
Meta-Analysis

Viral shedding of SARS-CoV-2 in body fluids associated with sexual activity: a systematic review and meta-analysis

Guilherme Amaral Calvet et al. BMJ Open. .

Abstract

Objective: To identify and summarise the evidence on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection and persistence in body fluids associated with sexual activity (saliva, semen, vaginal secretion, urine and faeces/rectal secretion).

Eligibility: All studies that reported detection of SARS-CoV-2 in saliva, semen, vaginal secretion, urine and faeces/rectal swabs.

Information sources: The WHO COVID-19 database from inception to 20 April 2022.

Risk of bias assessment: The National Institutes of Health tools.

Synthesis of results: The proportion of patients with positive results for SARS-CoV-2 and the proportion of patients with a viral duration/persistence of at least 14 days in each fluid was calculated using fixed or random effects models.

Included studies: A total of 182 studies with 10 023 participants.

Results: The combined proportion of individuals with detection of SARS-CoV-2 was 82.6% (95% CI: 68.8% to 91.0%) in saliva, 1.6% (95% CI: 0.9% to 2.6%) in semen, 2.7% (95% CI: 1.8% to 4.0%) in vaginal secretion, 3.8% (95% CI: 1.9% to 7.6%) in urine and 31.8% (95% CI: 26.4% to 37.7%) in faeces/rectal swabs. The maximum viral persistence for faeces/rectal secretions was 210 days, followed by semen 121 days, saliva 112 days, urine 77 days and vaginal secretions 13 days. Culturable SARS-CoV-2 was positive for saliva and faeces.

Limitations: Scarcity of longitudinal studies with follow-up until negative results.

Interpretation: SARS-CoV-2 RNA was detected in all fluids associated with sexual activity but was rare in semen and vaginal secretions. Ongoing droplet precautions and awareness of the potential risk of contact with faecal matter/rectal mucosa are needed.

Prospero registration number: CRD42020204741.

Keywords: COVID-19; INFECTIOUS DISEASES; Public health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Forest plot for meta-analysis of the presence of SARS-CoV-2 in saliva. (B) Forest plot for meta-analysis of persistence of SARS-CoV-2 in saliva for ≥14 days. The numbers in parentheses represent the article publication year and the reference listed in the online supplemental material.
Figure 2
Figure 2
(A) Forest plot for meta-analysis of the presence of SARS-CoV-2 in semen. (B) Forest plot for meta-analysis of persistence of SARS-CoV-2 in semen for ≥14 days. The numbers in parentheses represent the article publication year and the reference listed in the online supplemental material.
Figure 3
Figure 3
Forest plot for meta-analysis of the presence of SARS-CoV-2 in vaginal secretions. The numbers in parentheses represent the article publication year and the reference listed in the online supplemental material.
Figure 4
Figure 4
(A) Forest plot for meta-analysis of the presence of SARS-CoV-2 in urine. (B) Forest plot for meta-analysis of persistence of SARS-CoV-2 in urine for ≥14 days. The numbers in parentheses represent the article publication year and the reference listed in the online supplemental material.
Figure 5
Figure 5
Forest plot for meta-analysis of the presence of SARS-CoV-2 in faeces/rectal swab. The numbers in parentheses represent the article publication year and the reference listed in the online supplemental material.
Figure 6
Figure 6
Forest plot for meta-analysis of persistence of SARS-CoV-2 in faeces/rectal swab for ≥14 days. The numbers in parentheses represent the article publication year and the reference listed in the online supplemental material.
See this image and copyright information in PMC

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