Gilbert Donders 1,2, Christoph Depuydt 3, Willem Ombelet 4 , Francesca Donders 1, Jente Reumers1 and Eugene Bosmans 3,4

  1. Femicare VZW Clinical research Center, Tienen, 2) Dept OB/Gyn, Unversity Antwerp, 3) AML laboratories Antwerp, 4) Genk center of infertility, Genk Belgium

Amongst other important issues, during the COVID pandemic, there is concerns about how to confine the transmission of the virus to more people. Especially, when the so-called ‘quarantine measures’ are being relieved, in several societies, a resurge of new infections are noted. Also, besides transmission through air droplets and aerosol, and possibly poor hand hygiene, a lot is not yet known about transmission mechanisms and implication of multiple shedding routes of the virus. If in analogy with other replicating RNA viruses like Zika virus, Ebola and Marburg viruses that also cause viremia, the blood–testes barrier is by-passed by the virus, SARS-CoV-2 could persist for weeks or months in the male reproductive tract. Indeed, the virus can stay for a prolonged period of time in the male reproductive tract because 1) the immune response that is available in the rest of the body is not present in the testis because the immunogenic spermatozoa would otherwise be destroyed (hence the blood testis barrier), and 2) the SARS-CoV-2 virus needs cells it can infect (in the testis) to be able to replicate. Because the ACE-2 receptor is present on Leydig cells, spermatogonia and spermatozoa it is highly probable that the virus can replicate in the testis. The ACE-2 receptor that SARS-CoV-2 utilizes to infecting cells is present on Leydig cells, spermatogonia and even spermatozoa and would make it possible for the virus to replicate in the testis. Even if incapable of replicating within the male reproductive tract viral persistence could occur due to reduced immune-response (that is, within the testes, the immune response is limited to enable the survival of immunogenic sperm), we hypothesize that SARS-CoV-2 could remain hidden within the testes and semen for a long time after COVID-19 infection has taken place. If so, this would put survivors of COVID-19 at risk of infecting other people long after having had the disease and could help to explain why a second peak of invention occurs.

A second risk that requires more study in males  is the potential damage to the sperm quality, and hence, infertility. In a new study we tested sperm quality in males who were recently affected by SARS-Vo2 infection. We found a strong relation between severity of disease and extent of damage to the sperm quality. Furthermore we saw a slw recovery of the sperm characteristics, taking several months to recover. We hypothesize that specific anti-Sars-Cov 2- IgA binding to the sperm has a causal role. This is the second study of our group showing that sexually transmissible viruses not only can be transfecting sexual partners, but also can severely reduce fertility in males.

34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
Bucharest, September 3-5,