The male sexual and reproductive health in the wake of COVID-19 Pandemic. Can COVID19 be transmitted sexually?

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The male sexual and reproductive health
in the wake of COVID-19 Pandemic.
Can COVID19 be transmitted sexually?

Prof. Mulazim Hussain Bukhari
Principal,
Azad Jammu Kashmir Medical College, Muzzafar Abad.

The COVID19 is a mysterious disease and every day a new complication is appearing in this dreadful disease. But still the public is not cooperation to break the chain of this pandemic. The coronavirus disease is basically disease of blood vessels which may effect not only the lungs but any organ or system. Public nuisance and unvaccinated cases, are more prone to get COVID-19, people not getting vaccination or wearing mask and going for their shopping and congregations as usual are the other risk of transmission, a serious matter to be addressed. Now a new reason for worry lies in the reported testicular damage from COVID-19 infection in males especially after recovery during the long hailing. This is scary message which can greatly help in getting SOPs followed by masses. We need to develop an aesthetic sentence conveying the evidence collected so far. Complications of Covid-19 will surface long after the Pandemic is gone. However, those who are susceptible to get Covid-19 infection are enough to get vaccinated ASAP. The authors have not seen a study of those who got vaccinated & felt the downtrend in sexual function. It may be another study which needs to be carried out in future.


Prof. Mulazim Hussain Bukhari

Can COVID19 affect your male health?

There are few preliminary studies showing erectile dysfunction and COVID19. It has been seen in many prospective studies that the sperm count is decreased in this disease. We Know major source of entry of SARS-CoV-2 is thrift ACE2 and male Leydig cells are the site of production of this enzyme so these receptors are highly expressed in the testis, suggesting the possibility of testicular infection since the early stage of the disease.1-3

This enzyme plays important role in the production of spermatocytes and regulates spermatogenesis. Why COVID19 causes infertility or loss of libido. Loss of libido is a common problem that affects many men after getting recovery from COVID19. It’s linked to many issues, stress or tiredness, hormones level after this mysterious disease.

  1. Due to the involvement of Sertoli cells and Leydig cells, reproductive function might be affected.
  2. The virus is found in Seminal fluid because attachment to ACE2 receptors in male general system &seminiferous tubular injury was reported despite no evidence of the virus in the testis.4-7
  3. Psychological stress during and after the disease
  4. Solid evidence accumulated in the last decades support the notion that erectile function is an excellent surrogate marker of systemic health in general, and vascular performance in particular, sharing plenty of risk factors with cardiovascular disease. This is described by the equation ED = ED (endothelial dysfunction equals erectile dysfunction, and vice versa).8 Vascular integrity is necessary for erectile function and vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, resulting in impaired erectile function (9). The histological and immunological studies shows the loss of blood supply to human organs leads to erectile dysfunction.
  5. COVID-19 features a state of hyperinflammation promoted by TNF-α, IL-6 and IL-1β ; the same inflammatory cytokines have been associated with clinical progression of sexual dysfunction . It is worth noticing that the pro-inflammatory cytokines are also closely tied to testosterone levels: as previously stated, hypogonadal patients have higher concentrations of TNF-α, IL-6 and IL-1β as a result of impaired suppression.10-11

There is enough reason to suspect that male sexual and reproductive health could be affected in the survivors, by the sequelae of the COVID-19, both in the short and long terms. The males after recovery feel six times more dysfunction as compared to their pre COVID position and impotence. Erectile function, as a surrogate marker of cardiovascular/pulmonary health, could also become extremely valuable as a quick and inexpensive first-line assessment of the pulmonary and cardiovascular complications for COVID-19 survivors.

Corona virus Found in Semen: Can It Be Sexually Transmitted?

We have often seen that if the husband has the virus, the wife also gets it and the vice versa. Most of the causes are due to sharing of infected things, inhalation or physical contact, but it has now been shown that the presence of the virus in other body fluids, and especially in Semens, thereby may be an alternative mode of transmission. The available data is not sufficient to confirm the transmission of COVID19 through semen and respiratory secretions contribute more risk of SARS-CoV-2 transmission between partners during sexual contact than the semen.12-14

Wear the mask and get the vaccine to keep yourself safe form COVID19.

A histopathological, immunological and study was done on two COVID19 patients with histopathology and electron microscope. They demonstrated that the presence of the COVID-19 virus in the male sexual organ after, the initial infection in humans, due to widespread endothelial cell dysfunction from COVID-19. This contributes in erectile dysfunction.

References

  1. Douglas GC, O’Bryan MK, Hedger MP, Lee DK, Yarski MA, Smith AI, Lew RA. The novel angiotensin-converting enzyme (ACE) homolog, ACE2, is selectively expressed by adult Leydig cells of the testis. Endocrinology. 2004;145(10):4703–4711. doi: 10.1210/en.2004-0443.
  2. Younis JS, Abassi Z, Skorecki K. Is there an impact of the COVID-19 pandemic on male fertility? The ACE2 connection. Am J Physiol Endocrinol Metab. 2020;318(6):E878–E880. doi: 10.1152/ajpendo.00183.2020.
  3. Wang S, Zhou X, Zhang T, Wang Z. The need for urogenital tract monitoring in COVID-19. Nat Rev Urol. 2020;17(6):314–315. doi: 10.1038/s41585-020-0319-7.
  4. Wang Z, Xu X. scRNA-seq profiling of human testes reveals the presence of the ACE2 receptor, a target for SARS-CoV-2 infection in spermatogonia Leydig and Sertoli. Cells. 2020;9:4. doi: 10.3390/cells9040920.
  5. Verma S, Saksena S, Sadri-Ardekani H. ACE2 receptor expression in testes: implications in COVID-19 pathogenesis. Biol Reprod. 2020 doi: 10.1093/biolre/ioaa080.
  6. Paoli D, Pallotti F, Colangelo S, Basilico F, Mazzuti L, Turriziani O, Antonelli G, Lenzi A, Lombardo F. Study of SARS-CoV-2 in semen and urine samples of a volunteer with positive naso-pharyngeal swab. J Endocrinol Invest. 2020 doi: 10.1007/s40618-020-01261-1.
  7. Paoli D, Pallotti F, Turriziani O, Mazzuti L, Antonelli G, Lenzi A, Lombardo F. SARS-CoV-2 Presence in seminal fluid: myth or reality. Andrology. 2020 doi: 10.1111/andr.12825.
  8. Guay AT. ED2: erectile dysfunction = endothelial dysfunction. Endocrinol Metab Clin North Am. 2007;36(2):453–463. doi: 10.1016/j.ecl.2007.03.007.
  9. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. doi: 10.1038/nrdp.2016.3.
  10. Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020;130(5):2202–2205. doi: 10.1172/JCI137647.
  11. Maiorino MI, Bellastella G, Giugliano D, Esposito K. From inflammation to sexual dysfunctions: a journey through diabetes, obesity, and metabolic syndrome. J Endocrinol Invest. 2018;41(11):1249–1258. doi: 10.1007/s40618-018-0872-6
  12. Kresch E, Achua J, Saltzman R, Khodamoradi K, Arora H, Ibrahim E, Kryvenko ON, Almeida VW, Firdaus F, Hare JM, Ramasamy R. COVID-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis. World J Mens Health. 2021;39:e22. https://doi.org/10.5534/wjmh.21005