背景:严重急性呼吸道综合征冠状病毒2,是导致2019年冠状病毒病的病毒,影响多个器官。病毒通过血管紧张素转换酶2和生殖器官中存在的宿主因子进入细胞,引起人们对精液和生殖功能中病毒脱落的担忧。
目的:对轻度感染患者精液中的严重急性呼吸道综合征冠状病毒2进行调查,确定受精浆感染的细胞,并探讨感染对性激素和精液参数的影响。
方法:对54例轻度严重急性呼吸综合征冠状病毒2感染男性进行前瞻性研究。在症状发作后7、15、30、60、90、180和365天收集精液,检测血清中的严重急性呼吸综合征冠状病毒2RNA,唾液,尿液,还有精液.使用Vero细胞培养评估精液中感染性严重急性呼吸道综合征冠状病毒2的存在。使用针对严重急性呼吸综合征冠状病毒2核蛋白抗原和细胞标志物的免疫荧光鉴定感染的精液细胞。精液特征以及睾丸激素,抑制素B,黄体生成素,并测定促卵泡激素水平。
结果:11%的患者至少有一种严重急性呼吸综合征冠状病毒2RNA阳性精液。一名患者在感染发作后90天出现病毒精液脱落,在第7天,从精液和40%的细胞部分中分离出具有复制能力的病毒。精子准备后,在第7天和第15天,90%的比例为严重急性呼吸综合征冠状病毒2RNA阳性。上游率仅在第7天呈阳性。在精液中,核蛋白抗原主要在脱落的上皮细胞中检测到,而在支持细胞中检测到的频率较低。精子计数和活动精子计数在第30天低于第7天。急性期精液中的圆形细胞增加。在第7天和第15天,严重急性呼吸综合征冠状病毒2RNA阳性精液的精子数量和活动精子数量低于阴性精液,而精液体积和促卵泡激素水平增加。长期随访没有证据表明对激素或精液特征有不利影响。
结论:2019年未住院的轻度冠状病毒病患者中,有11%的患者精液中有严重急性呼吸道综合征冠状病毒2排泄物,在一名患者中持续长达90天。没有生殖细胞被病毒感染,但检测到核蛋白抗原阳性的上皮精液细胞和支持细胞提示生殖道感染。尽管不常见,精液在急性期可能含有具有复制能力的病毒,在性接触和辅助生殖过程中存在严重急性呼吸道综合征冠状病毒2传播的潜在风险.轻度冠状病毒病2019对精子发生和生殖激素的影响是中等和可逆的。
BACKGROUND: Severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019, affects multiple organs. The virus enters cells through angiotensin-converting enzyme-2 and host factors present in genital organs, leading to concern over virus
shedding in semen and reproductive function.
OBJECTIVE: To investigate severe acute respiratory syndrome coronavirus 2 in semen from patients with a mild infection, identify the seminal infected cells, and explore the effect of the infection on sex hormones and semen parameters.
METHODS: Prospective study of 54 men with mild severe acute respiratory syndrome coronavirus 2 infection. Semen was collected at 7, 15, 30, 60, 90, 180, and 365 days after symptom onset, and severe acute respiratory syndrome coronavirus 2 RNA was measured in serum, saliva, urine, and semen. The presence of infectious severe acute respiratory syndrome coronavirus 2 in semen was assessed using Vero cell culture. Infected semen cells were identified using immunofluorescence against severe acute respiratory syndrome coronavirus 2 nucleoprotein antigen and cell markers. Semen characteristics as well as testosterone, inhibin B, luteinizing hormone, and follicle-stimulating hormone levels were determined.
RESULTS: 11% of patients had at least one severe acute respiratory syndrome coronavirus 2 RNA-positive semen. One patient had viral semen
shedding up to day 90 after infection onset, with replication-competent virus isolated from semen and 40% cell fraction at day 7. After sperm preparation, 90% fraction was severe acute respiratory syndrome coronavirus 2 RNA-positive at days 7 and 15. The swim-up fraction was positive only on day 7. In semen, nucleoprotein antigen was detected mainly in exfoliated epithelial cells and less frequently in Sertoli cells. Sperm count and motile sperm count were lower at day 30 than at day 7. Round cells in semen were increased during the acute phase. At days 7 and 15, sperm count and motile sperm count were lower in severe acute respiratory syndrome coronavirus 2 RNA-positive semen compared with negative semen, while semen volume and follicle-stimulating hormone levels were increased. Long-term follow-up shows no evidence of a detrimental effect on hormonal or semen characteristics.
CONCLUSIONS: 11% of patients with mild coronavirus disease 2019 who were not hospitalized had severe acute respiratory syndrome coronavirus 2 excretions in semen, which persisted for up to 90 days in one patient. No germ cells appeared infected by the virus, but the detection of nucleoprotein antigen-positive epithelial semen cells and Sertoli cells suggests genital tract infection. Albeit infrequent, semen may contain the replication-competent virus during the acute phase with potential risk of severe acute respiratory syndrome coronavirus 2 transmissions during sexual contact and assisted reproduction procedures. The effect of mild coronavirus disease 2019 on spermatogenesis and reproductive hormones was moderate and reversible.