key: cord-0804400-k8g9bb5h authors: Patel, Shailesh Kumar; Pathak, Mamta; Sah, Ranjit; Kumar, Akshay; Malik, Yashpal Singh; Rodríguez-Morales, Alfonso J.; Dhama, Kuldeep title: Is Sexual Route a Matter of Concern for the SARS-CoV-2/COVID-19? date: 2020-06-12 journal: Arch Med Res DOI: 10.1016/j.arcmed.2020.06.008 sha: ecd7bb6a3a0861373fadf507725f63671ffa82c3 doc_id: 804400 cord_uid: k8g9bb5h nan OPINION Is Sexual Route a Matter of Concern for the SARS-CoV-2/COVID-19? The ongoing COVID-19 pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have infected 7.0 million people globally (June 6, 2020). This virus is detected in respiratory aerosols, stool, urine, and saliva, but whether non-respiratory body fluids like vomit, breast milk, urine, or semen contain viable infectious viruses is yet to be unraveled (1) . Moreover, no evidence of sexual transmission is yet available. Detailed investigations in this regard are warranted. However, all forms of sexual contact are reported to carry a potential risk of viral transmission as it is readily transmitted by fomites and aerosols. Then, infected individuals may spread the respiratory secretions onto their personal objects and skin, leading to further transmission to a sexual partner (2). The SARS-CoV-2 shares 80% sequence homology with the SARS-CoV and utilizes the angiotensinconverting enzyme 2 (ACE2) receptors with higher binding affinity than SARS-CoV (3) (4) . The expression of ACE2 is reported in a wide range of human reproductive tissues like seminiferous ducts cells, spermatogonia, Sertoli and Leydig cells, suggesting the potential risk of SARS-CoV-2 infection in the male reproductive system (5) . Besides, the presence of furin cleavage sites in SARS-CoV-2 increases the ability of the virus to internalize into cells, and enhanced expression of furin domains in the epididymis further increases the risk of infection to genitalia (3, 6) . As orchitis attributed to germ cell destruction along with testicular damage was reported in SARS-CoV infection, the possibility of testicular damage and fertility-related concerns in COVID-19 patients could not be ignored (7) Arch Med Res Although as many as 27 viremia associated viruses were reported in human semen, but this number may represent only the tip of the iceberg and need investigation. Moreover, non-sexually transmitted viruses may be present in genital secretions (12) (13) . Hence, a detailed investigation on viral detection followed by its persistence in testes may prove crucial for deadly viruses like SARS-CoV-2 in clinical practice till confirmation of the sexual transmission status. The data derived from the SARS-CoV infection suggests that andrological consultation and evaluation of gonadal function, including detailed semen examination, must be carried out in COVID-19 recovered patients, especially in reproductive age. Apart from avoiding contact with saliva and blood of COVID-19 patient, examination for detection of SARS-CoV-2 in the semen of the infected and the recovering patients and monitoring fetal development are required to prevent and control COVID-19 (10) . Clinical Characteristics of Coronavirus Disease 2019 in China Sexual Health in the SARS-CoV-2 Era Structural basis of receptor recognition by SARS-CoV-2 A Novel Coronavirus from Patients with Pneumonia in China scRNA-seq Profiling of Human Testes Reveals the Presence of the ACE2 A Target for SARS-CoV-2 Infection in Spermatogonia Analysis of furin ectodomain shedding in epididymal fluid of mammals: demonstration that shedding of furin occurs in vivo SARS-CoV-2 and the testis: similarity with other viruses and routes of infection No evidence of severe acute respiratory syndrome-coronavirus 2 in semen of males recovering from coronavirus disease 2019 Study of SARS-CoV-2 in semen and urine samples of a volunteer with positive naso-pharyngeal swab Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease SARS-CoV-2 Presence in seminal fluid: myth or reality Virus in Semen and the Risk of Sexual Transmission Zika Virus Shedding in Semen of Symptomatic Infected Men Received for publication June 6, 2020; accepted June 8, 2020 (ARCMED_2020_901).