Clinical characteristics and results of semen tests among men with Covid-19

by Diangeng Li, Meiling Jin, Pengtao Bao, Weiguo Zhao, Shixi Zhang

JAMA Network Open, 7 May 2020;3(5):e208292 (Open access)


The virus responsible for Covid-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in stool, gastrointestinal tract, saliva, and urine samples. However, little is known about semen.


This cohort study was performed after patients gave written informed consent for research purposes, and in compliance with the Helsinki Declaration with the approval of the ethics committee of Shangqiu Municipal Hospital, Shangqiu, China. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

We identified all male patients with laboratory-confirmed Covid-19 aged 15 years and older between January 26, 2020, and February 16, 2020, in Shangqiu Municipal Hospital, which is.. a designated hospital for the treatment of Covid-19…. Enrolled patients were asked to provide a semen sample for SARS-CoV-2 testing via RT-PCR….

…A total of 38 patients were enrolled for semen testing. Of the 38 participants who provided a semen specimen, 23 participants (60.5%) had achieved clinical recovery and 15 participants (39.5%) were at the acute stage of infection. Results of semen testing found that 6 patients (15.8%) had results positive for SARS-CoV-2, including 4 of 15 patients (26.7%) who were at the acute stage of infection and 2 of 23 patients (8.7%) who were recovering, which is particularly noteworthy. But there was no significant difference between negative and positive test results for patients by age, urogenital disease history, days since onset, days since hospitalization, or days since clinical recovery….


In this cohort study, we found that SARS-CoV-2 can be present in the semen of patients with COVID-19, and SARS-CoV-2 may still be detected in the semen of recovering patients. 

Even if the virus cannot replicate in the male reproductive system, it may persist, possibly resulting from the privileged immunity of testes. So far, researchers have found 27 viruses associated with viremia in human semen. But the presence of viruses in semen may be more common than currently understood, and traditional non-sexually transmitted viruses should not be assumed to be totally absent in genital secretions.

This study is limited by the small sample size and the short subsequent follow-up. Therefore, further studies are required with respect to the detailed information about virus shedding, survival time, and concentration in semen. If it could be proved that SARS-CoV-2 can be transmitted sexually in future studies, sexual transmission might be a critical part of the prevention of transmission, especially considering the fact that SARS-CoV-2 was detected in the semen of recovering patients. Abstinence or condom use might be considered as preventive means for these patients. In addition, it is worth noting that there is a need for studies monitoring fetal development. Therefore, to avoid contact with the patient’s saliva and blood may not be enough, since the survival of SARS-CoV-2 in a recovering patient’s semen maintains the likelihood to infect others. Our study might contribute by providing new information to the current discourse regarding Covid-19 prevention and control.


Body fluids may contribute to human-to-human transmission of [Covid-19]: evidence and practical experience

Chinese Medicine 2020;15:58. (Open access)

by Amir Hossein Mohseni, Sedigheh Tghinezhad-S, Zhiganag Xu, Xiangsheng Fu

Abstract (excerpts)

Background: Although much effort has been spent on clarifying the transmission route of SARS-CoV-2, but, very little evidence is available regarding the relationship between human body fluids and transmission of SARS-CoV-2 virus. Considerable evidence from hospital in Wuhan indicates that strict rules to avoid occupational exposure to patients’ body fluids in healthcare settings, particularly among every medical staff, limited person-to-person transmission of nosocomial infections by direct or indirect contact.


We tried to provide important information for understanding the possible transmission routes via body fluids including bronchoalveolar-lavage [introduction of fluid into the lungs removed for examination], saliva, blood, urine, faeces, sputum, tears, and semen in order to control Covid-19 occurrences.

Findings (excerpts, simplified)

  • The virus was isolated from faeces and anal swabs from Covid-19 patients.
  • The virus was not found in vaginal discharge; hence, it cannot be transmitted during delivery.
  • The virus is absent in the cord blood, neonatal throat swab, breastmilk and amniotic fluid. However, a recent study published by another group showed that the fetal liver can be infected by Covid-19 during pregnancy.
  • Because of the presence of the ACE2 receptor in some organs such as lung, gastrointestinal tract, liver, heart, kidneys, testis, and placenta, we believe that the transmission of SARS-CoV-2 is not limited to the respiratory transmission. It is thus predictable that the exposure to human body fluids such as bronchoalveolar-lavage, saliva, blood, urine, faeces, sputum, tears, and semen especially among asymptomatic patients may represent a risk factor for the invasion of Covid-19 into the human body.
  • Previous studies regarding SARS-CoV described the potential route of contamination via sweat gland cells in the skin, suggesting its possible role in the transmission of SARS-CoV-2 to individuals who are in an unprotected contact or in direct contact with the skin of infected patients. In addition, the transmission of SARS-CoV-2 via semen is potentially possible due to the presence of ACE2 in the cells of the testis. However, this specific type of transmission still remains unclear.