key: cord-274090-eab7i4f6
authors: Gaspari, Valeria; Lanzoni, Anna; Patrizi, Annalisa; Orioni, Gionathan; Viviani, Filippo; Bardazzi, Federico
title: Can Covid‐19 be a sexually transmitted disease? Posterity will judge
date: 2020-05-24
journal: Dermatol Ther
DOI: 10.1111/dth.13676
sha: 
doc_id: 274090
cord_uid: eab7i4f6

nan

Up to now the precise mode of transmission of SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) has still not been completely described, however the main route is through humanto-human transmission via droplets 1 . Multiple studies have concluded that asymptomatic carriers can spread the virus unknowingly 2 , thus leading governments to implement very restrictive rules of social distancing, also recommending the avoidance of multiple sexual intercourses.

The knowledge of all possible modes of transmission of SARS-CoV-2 infection is the key to improving both the identification of the asymptomatic population and the necessary isolation measures in order to further flatten the curve.

We operate in a free service for the prevention and treatment of sexually transmitted diseases (STDs), and owing to the lack of publications concerning this specific population, we are speculating that a certain percentage of the asymptomatic population could be spreading SARS-CoV-2 through sexual contact (vaginal, anogenital and orogenital).

The presence of SARS-CoV-2 RNA in the feces of COVID-19 patients (66.67%) has already been demonstrated in recent studies in Wuhan, without being statistically related to gastrointestinal symptoms and/or disease severity. Furthermore, 64.29% of these patients showed a persistent positivity for RNA search by polymerase chain reaction (PCR) in the stool following viral clearance (negative nasopharyngeal and oropharyngeal swabs) 3 .

From a molecular point of view, the ACE2 (angiotensin-converting enzyme 2) receptor, largely expressed along the gastrointestinal mucous membranes, has been demonstrated as the cell entry for SARS-CoV2 4,5 .

The human testis has also been indicated as a potential target of SARS-CoV-2, due to the expression of ACE2 receptor in the Leydig cells and cells of the seminiferous tubules, leading to potential defects in spermatogenesis 6 . In addition, some authors suggest that the human testis could provide another potential route of infection. Moreover, the positivity for SARS-CoV-2 on vaginal swab raises the possibility of both sexual and mother-to-child transmission 7 , although further studies are needed on these issues since no definitive proofs have been found. Over the past weeks we have observed 7 cases of confirmed SARS-CoV-2 infection in our MSM population. This additional data seems to support our speculation, however rectal swabs for the execution of SARS-CoV-2 PCR are not still available in our STDs clinic.

In conclusion, it would be useful to confirm the possibility of other alternative ways of viral transmission. If these speculations are confirmed, we should consider implementing an anal swab in all COVID-19 patients, also in those with negative pharyngeal swab.

A further step would be adding SARS-CoV-2 serology, pharyngeal, anal and vaginal swabs to our usual STD screening also in the asymptomatic population, in order to identify positive cases and to confirm the SARS-CoV-2 orogenital route of transmission.

COVID-19 Outbreak: An Overview

Evidence for Gastrointestinal Infection of SARS-CoV-2

scRNA-seq Profiling of Human Testes Reveals the Presence of the ACE2 Receptor, A Target for SARS-CoV-2 Infection in Spermatogonia

SARS-CoV-2 possible contamination of genital area: implications for sexual and vertical transmission routes

Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area