key: cord-0799035-2okv8elu
authors: Ahmad, Mohd Faizal; Mahakkanukrauh, Pasuk; Das, Srijit
title: The detection of SARS-CoV-2 virus in the vaginal fluid of females with severe COVID-19 infection: scientific facts
date: 2020-10-21
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa1608
sha: dbe82fdfd8a1893f44ebcf4088c1a0ef018e45a7
doc_id: 799035
cord_uid: 2okv8elu

nan

M a n u s c r i p t 2 Dear Editor, We read with much interest the published article by Qiu et al. 1 At this juncture; we would like to express our scientific thoughts related to the published article. The sample using severe SARS-CoV-19 patients was a good approach as the systemic spread of the virus via blood is postulated, including that at the vaginal area. The usage of nucleic acid amplification tests (NAAT), such as RT-PCR is a gold standard. Therefore, in the present study, any undetectable virus in the vaginal fluid is considered to be reliable.

There are few critical points to highlight. The first study conducted in Huazhong University In an earlier study conducted in Wuhan, the mean incubation period for COVID-19 was 5.2 days among 425 cases, though it varied widely between individuals. 3 Therefore, to date, the virus shedding patterns are not yet well understood and further investigations are needed to better understand the timing, compartmentalization and quantity of viral shedding to inform optimal specimen collection. In the present study, the sample was taken 17 days post infection and revealed negative results. If there is a small amount of virus, the amplification may not be detected, and the authors have rightly admitted such facts. It would be interesting to consider (i) the amount of virus, which may be too less in relation to the incubation period or (ii) the prevailing atrophic conditions of the vagina and cervix which have less or even absence of expression of ACE2 receptors. It is interesting to note that the ACE2 receptor is a receptor for the viruses. 2 An earlier study elaborated numerous expressions of ACE2 receptor A c c e p t e d M a n u s c r i p t 3 in reproductive females. 4 Therefore, the usage of post-menopausal women may be considered to contradict the earlier recommendation to postulate the presence of virus infection in vaginal fluid. The atrophic vaginal environment may not be able to host the virus compared to the well oestrogenised tissue (reproductive age group). Therefore, repeating sample may be done in negative sampling like this, in order to consolidate the findings.

It is an accepted fact that viral genetic material may be found at different anatomical sites in the body. Hence, in future studies, it may be interesting to study the Covid-19 genetic material in cervical cytology samples. A potential interaction with Human Papilloma Virus (HPV) could be postulated. We recommend that future studies should be performed within the reproductive age group with RT-PCR from vaginal fluid, and it should be done within seven days of infection. We thank the editor and congratulate the authors for publishing such an interesting article.

None of the authors has any conflicts to disclose.

A c c e p t e d M a n u s c r i p t 4

SARS-CoV-2 Is Not Detectable in the Vaginal Fluid of Women With Severe COVID-19 Infection

Clinical features and sexual transmission potential of SARS-CoV-2 infected female patients: a descriptive study in Wuhan

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

Potential influence of COVID-19/ACE2 on the female reproductive system