As fertility clinics around the world resumed care, the first report detecting SARS-CoV-2 in semen was published on May 7, 2020, in an open letter to JAMA1.
In this report, the diagnosis of COVID-19 was made in male patients admitted to a hospital in Henan province with laboratory-confirmed testing. Thirty-eight men were able to provide a semen specimen, and 60.5% of these men had achieved clinical recovery while 39.5% were still in the acute stage of infection. Six of the 38 (15.8%) semen samples tested positive for SARS-CoV-2 (Fig. 1). More specifically, 4 of 15 (26.7%) in the acute stage of infection and 2 of 23 (8.7%) recovering patients had semen samples that were positive. In the 2 patients who were recovering, they were 2 and 3 days since clinical recovery and had been hospitalized 10 and 13 days, respectively. In those who tested positive and were in the acute stage of infection, they had been hospitalized a range of 2–8 days. All patients with positive semen samples had symptoms for 6–16 days1.
This is the first report providing evidence of SARS-CoV-2 in semen. However, many questions remain. First, and most importantly, is it possible to transmit the virus via semen? If not, then the significance of a positive semen sample is moot. Second, nearly three-quarters of tested patients did not have virus detected in the semen. We do not yet understand why only some patients have positive samples. This may be related to the viral load and potential severity of disease, as there was no difference in number of days hospitalized or days since clinical recovery between those who tested positive versus those who tested negative. Or, it may have to do with individual patient characteristics that were not examined. Third, when do the samples become positive, and when do they revert to negative in the time course of the disease? Each man provided only a single sample, thus failing to answer this question. In another recently published report, 34 men with only mild to moderate disease provided a single sample at a mean of 31 days post COVID-19 diagnosis2. None of these men had samples which tested positive. Thus, we do not know if this is because they only had mild-moderate disease and did not have sufficiently high viral loads to affect the semen or whether the time from diagnosis to testing of the semen was sufficiently long for the virus to be cleared. All of these questions remain and should be considered when counseling patients.
Conflict of interest disclosures
The author declares that there is no financial conflict of interest with regard to the content of this report.
1. Li D, Jin M, Bao P, et al. Clinical characteristics and results of semen tests among men with coronavirus
disease 2019. JAMA Netw Open 2020;3:e20829210.1001/jamanetworkopen.2020.8292.
2. Pan F, Xiao X, Guo J, et al. No evidence of SARS-CoV-2 in semen of males recovering from COVID-19. Fertil Steril 2020;113:1135–9.