Abstract

INTRODUCTION AND OBJECTIVE:

Long COVID, a chronic condition following SARS-CoV-2 infection, has raised concerns regarding its effects on the male reproductive system, particularly viral persistence in immune-privileged sites, such as the testis. This study investigates whether SARS-CoV-2 can be detected in the semen of patients recovering from mild and moderate COVID-19, examining viral persistence up to six months post-infection.

METHODS:

This observational, prospective study included 38 male COVID-19 patients, divided into two groups based on symptom severity: mild (n=27) and moderate (n=11). Semen samples were collected between 15 to 45 days, 3 and 6 months after symptom onset. Semen parameters were evaluated according to WHO guidelines. Semen was analyzed to detect viral RNA using RT-qPCR and to observe lymphocyte profiles with flow cytometry. Virus isolation was conducted using Vero cell cultures, immunofluorescence, and transmission electron microscopy (TEM).

RESULTS:

SARS-CoV-2 RNA was detected in the semen of 55% (21/38) of the patients, with a higher detection rate in the moderate group (91%). Positive samples showed high cycle thresholds (Ct=38-39). Viral persistence was confirmed through Vero cell culture in 17 patients, with infectious viral particles detected for up to 8 months after infection. Immunofluorescence and TEM successfully detected viral proteins and particles within the Vero cells. Although sperm quality initially decreased in count, concentration, and motility during early collections, recovery was noted by the 6-month mark. Inflammatory markers (CD3, CD4, CD8, CD45) also peaked at 3 months but returned to baseline levels by 6 months.

CONCLUSIONS:

This study confirms that SARS-CoV-2 can persist in the semen of patients who have recovered from COVID-19, indicating that the male genital tract may be a reservoir for the virus. The virus’s long-term presence highlights the need for further research into the reproductive implications of COVID-19 and its potential role in long COVID.