The authors say they are the first to show:
- The longer the severe condition, the lower the number of surviving germ cells.
- There was fluctuation in several essential testicular genes.
- The intratesticular testosterone levels are 30 times reduced in the testes of COVID-19 patients.
The control group was composed of six patients who had undergone testicle removal after prostate cancer was suspected. Collection of both testicles from the test group was performed within 3 hours of death after a family member signed an informed consent document.
Recent research on semen demonstrates that patients who recovered from COVID-19 reestablish their sperm quality after 3 months of infection.
That study, in Fertility and Sterility, found that sperm quality was initially reduced for months in some men after recovery from COVID-19.
The team studied semen samples from 120 Belgian men (mean age, 35 years) at an average 52 days after their last COVID-19 symptoms. The semen was not found to be infectious.
But among 35 men who provided samples within a month after infection, reductions in sperm motility were evident in 60% and sperm counts were reduced in 37%, according to the report.
Testicular damage
The results [of the Costa et al. paper] emphasize the importance of testicular damage in severe COVID-19,” Rafael Kroon Campos, PhD, a postdoctoral fellow in the department of microbiology & immunology at the University of Texas Medical Branch at Galveston, said in an interview.
He noted that other viruses have also been shown to infect or otherwise cause testicular damage or orchitis, such as Zika, Ebola, and the closely related SARS-CoV-1. Sexual transmission has been documented for Zika and Ebola viruses.
Dr. Campos said with SARS-CoV-2, it is unclear whether sexual transmission plays a role.
“Some reports found evidence of viral RNA in semen, but these were rare occurrences. The study by Costa and colleagues used a combination of sensitive techniques and they were able to detect a small amount of viral RNA and viral protein in the testicular tissue of the deceased patients, as well as show viral factories indicating replication of the virus by electron microscopy,” he said.
Dr. Campos said the findings are particularly important and concerning because of the large number of severe cases of COVID-19.
“It is critical to continue to investigate the impact of the disease in testes, including the impact of different variants of concern on testicular damage,” he said.
Dr. McNeil and Dr. Campos have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.