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Calvet GA, Kara E, Gonsalves L, Seuc AH, de Oliveira RDVC, Thwin SS, Gomez Ponce de León R, Gámez MC, Peña GM, Pendás BVR, Alzugaray MG, Carballo GO, Cala DC, Guimarães PMQ, Bonet M, Taylor M, Thorson A, Kim C, Ali M, Broutet N. Viral shedding of SARS-CoV-2 in body fluids associated with sexual activity: a systematic review and meta-analysis. BMJ Open 2024; 14:e073084. [PMID: 38387982 PMCID: PMC10882346 DOI: 10.1136/bmjopen-2023-073084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE To identify and summarise the evidence on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection and persistence in body fluids associated with sexual activity (saliva, semen, vaginal secretion, urine and faeces/rectal secretion). ELIGIBILITY All studies that reported detection of SARS-CoV-2 in saliva, semen, vaginal secretion, urine and faeces/rectal swabs. INFORMATION SOURCES The WHO COVID-19 database from inception to 20 April 2022. RISK OF BIAS ASSESSMENT The National Institutes of Health tools. SYNTHESIS OF RESULTS The proportion of patients with positive results for SARS-CoV-2 and the proportion of patients with a viral duration/persistence of at least 14 days in each fluid was calculated using fixed or random effects models. INCLUDED STUDIES A total of 182 studies with 10 023 participants. RESULTS The combined proportion of individuals with detection of SARS-CoV-2 was 82.6% (95% CI: 68.8% to 91.0%) in saliva, 1.6% (95% CI: 0.9% to 2.6%) in semen, 2.7% (95% CI: 1.8% to 4.0%) in vaginal secretion, 3.8% (95% CI: 1.9% to 7.6%) in urine and 31.8% (95% CI: 26.4% to 37.7%) in faeces/rectal swabs. The maximum viral persistence for faeces/rectal secretions was 210 days, followed by semen 121 days, saliva 112 days, urine 77 days and vaginal secretions 13 days. Culturable SARS-CoV-2 was positive for saliva and faeces. LIMITATIONS Scarcity of longitudinal studies with follow-up until negative results. INTERPRETATION SARS-CoV-2 RNA was detected in all fluids associated with sexual activity but was rare in semen and vaginal secretions. Ongoing droplet precautions and awareness of the potential risk of contact with faecal matter/rectal mucosa are needed. PROSPERO REGISTRATION NUMBER CRD42020204741.
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Affiliation(s)
| | - Edna Kara
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lianne Gonsalves
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Armando Humberto Seuc
- National Institute of Hygiene Epidemiology and Microbiology, Habana, La Habana, Cuba
| | | | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Melanie Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caron Kim
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Lee PE, Kozak R, Alavi N, Mbareche H, Kung RC, Murphy KE, Perruzza D, Jarvi S, Salvant E, Ladhani NNN, Yee AJM, Gagnon LH, Jenkinson R, Liu GY. Detection of SARS-CoV-2 contamination in the operating room and birthing room setting: a cross-sectional study. CMAJ Open 2022; 10:E450-E459. [PMID: 35609928 PMCID: PMC9259417 DOI: 10.9778/cmajo.20210321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The exposure risks to front-line health care workers caring for patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery are unclear, and an understanding of sample types that may harbour virus is important for evaluating risk. We sought to determine whether SARS-CoV-2 viral RNA from patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery was present in the peritoneal cavity of male and female patients, in the female reproductive tract, in the environment of the surgery or delivery suite (surgical instruments or equipment used, air or floors), and inside the masks of the attending health care workers. METHODS We conducted a cross-sectional study from November 2020 to May 2021 at 2 tertiary academic Toronto hospitals, during urgent surgeries or obstetric deliveries for patients with SARS-CoV-2 infection. The presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real-time reverse transcription polymerase chain reaction (RT-PCR). Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of health care workers' masks positive for SARS-CoV-2 RNA. We included adult patients with positive RT-PCR nasal swab undergoing obstetric delivery or urgent surgery (from across all surgical specialties). RESULTS A total of 32 patients (age 20-88 yr) were included. Nine patients had obstetric deliveries (6 cesarean deliveries), and 23 patients (14 male) required urgent surgery from the orthopedic or trauma, general surgery, burn, plastic surgery, cardiac surgery, neurosurgery, vascular surgery, gastroenterology and gynecologic oncology divisions. SARS-CoV-2 RNA was detected in 20 of 332 (6%) patient and environmental samples collected: 4 of 24 (17%) patient samples, 5 of 60 (8%) floor samples, 1 of 54 (2%) air samples, 10 of 23 (43%) surgical instrument or equipment samples, 0 of 24 cautery filter samples and 0 of 143 (95% confidence interval 0-0.026) inner surface of mask samples. INTERPRETATION During the study period of November 2020 to May 2021, we found evidence of SARS-CoV-2 RNA in a small but important number of samples obtained in the surgical and obstetric operative environment. The finding of no detectable virus inside the masks worn by the health care teams would suggest a low risk of infection for health care workers using appropriate personal protective equipment.
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Affiliation(s)
- Patricia E Lee
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.
| | - Robert Kozak
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Nasrin Alavi
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Hamza Mbareche
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Rose C Kung
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Kellie E Murphy
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Darian Perruzza
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Stephanie Jarvi
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Elsa Salvant
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Noor Niyar N Ladhani
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Albert J M Yee
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Louise-Helene Gagnon
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Richard Jenkinson
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Grace Y Liu
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
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