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

  1. Pengfei Cui
  2. Zhe Chen
  3. Tian Wang
  4. Jun Dai
  5. Jinjin Zhang
  6. Ting Ding
  7. Jingjing Jiang
  8. Jia Liu
  9. Cong Zhang
  10. Wanying Shan
  11. Sheng Wang
  12. Yueguang Rong
  13. Jiang Chang
  14. Xiaoping Miao
  15. Xiangyi Ma
  16. Shixuan Wang

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Abstract

Background

As of March 2, 2020, SARS-CoV-2 has infected more than 80174 people and caused 2915 deaths in China. This virus rapidly spreads to 56 countries worldwide. Thus, in order to effectively block its transmission, it is urgent to uncover all the possible transmission routes of SARS-CoV-2.

Methods

From January 28 to February 18, 2020, 35 female patients diagnosed with COVID-19 in Tongji Hospital were included in this descriptive study. The gynecologic history, clinical characteristics, laboratory findings and chest computed tomography (CT) of all patients were recorded in detail. To examine whether there is sexual transmission through vaginal from female to her partner, we employed real-time polymerase chain reaction testing (RT-PCR) to detect SARS-CoV-2 in vaginal environment (including vaginal discharge, cervical or vaginal residual exfoliated cells) and anal swab samples, and inquired recent sexual behaviors from the patients.

Findings

The age range of the 35 patients with COVID-19 was 37-88 years. Over 50% patients infected with SARS-CoV-2 had chronic diseases. We tested the vaginal environment and anal swabs from the 35 female patients with COVID-19 and found that only an anal swab sample from one patient was positive for SARS-CoV-2. All the samples from vaginal environment were negative for SARS-CoV-2. The infection rate of the patients’ sexual partner was 42·9%. Additionally, two female patients admitted having sex with their partners during a possible infection incubation period, while one patient’s partner was uninfected and the other patient’s partner was diagnosed with COVID-19 (after the diagnosis of the female patient).

Conclusion

No positive RT-PCR result was found in the vaginal environment perhaps due to the lack of ACE2 expression, which is the receptor of SARS-CoV-2, in the vagina and cervix tissues (human protein atlas). The results from this study show no evidence of transmission of SARS-CoV-2 through vaginal sex from female to her partner. However, the risk of infection of non vaginal sex and other intimate contacts during vaginal sex should not be ignored.

Funding

This work was financially supported by the Clinical Research Pilot Project of Tongji hospital, Huazhong University of Science and Technology (No. 2019CR205).

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  1. ScreenIT

    SciScore for 10.1101/2020.02.26.20028225: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was reviewed and approved by the Medical Ethical Committee of Tongji Hospital of Huazhong University of Science and Technology (TJ-IRB20200208).
    Consent: Written informed consent was obtained from each enrolled patient.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableStudy design and patients: In this study, we recruited 35 female COVID-19 patients from January 28 to February

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All samples were tested for SARS-CoV-2 with the Chinese Center for Disease Control and Prevention (CDC) recommended Kit (DAAN GENE, Guangzhou, China or BioPerfectus Technologies, Jiangsu, China), following WHO guidelines for real-time RT-PCR.
    BioPerfectus
    suggested: None
    Statistical analysis: SPSS software, version 20·0, was used for statistical analysis.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, the sample size was relatively small in which only 35 patients with SARS-CoV-2 positive or CT suspected was included; much more patients including sexually active women are needed to confirm our findings in the future. Second, samples from partner of the patients enrolled is missing, including anal swabs, semen, and urethral orifice swabs. Nevertheless, the data in our study revealed the epidemiological and clinical characteristics of female patients with COVID-19 in a new prospective. In summary, though no evidence was found in this study that SARS-CoV-2 can be transmitted by vaginal sex from female to the partner. Considering the complexity of sexual behavior and the transmission potential of asymptomatic infectives, we suggest that people who lived in the epidemic areas, have tourism history from epidemic areas and were potentially asymptomatic infected should be very cautious about sex behavior and avoid oral/anal sex especially, which may be helpful to prevent further spreading of SARS-CoV-2.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.02.26.20028225 on medRxiv