Abstract
Coronavirus Disease 2019 (COVID-19) has created a global pandemic. Global epidemiological results show that elderly men are susceptible to infection of COVID-19. The difference in the number of cases reported by gender increases progressively in favor of male subjects up to the age group ≥60–69 (66.6%) and ≥70–79 (66.1%). Through literature search and analysis, we also found that men are more susceptible to SARS-CoV-2 infection than women. In addition, men with COVID-19 have a higher mortality rate than women. Male represents 73% of deaths in China, 59% in South Korea, and 61.8% in the United States. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen of COVID-19, which is transmitted through respiratory droplets, direct and indirect contact. Genomic analysis has shown that SARS-CoV-2 is 79% identical to SARS-CoV, and both use angiotensin-converting enzyme 2 (ACE2) as the receptor for invading cells. In addition, Transmembrane serine protease 2 (TMPRSS2) can enhance ACE2-mediated virus entry. However, SARS-CoV-2 has a high affinity with human ACE2, and its consequences are more serious than other coronaviruses. ACE2 acts as a “gate” for viruses to invade cells and is closely related to the clinical manifestations of COVID-19. Studies have found that ACE2 and TMPRSS2 are expressed in the testis and male reproductive tract and are regulated by testosterone. Mature spermatozoon even has all the machinery required to bind SARS-CoV-2, and these considerations raise the possibility that spermatozoa could act as potential vectors of this highly infectious disease. This review summarizes the gender differences in the pathogenesis and clinical manifestations of COVID-19 and proposes the possible mechanism of orchitis caused by SARS-CoV-2 and the potential transmission route of the virus. In the context of the pandemic, these data will improve the understanding of the poor clinical outcomes in male patients with COVID-19 and the design of new strategies to prevent and treat SARS-CoV-2 infection.
Highlights
In early December 2019, several cases of pneumonia of unknown etiology were reported in China (Wuhan City of Hubei Province)
The presence of these activating proteases and angiotensin-converting enzyme 2 (ACE2) in the sperm plasma membrane provides the possibility for the sexual transmission of the virus
Recent publications indicate that human sperm express angiotensin II type 1 receptor (AT1R), angiotensin II type 2 receptor (AT2R), and the angiotensin [17] MAS receptor [48, 108]
Summary
In early December 2019, several cases of pneumonia of unknown etiology were reported in China (Wuhan City of Hubei Province). Since the outbreak of COVID-19 in December 2019, the number of infected cases has increased exponentially, and it was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. In the past two decades, coronaviruses have caused two serious pandemics, including SARS in 2002 and Middle East Respiratory Syndrome (MERS) in 2012 [3]. They all belong to the β-coronavirus cluster, SARS-CoV-2 has caused more infections, deaths and economic disruptions. The possible mechanism of orchitis caused by SARS-CoV-2 and the potential transmission route of the virus are explored, emphasizing the challenges faced by male reproductive health in this pandemic
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