Perspectives on COVID-19 and Sexual Health; a Letter to Editor

The pandemic of coronavirus, known as COVID-19, has swept the world during the past several months. The exponential growth of this outbreak led World Health Organization to announce it as the sixth public health emergency of international concern on 30 January 2020 (1). Coronavirus is transmitted through direct contact with the patient (coughing, sneezing, respiratory droplets). Respiratory droplets spread through close contact from person to person (hugging, kissing, and patient care) can transmit coronavirus (2). There is also evidence of oral-fecal transmission (3-5). Despite the presence of angiotensin-converting enzyme (ACE2) as receptor of coronavirus in testicles, there is very little evidence of transmission through sexual contact with male patients (6). A study detected Coronavirus in seminal fluid of 34 recovered male patients with mild symptoms (7), but it has not been observed in semen of active COVID-19 patients. The lack of observation; undoubtedly, does not rule out the possibility of sexual transmission of coronavirus. On the other hand, there is no evidence of COVID-19 transmission by vaginal secretions through sexual contact or from mother to child (vertical transmission) (8-10). The impact of COVID-19 on different aspects of human life, including personal life, social activities, and interpersonal relations, has led to serious challenges for scientists and public health practitioners. While the main challenge faced by public health practitioners and health policymakers is to save lives and reduce fatalities, the impact extends to personal, mental, and social health of the community. With governments being engaged in adopting quick policies and solutions to cut the transmission chain and provide healthcare and rehabilitation services to the ever-increasing patients, the burden of the epidemic on health system obviously af- fects the sexual health of individuals. The impact is particularly severe in low- and middle-income countries. Past experience in management of infectious disease epidemics suggest that while indirect impact of the epidemic on sexual health is profound and considerable, this impact is often neglected due to absence of direct relationship between sexual health and spread of those outbreaks. Studies during Ebola outbreak indicated a significant reduction in usage of family planning services as the result of lockdown rules and suspension of sexual healthcare providers (11, 12).