SARS‐CoV‐2 infection and impact on female genital tract: An untested hypothesis

Abstract

COVID pandemic consists one of the most challenging medical realities. Apart from affecting respiratory system, current evidence has demonstrated multiorgan manifestations that SARS-Cov-2 infection may actually have. However, one of the medical hypotheses not yet thoroughly tested is the impact on female reproductive system and more specifically cervix. No large observational studies have been performed to test presence of SARS-Cov-2 in cervical samples, while potential correlation and impact on HPV infection has not yet been examined. In this context, our research team has already planned to begin a prospective observational study regarding detection rates of SARS-CoV-2 genetic material in cervical cytology. The collected specimen will be analyzed for the presence of COVID-19 genetic material and in case of positive results, HPV typing will be performed as well in order to detect potential correlations between SARS-CoV-2 infection and HPV-infection. We would therefore like to launch our idea to control for SARS-CoV-2 infection in cervical specimen as well as examine potential correlation with HPV infection. Potential scientific proof of such hypothesis would change much regarding follow-up of HPV-positive patients while also triggering further research regarding aitiopathogenetic pathways of COVID. Communication of such a medical hypothesis could potentially motivate colleagues worldwide to expand their interest also on the research of SARS-CoV-2 cervical infection, in an effort to optimize our level of knowledge towards this new threatening and unknown reality of SARS-CoV-2.

COVID‐19 and human papillomavirus: Paradoxical immunity

“…The authors also suggested that this observation should motivate further investigations to uncover what exactly is happening in patients affected by COVID-19. 6 Our report, in contrast, supports a possible negative correlation between SARS-CoV-2 and HPV infections. We hypothesized that excessive inflammatory response toward SARS-CoV-2 infection may trigger a paradoxical immune reaction resulting in regression of viral warts.…”

SARS-COV-2and female reproductive system

“…Although it is not possible to correlate SARS-COV-2 infection and the development of CIN1, dysregulation of the immune system is considered a known factor for the occurrence of cervical pathology. Thus, it is pertinent to alert patients infected by HPV and contaminated by COVID-19, to be observed more regularly to optimize early detection of lesions [1], which may have contributed to the appearance of cervical lesions. The first report of the detection of SARS-COV-2 in a vulvar lesion was published in 2020.…”

“…Although the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) preferentially affects the respiratory system, its presence has already been identified in multiple organs [1], including heart, lung, liver and pancreas. Furthermore, there is increasing evidence that the virus can also reach the genitourinary system, involving testis, ovary, vagina, uterus and placenta [2,3].…”

“…Recently, the hypothesis that the virus attacks the cervix has been raised, considering that it is commonly affected by another virus, the human papillomavirus (HPV). This hypothesis is supported by the fact that HPV, a virus with tropism for the cervix, and coronavirus share common characteristics in terms of transmission processes and life cycle, although they do not have genetic similarities [1]. When the coronavirus invades the target cell, it binds to the angiotensin-converting enzyme 2 (ACE2) receptor, which modulates the levels of angiotensin II and angiotensin 1-7 in cell process, and so, human cells with ACE2 expression are believed to be the target of SARS-CoV-2 infection.…”

COVID-19 Infection in the Human Reproductive Tract of Men and Nonpregnant Women

“…The organ-and cell-specific expression of ACE2 imply its regulatory role in cardiovasculature, kidneys, and fertility. 71,72 In relation to fertility, the expression of ACE2 in the ovaries and testes suggests that it plays a regulatory role in steroidogenesis, and thus affects germ cells and reproductive health. 73 Angiotensin-converting enzyme 2 acts as the entry point into cells for several coronaviruses.…”