Sexual Health and Safety During the COVID-19 Outbreak

Because SARS-CoV-2 is present in respiratory secretions and spreads through aerosolized particles, all types of in-person sexual activity “probably” carry some risk for transmitting the virus that causes COVID-19, according to three doctors affiliated with Massachusetts General Hospital in Boston.

Abstinence is the lowest risk approach to sex during the pandemic, and masturbation is additional safe recommendation for patients, according to Jack Turban, M.D., M.H.S., Alex S. Keuroghlian, M.D., M.P.H. and Kenneth Mayer, M.D., writing in yesterday’s Annals of Internal Medicine. Keuroghlian and Mayer are also affliated with the Fenway Instittue in Boston.

They note, though, the lack of data about sexual transmission of SARS-CoV-2 in their “ideas and opinions” piece for the journal published by the American College of Physicians in Philadelphia.  Turban, Keuroghlian, and Mayer reference two small studies that showed no detectable SARS-CoV-2 in semen or vaginal secretions, although they point to a third study that found evidence of the virus in 16% (6 of 38) of semen samples. The authors of that study, which was published on May 7 in the JAMA Network Open, say that “even if the virus cannot replicate in the male reproductive system, it may persist, possibly resulting from the privileged immunity of testes.”

Whether evidence of the presence of SARS-CoV-2 in semen means the infection can be transmitted vai semen is unknown, but the authors say “it would be prudent o consider semen as potentially infectious.” Their advice about SARS-Cov-2 in urine is the similar. 

The trio of physicians also say that patients can be counseled to engage in sexual activity with partners remotely via the telephone or video chats but should also be warned about the risk of partners taking screenshots of conversation.

For those for whom abstinence from in-person sexual activity is “not achievable,”  Turban, Keuroghlian and Mayer suggest that having sex with someone with whom they are self-quarantining is the best approach.

They also mention that antibody tests may play an important role in evaluating COVID-19 sexual risks and safe sex practices as it has with HIV. People who test positive for antibodies against SARS-CoV-2 may have relative immunity against contracting an infection. That immunity may, therefore, allow for “serosorting of individuals for sexual activity.”  Safe sex, with respect to SARS-CoV-2 transmission, may be possible among those have tested positive for the antibodies, according to Turban, Keuroghlian and Mayer.