COVID-19 Transmission Routes

On-Site Staff

June 22, 2020

The research suggests that it is possible to get the disease through sexual activities.

Respiratory droplets
From the beginning of the COVID-19 pandemic, it was believed that the virus could be mainly spread through droplets via close person-to-person contact while talking, sneezing, or coughing, similar to influenza. Current research indicates that the respiratory droplets containing the virus cannot travel more than six feet (thus the “six feet” social distancing recommendation by the CDC) (1). Do recent news articles suggest that sexual contact leads to the spread of COVID-19, but is this just due to the respiratory droplet spread, or is there another route of transmission?

The sexual spread of COVID-19
The research suggests that it is possible to get the disease through sexual activities (2). This was introduced in the media recently when one study discovered that more than 15% of individuals who tested positive for COVID-19, were found to have the virus in their semen (2). However, there is no proof it can be transmitted through semen (2). It is crucial to inform the public about recent discoveries because one can be under the impression that the mask will prevent them from getting sick. However, people could be exposed by other routes of infection. According to Ian Jones, Ph.D., professor of virology at the University of Reading, this study is difficult to validate (2). The study is based on a small sample, and there is no data of SARS-CoV-2 sexual spread so far, so the possibility of getting it through semen is very rare (2). The scarce research and experts’ opinions are the only two sources of knowledge of spreading SARS-CoV-2 sexually, so there is a need to follow publications daily to find out more information.

Saliva and mucus membranes
While the person-to-person spread of the virus remains the main mode of transmission of SARS-CoV-2 by respiratory droplets, it is possible for it to be spread after a person touches a contaminated surface and then touches his or her mucous membranes (their mouth, eyes, or nose) (1). The possible transmission of the virus via direct and indirect contact with a sick person’s saliva was documented in several studies (3); therefore it is safe to say SARS-CoV-2 is spread by saliva and mucous membranes, rather than semen during sexual intercourse.

Fecal-oral route
The research also shows that COVID-19 can be spread through the fecal route (4). Because the sexual activity might involve vaginal, anogenital, and urogenital activities, there is a chance the virus can be transmitted this way, although there is no evidence as of now (2). According to Gaspari et al. (5), the virus stays longer in feces than in oropharyngeal cavities, so individuals who test negative for COVID-19 using traditional testing methods can still be spreading the disease this way. There is some data about possible transmission of the novel virus through sewage, where it was detected. This phenomenon can be explained by normal shedding of the pathogenic organism long after the respiratory symptoms have disappeared (6).

In conclusion, because there is still a significant amount of research being conducted on SARS-CoV-2 transmission and development of COVID-19, we cannot be sure if sexual transmission plays a role. It is likely that the close contact of sexual intercourse would lead to the development of COVID-19. However, It would be challenging to distinguish between sexual, respiratory, and fecal transmission. More research is needed to further understand the routes of transmission and the development of COVID-19.

1. CDC. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Jun 11]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html
2. McCall Becky. SARS-CoV-2 in Semen of COVID-19 Patients? [Internet]. Medscape. 2020 [cited 2020 Jun 10]. Available from: http://www.medscape.com/viewarticle/930127
3. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci [Internet]. 2020 Mar 3 [cited 2020 Jun 11];12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054527/
4. Patrì A, Gallo L, Guarino M, Fabbrocini G. Sexual transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A new possible route of infection? J Am Acad Dermatol. 2020 Jun;82(6):e227.
5. Gaspari V, Lanzoni A, Patrizi A, Orioni G, Viviani F, Bardazzi F. Can Covid‐19 be a sexually transmitted disease? Posterity will judge. Dermatol Ther [Internet]. 2020 May 24 [cited 2020 Jun 11]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267046/
6. Heller L, Mota CR, Greco DB. COVID-19 faecal-oral transmission: Are we asking the right questions? Sci Total Environ. 2020 Aug 10;729:138919.

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