Covid-19 detection in the female lower genital tract
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over two million people, caused thousands of deaths, and become a worldwide pandemic. In order to effectively block its transmission, all possible transmission routes must be determined. SARS-CoV-2 has been identified previously in throat, anal swabs, urine, and tears. However, little has been reported about SARS-CoV-2 and the female genital tract, which may provide direct evidence on sexual- and mother-to-child transmissions. The aim of this study was to determine whether SARS-CoV-2 exists in the lower female genital tract

The age range of the 35 patients was 37-88 years. Over 50% of patients had chronic diseases. The interval from the first symptoms of COVID-19 to the time of taking the samples varied between 8 to 41 days. Twenty-eight patients had entered menopause. One patient was postpartum and had just undergone a cesarean section. Accordingly, the sampling covered women who were postpartum, postmenopausal, and those of childbearing age. Results from all samples of vaginal fluid, cervical exfoliated cells, and anal swab. One anal swab sample was positive, which is consistent with previous research, and indicated that the digestive tract was a possible transmission route.

All samples from the lower genital tract were negative for SARS-CoV-2. This negative result might be explained by the negative expression of ACE2, the receptor of SARS-Cov-2, in the vagina, and cervix. breast milk from one postpartum patient obtained on the third day after giving birth. A neonatologist helped to obtain neonatal throat swab samples. All the samples were SARS-CoV-2 negative, consistent with the previous study in which no SARS-CoV-2 was found in amniotic fluid, umbilical cord blood, and neonatal throat swabs. Strengths of the study include that both reproductive-age and post-menopausal women were included, multiple sites of the vagina were sampled, and all samples were double-tested. Similar results were reported recently in a smaller study (n=10) in which no SARS-CoV-2 was detected in the vaginal fluid.

Conclusively, SARS-CoV-2 was not found in vaginal fluid and cervical exfoliated cells. Results showed that the lower female genital tract may not be a transmission route for SARS126 CoV-2. These results may provide evidence used to guide the choice of delivery method for SARS-CoV-2 infected pregnant women.

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