Hepatitis E viruses detectable in the ejaculate of chronically infected people
In most cases, hepatitis E disease is not a particular threat and will heal on its own. But people with a weakened immune system can develop chronic hepatitis E and cause severe liver damage. In a recent study it has now become clear that HEV can also be detected in the ejaculate in chronically infected men, which may be related to recurring reactivations of the virus.
Infections with the hepatitis E virus (HEV) are also relatively widespread in Germany and, according to the Robert Koch Institute (RKI), around every sixth adult in this country carries the corresponding antibodies. As a rule, the infections are harmless, but in people with a weakened immune system they can also take a chronic course and lead to cirrhosis of the liver after just a few years. In men, the testes could form a retreat for the viruses, which enables reactivation after supposedly successful therapy.
HEV in Ejaculate
The research team led by Dr. Sven Pischke from the German Center for Infection Research (DZIF), Dr. Thomas Horvatits from the University Medical Center Hamburg-Eppendorf (UKE) and Prof. Dr. Eike Steinmann from the Ruhr University Bochum (RUB) and Prof. Reimar Johne from the Federal Office for Risk Assessment (BfR) made an exciting discovery in their current studies: HEV can still be detected in the ejaculate even after drug therapy. The relevant study results were published in the journal “Journal of Hepatology”.
In their study, the researchers examined “using electron microscopy, polymerase chain reaction, density centrifugation and genome sequencing, the blood, urine, stool and ejaculate from a total of nine hepatitis E patients: including three immunosuppressed patients with chronic viral hepatitis E and six other test subjects with an intact immune system and an acute hepatitis E infection, ”explains the DZIF in a press release on the study results.
Reactivation of the virus
In the studies, two of the three chronically infected patients found a significantly higher viral load in the ejaculate than in the blood, and HEV could no longer be detected in the blood under therapy with the antiviral drug ribavirin, but it was in the ejaculate, reports the DZIF. After the treatment, the viral load in serum, ejaculate and stool rose rapidly again, which should be seen as a possible indication of a reactivation of the HEV infection affecting the whole body.
The place of retreat in the male reproductive system could be responsible for the fact that viral hepatitis E is reactivated in men with chronic hepatitis E despite antiviral therapy and initially falling virus concentration in the blood. In the six immunocompetent patients with acute hepatitis E, however, no HEV could be detected in the ejaculate.
Male reproductive system as a place of retreat
“Evolution has shown that the blood-testicular barrier is impermeable to cells of the immune system and pollutants”, but “if patients with a weakened immune system become infected with hepatitis E, the virus can pass the barrier unhindered and remain in the male gonads” , explains Dr. Pischke. In this case, the “blood-testicular barrier is a disadvantage for the patient, because immune cells cannot penetrate the testicles to fight the pathogens there.”
Hepatitis E infection also sexually transmitted?
According to the RKI, infection with HEV usually occurs in Germany through contaminated game or pork. Infections from contaminated water are also mentioned. However, human-to-human infections are rated as extremely unlikely in Germany. In view of the current study results, however, the question arises whether chronically infected hepatitis E patients are infectious for their sexual partners through the ejaculate. According to the DZIF, this should now be investigated in further studies. (fp)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical professionals.
Dipl. Geogr. Fabian Peters
- Robert Koch Institute (RKI): Hepatitis E RKI-Ratgeber (as of February 16, 2021), rki.de
- Thomas Horvatits, Jan-Erik Wißmann, Reimar Johne, Martin H. Groschup, Ashish K. Gadicherla, Julian Schulze zur Wiesch, Martin Eiden, Daniel Todt, Rudolph Reimer, Lisa Dähnert, Anja Schöbel, Karoline Horvatits, Rabea Lübke, Christine Wolschke, Francis Ayuk, Meike Rybczynski, Ansgar W. Lohse, Marylyn M. Addo, Eva Herker, Marc Lütgehetmann, Eike Steinmann, Sven Pischke: Hepatitis E virus persists in the ejaculate of chronically infected men; in: Journal of Hepatology (published January 20, 2021), journal-of-hepatology.eu
- German Center for Infection Research (DZIF): Hepatitis E viruses survive in the ejaculate of chronically infected patients (published February 16, 2021), dzif.de
This article is for general guidance only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.