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CMVH, HSV et procréation

HCMV, HSV and procreation

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Si la présence d’herpès virus simplex et de cytomégalovirus dans le sperme a été décrite depuis longtemps et ne semble pas avoir de retentissement sur la fonction reproductrice, le rôle des spermatozoïdes dans la transmission de ces virus n’est pas encore résolu. A partir de l’adolescence, l’infection à cytomégalovirus est considérée comme acquise essentiellement par voie sexuelle. La fréquence d’isolement du virus à partir du sperme varie de 2,4% chez des sujets hétérosexuels, non infectés par le virus de l’immunodéficience humaine (VIH), à 20 % chez les sujets homosexuels, atteignant 33 % chez ceux d’entre eux qui sont VIH séropositifs. L’examen en microscopie électronique a démontré la présence de particules virales dans les spermatozoïdes d’hommes mais, à ce jour, aucune contamination de l’œuf par des spermatozoïdes infectés ni aucune induction d’anomalies fœtales par transmission verticale n’ont été observées chez l’homme.

L’herpès virus simplex, notamment le type 2 (HSV-2), a été isolé de prélèvements urétraux, du liquide prostatique et de divers tissus du tractus génital mâle chez des hommes ne présentant aucune lésion génitale et même aucun antécédent d’herpès génitaux. En revanche la plupart des tentatives d’isolement de ce virus à partir du sperme a été infructueuse. Un cas de transmission de HSV-2 après insémination artificielle a cependant été décrit apportant la preuve que le sperme peut véhiculer le virus et le transmettre à l’occasion de rapports sexuels.

Abstract

At least two members of the herpesviridae family, the human cytomegaloviruses (HCMV) and the herpes simplex viruses (HSV) can be found in human semen; but the role of the germ cells in the sexual transmission of these viruses is not clear. In teenagers and the adult population, sexual contact is considered to be a common mode of HCMV acquisition. HCMV was isolated from semen specimens of 33 % of HIV infected homosexual men, 20 % of HIV uninfected homosexual men and only of 2,4 % of healthy heterosexual men. Virus particles could be demonstrated by electron microscopy examination inside the sperm head as well as in the seminal liquid but at present, there is no direct evidence either for HCMV transmission via fertilization or for induction of fetal anomalies by vertical transmission. Transmission via donor semen is undoubtedly possible although not yet described and it may be safer to employ HCMV seronegative donor for all recipients, regardless of the recipient’s serologic status.

The development of serologic assays that differentiate the two serotypes of HSV demonstrated the worldwide distribution of genital HSV-2 which has been increasing in many developed countries throughout the last two decades. In several studies, HSV-2 has been recovered from the male reproductive tract, specifically the prostate, seminal vesicles, vasa and testes, in the absence of active lesions. In contrast, tissue cultures of semen sampled during lesion-free periods had been uniformly negative for HSV. However recently, one report documents transmission of HSV-2 via therapeutic donor insemination and illustres the fact that semen might be a vehicle of transmission of HSV. At present, it is adequate to recommend that men, with a history of a recurrent genital herpes or who have a sexual partner with such a history, are excluded as potential semen donors. Further, in the near future, with the increase of asymptomatic viral shedding from the genital tract, the presence of HSV-2 antibody could be added as an exclusion criterion.

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Correspondence to Elisabeth Dussaix.

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Dussaix, E. CMVH, HSV et procréation. Androl. 4, 414–420 (1994) doi:10.1007/BF03034724

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Mots-clés

  • HSV
  • CMVH
  • fertilité
  • sperme
  • insémination artificielle

Key Words

  • human spermatozoa
  • CMV
  • HSV
  • artificial insemination