Neonatal HSV infection occurs in a variety of settings, with a rate of 1-6 per 20,000 births. The majority of infections are incurred at delivery, from exposure to HSV in maternal genital secretions. Postnatal HSV infections occur via transmission by healthcare givers with oral lesions. This study, by Gesundheit el al (2004), evaluates a series of eight cases of neonate genital herpex simplex virus type 1 (HSV-1) infection following Jewish ritual circumcisions conducted in three hospitals in Israel and one hospital in Canada.
The infants developed HSV-1 symptoms roughly one week after ritual circumcision (± 2.5 days). The traditional ritual requires that the rabbi perform oral suctioning (metzitzah) of the blood after cutting off of the foreskin, a practice that has been largely abandoned by the majority mohels, or rabbis that perform circumcisions. Most mohels now use a special suction device for the procedure instead of their own lips. The eight oral metzitzah were performed by four different mohels, all of whom tested seropositive for HSV, although their mouth cultures came out negative. In one particular case, there was a five-year interval between the transmission of HSV two separate infections by the same mohel to two different patients. There was no clinical evidence of oral or vaginal herpes in any of the mothers.
Six neonates were given intravenous acyclovir therapy. Four neonates continued to experience episodic attacks of HSV-1 infection, while one infant developed HSV encephalitis.
Jewish ritual circumcision with oral metzitzah carries a real risk of transmission of HSV-1 infection from mohels to nonimmune neonates, with serious health consequences to the infant. Nevertheless, a number of orthodox rabbis continue to resist doing away with the traditional ritual of oral performing metzitzah during the act of circumcision.
Works Cited
Gesundheit B., Grisaru-Soen G., Greenberg D., Levtzion-Korach O., Malkin D., Petric
M., Koren G., Tendler M.D., Ben-Zeev B., Vardi A., Dagan R., Engelhard D.
“Neonatal genital herpes simplex virus type 1 infection after Jewish ritual
circumcision: modern medicine and religious tradition.” Pediatrics 114.2
(2004): e259-63. Web.
