Rare Circumcision Ritual Carries Herpes Risk
Traditional Jewish Practice May Put Babies at Risk for Genital Herpes Infection
Aug. 2, 2004 -- A rare Jewish circumcision practice may put
young infants at risk for genital herpes with potentially severe complications,
according to a new study.
Researchers in Israel have documented eight cases in which male
infants became infected with the herpes simplex virus type 1 (HSV-1) after
undergoing circumcision that included direct oral-genital contact between the
infant and the circumciser (mohel). One of the infants suffered brain
damage as the result of his infection.
Male circumcision is the removal of the foreskin (prepuce),
which is a fold of skin that covers and protects the tip of the penis.
According to Jewish custom and traditions, newborn Jewish boys
are ritually circumcised at eight days of age, and complications are generally
However, a small number of Orthodox rabbis advocate an ancient
practice in which the circumciser sucks the blood from the infant's
circumcision wound until the bleeding stops, a ritual known as
Researchers say the vast majority of ritual circumcisions are
currently performed with a sterile suctioning device and not oral suction by
Rare Circumcision Ritual Puts Infants at Risk
In their study, published in the August issue of
Pediatrics, researchers describe eight cases in which Jewish infants
developed genital herpes an average of a week after circumcision. None of the
infant's mothers had evidence of oral or genital herpes, the most frequent
modes of transmission to newborns.
In all cases, the traditional circumciser had performed the
metzitzah custom involving direct oral contact with the infants'
Six of the infants required treatment with intravenous
antibiotics, and four had recurrent genital herpes infections. In addition, one
infant suffered brain damage and seizures as a result of complications caused
by his infection.
Four of the mohels were available for testing, and all
of them tested positive for antibodies for HSV-1, which indicated that they
were carriers of the virus. Yet none had tested positive for the virus in their
Researchers say that after the initial cases of herpes in
circumcised infants were reported, the Chief Rabbinate of Israel pronounced in
2002 the legitimacy of using instrumental suction in cases in which there is a
risk of infection.
"We support ritual circumcision but without oral
metzitzah, which might endanger the newborns and is not part of the
religious procedure," write researcher Benjamin Gesundheit, MD, of Ben
Gurion University in Israel, and colleagues.