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.
According to Jewish custom and traditions, newborn Jewish boys are ritually circumcised at eight days of age, and complications are generally very rare.
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 metzitzah.
Researchers say the vast majority of ritual circumcisions are currently performed with a sterile suctioning device and not oral suction by the mohel.
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' genitals.
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 mouth.
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.