Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition.
OBJECTIVE
Genital neonatal herpes simplex virus type 1 (HSV-1) infection was observed in a series of neonates after traditional Jewish ritual circumcision. The objective of this study was to describe neonate genital HSV-1 infection after ritual circumcision and investigate the association between genital HSV-1 after circumcision and the practice of the traditional circumcision.


METHODS
Eight neonates with genital HSV-1 infection after ritual circumcision were identified.


RESULTS
The average interval from circumcision to clinical manifestations was 7.25 +/- 2.5 days. In all cases, the traditional circumciser (the mohel) had performed the ancient custom of orally suctioning the blood after cutting the foreskin (oral metzitzah), which is currently practiced by only a minority of mohels. Six infants received intravenous acyclovir therapy. Four infants had recurrent episodes of genital HSV infection, and 1 developed HSV encephalitis with neurologic sequelae. All four mohels tested for HSV antibodies were seropositive.


CONCLUSIONS
Ritual Jewish circumcision that includes metzitzah with direct oral-genital contact carries a serious risk for transmission of HSV from mohels to neonates, which can be complicated by protracted or severe infection. Oral metzitzah after ritual circumcision may be hazardous to the neonate.
Pediatric Hematology/Oncology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
Benjamin
B
Gesundheit
Galia
G
Grisaru-Soen
David
D
Greenberg
Osnat
O
Levtzion-Korach
David
D
Malkin
Martin
M
Petric
Gideon
G
Koren
Moshe D
MD
Tendler
Bruria
B
Ben-Zeev
Amir
A
Vardi
Ron
R
Dagan
Dan
D
Engelhard
D002944:Circumcision, Male / Q000009:adverse effects*; D002977:Clergy; D020803:Encephalitis, Herpes Simplex / Q000209:etiology; D006561:Herpes Simplex / Q000635:transmission*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D006801:Humans; D007231:Infant, Newborn; D007599:Judaism; D008297:Male