title: Neonatal Herpes Simplex Virus Type 1 Infection and Jewish Ritual Circumcision With Oral Suction: A Systematic Review.
abstract: Jewish ritual circumcision rarely but occasionally includes a procedure involving direct oral suction of the wound, which can expose an infant to infection with herpes simplex virus type 1 (HSV-1). This practice has provoked international controversy in recent years, but no systematic review of the clinical literature has previously been published. We designed this review to identify and synthesize all published studies examining the association between circumcision with direct oral suction and HSV-1 infection. Our search strategy identified 6 published case series or case reports, documenting 30 cases between 1988 and 2012. Clinical findings were consistent with transmission of infection during circumcision, although the evidence base is limited by the small number of infections and incomplete case data. Published evidence suggests that circumcision with direct oral suction has resulted in severe neonatal illness and death from HSV-1 transmission, but further research is necessary to clarify the risk of infection.
authors.affiliation: Center for Evidence-Based Practice.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Leas
authors.affiliation: Center for Evidence-Based Practice Department of Medicine Center for Clinical Epidemiology and Biostatistics Leonard Davis Institute of Health Economics Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
mesh_terms: D002562:Ceremonial Behavior; D002944:Circumcision, Male / Q000009:adverse effects* / Q000208:ethnology* / Q000379:methods*; D006561:Herpes Simplex / Q000208:ethnology* / Q000401:mortality / Q000635:transmission*; D018259:Herpesvirus 1, Human; D006801:Humans; D007231:Infant, Newborn; D007585:Jews; D007599:Judaism; D008297:Male; D018570:Risk Assessment; D013396:Suction / Q000009:adverse effects
keywords: circumcision; herpes simplex virus; neonatal