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PEDIATRICS Vol. 114 No. 2 August 2004, pp. e259-e263

ELECTRONIC ARTICLE

Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition

Benjamin Gesundheit, MD*, Galia Grisaru-Soen, MD{ddagger}, David Greenberg, MD§, Osnat Levtzion-Korach, MD||, David Malkin, MD, Martin Petric, PhD#, Gideon Koren, MD**, Moshe D. Tendler, PhD{ddagger}{ddagger}, Bruria Ben-Zeev, MD{ddagger}, Amir Vardi, MD{ddagger}, Ron Dagan, MD§ and Dan Engelhard, MD||

* Pediatric Hematology/Oncology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
{ddagger} Safra Children's Hospital, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
§ Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
|| Department of Pediatrics, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel
Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
# Department of Pediatric Laboratory Medicine, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
** Department of Clinical Pharmacology and Toxicology, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
{ddagger}{ddagger} Department of Biology, Talmudic Law and Jewish Medical Ethics, Yeshiva University, New York, New York

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.

Conclusion. 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.

Key Words: ritual circumcision • herpes simplex infection • infection of the newborn • Jewish tradition

Abbreviations: HSV, herpes simplex virus

Received for publication Nov 20, 2003; Accepted Feb 18, 2004.


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