This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (6)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gesundheit, B.
Right arrow Articles by Engelhard, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gesundheit, B.
Right arrow Articles by Engelhard, D.
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Herpes Simplex
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.