Herpes simplex virus infection among 11 infants that resulted from ritual Jewish orthodox circumcisions has prompted CDC officials to make practitioners aware of this practice and related risk for infection and the need for parental education on the issue.
The New York City Department of Health and Mental Hygiene investigated 11 cases of infant herpes simplex virus after out-of-hospital Jewish orthodox circumcision, which occurred between November 2000 and December 2011. Six of those cases had parent-confirmed reports that orogenital suction, in which the penis is placed directly in the circumciser’s, or mohel’s, mouth to suction away blood, took place — three of which were performed by the same mohel. The other five HSV cases had evidence to indicate that orogenital suction probably occurred. Infection resulted in the hospitalization of 10 infants, and two children died as a result.
Investigators reported that the risk for neonatal HSV-1 or untyped HSV after Jewish ritual circumcision with confirmed or probable direct orogenital suction from April 2006 to December 2011 in New York was estimated to be 24.4 per 100,000. This risk is 3.4 times higher than for male infants who did not have direct orogenital suction.
In an accompanying editorial, the CDC stated that preventing orogenital suction is difficult because it is a part of a religious ceremony that takes place outside of health care settings, so ritual circumcisers must be encouraged to adopt safe practices, and parents must be educated about the risks.
“Even where neonatal HSV reporting is not mandated, physicians should notify local health departments about cases potentially associated with direct orogenital suction to prevent further cases” the researchers wrote. “Local health departments should then notify the mohel who performed the procedure, so that he can voluntarily cease putting infants at risk. To protect infants’ health, public health departments might need to take legal measures to ensure mohelim associated with cases of neonatal herpes cease the practice of direct orogenital suction.”
Disclosure: The researchers report no relevant financial disclosures.