An ultra-Orthodox Jewish circumcision practice in which the circumciser places his mouth on a newborn's newly circumcised penis and sucks blood away from the wound carries a risk of transmitting the herpes virus to the baby, sometimes fatally, according to a new report from the Centers for Disease Control and Prevention.
The report is based on researchers' investigation into the cases of 11 infants in New York City who were infected with the herpes virus after this procedure, known as metzitzah b’peh ("direct orogenital suction"), between November 2000 and December 2011. Ten of these infants were hospitalized, and two died.
Some of the infants’ parents were not aware this technique would be a part of their child’s circumcision, the researchers found. Parents should be aware of the risk of herpes in metzitzah b’peh, and should inquire in advance whether direct orogenital suction will be performed so the practice can be avoided, the CDC researchers said.
"Oral contact with a newborn’s open wound risks transmission of [ herpes simplex virus ] and other pathogens," the researches wrote in their report. "Circumcision is a surgical procedure that should be performed under sterile conditions."
The virus that was found in most of the infants, called herpes simplex virus type 1 (HSV-1) — which is typically associated with cold sores, but does not always cause any symptoms — is highly prevalent in the general adult population, the report said. A 2004 study showed that 73 percent of adults ages 20 and older in New York City carried the virus.
At least three of the infants, including one who died, were circumcised by the same person, the report said. The New York City Commissioner of Health has issued a directive ordering that person to stop performing direct orogenital suction during circumcisions.
At least three mohliem (circumcisers) performed the circumcisions of the 11 infected infants, and there may have been as many as eight mohliem, the CDC said. In some cases, parents refused to identify their child's circumciser to CDC officials.
The rate of newborn boys who undergo direct orogenital suction and contract herpes infections is 24.4 per 100,000, the report said. That's 3.4 times higher than the rate of herpes infections seen in the general newborn male population, which is 8 per 100,000. Other cases of herpes are typically transmitted from mother to infant during delivery.
Neonatal herpes infections is a potentially disabling, life-threatening infection, the report said.
Physicians should counsel parents considering out-of-hospital circumcisions about the risks of direct orogenital suction, and should consider herpes infection when evaluating a newborn male infant with a fever following Jewish ritual circumcision, and inquire about direct orogenital suction, the CDC said.
Mohelim should inform parents about whether they perform direct orogenital suction, and explain the risk of virus transmission, so that parents can choose not to have their newborns exposed, the report said.