Ritual in Some Jewish Circumcisions Raises Risk of Herpes Infection: Report

THURSDAY, June 7 (HealthDay News) -- The practice of "oral-genital suction" performed during some Orthodox Jewish circumcision ceremonies could leave the infant with a potentially fatal herpes virus infection, health officials warn.

New York City and federal health authorities issued a public advisory Thursday cautioning against the sucking practice because it has been linked to 11 infants becoming infected with the herpes simplex virus type 1 since 2000. Ten of the infected newborns were hospitalized, two developed brain damage and two died, the health officials said.

A newborn can become infected when the adult performing the circumcision places his mouth on the circumcision wound to siphon blood away from the cut. The ritual is only embraced by a handful of sects within the Orthodox Jewish community, according to New York City Health Commissioner Dr. Thomas Farley.

"There is no safe way to perform oral suction on any open wound in a newborn," Farley said in a news release. "Parents considering ritual Jewish circumcision need to know that circumcision should only be performed under sterile conditions, like any other procedures that create open cuts, whether by mohelim [the circumciser] or medical professionals."

A report on the infections also appears in the June 8 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Almost 80 percent of adults carry the herpes simplex virus type 1, which is usually spread orally through common activities and is different from the sexually transmitted type 2 version of the virus. The common cold sore is a typical sign of infection with the herpes simplex virus type 1, but most people don't know they are infected because they have no history of symptoms, officials said.

In six of the 11 circumcision cases, health care providers confirmed that the suction ritual had taken place, although there was evidence of a connection in the other five cases. The ritual more than tripled the risk of infection among newborns getting circumcised, the CDC report stated.

New York's deputy health commissioner, Dr. Jay Varma, said: "The [New York City Department of Health and Mental Hygiene] has been concerned about this problem for some time. And so we are taking the approach right now to try and educate parents and the community about the dangers of this very specific procedure.

"The infections we're talking about are not the ones people normally associate with sexual type interaction," he added. "Many actually acquire herpes type 1 when they are children, because it can be gotten through very casual contact. This causes what people commonly call cold sores in the mouth.

"We're not implying in any way that these mohel [circumcisers] have done anything untoward in a sexual context," Varma said. "The point is that regardless if you're a mohel or someone else, having direct contact with the mouth and an open wound is a hazard."

To highlight the risks involved, Varma cited an incident in 2004 when twin boys were diagnosed with herpes following oral-genital suction during circumcision. About two weeks later, both babies developed fevers and lesions around their genitals, buttocks and abdomen. One of boys later died.

The boys' mother and hospital staffers were ruled out as a possible source of infection.

Dr. Philip Tierno, director of clinical microbiology and pathology at New York University Medical Center, said the sucking practice is a "bad idea."

"There are about 500 different microorganisms in the human mouth," he said. "So, I think it's insanity. It's not only unhygienic, but it can potentially kill the child. So, for the protection of children this is a practice that should be discontinued."

More information

For more on herpes, visit the U.S. National Library of Medicine.

SOURCES: Jay Varma, M.D., deputy commissioner, disease control, New York City Department of Health and Mental Hygiene; Philip Tierno, M.D., Ph.D., director, clinical microbiology and pathology, New York University Medical Center, New York City; June 6, 2012, advisory, New York City Department of Health and Mental Hygiene; June 8, 2012, Morbidity and Mortality Weekly Report, online

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