Circumcision Ritual Carries Herpes Risk

Experts caution against ancient custom of oral blood suctioning

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By
HealthDay Reporter

TUESDAY, Aug. 3, 2004 (HealthDayNews) -- Ritual Jewish circumcisions that include metzitzah, the oral suctioning of blood from the wound, place newborns at risk of contracting the herpes virus from the mohels who perform it and should be eliminated from the procedure, a new study asserts.

The warning applies to a very limited number of circumcisions, as most mohels these days use a suction device such as a mucus extractor rather than their mouths, the experts point out.

"This is rarely done in the United States, and even in Israel is uncommon," said Dr. George Kaplan, a San Diego pediatric urologist and former member of the American Academy of Pediatrics' task force on circumcision. Kaplan was not involved in the study, which appears in the August issue of Pediatrics.

Moshe D. Tendler of Yeshiva University in New York City and his co-authors evaluated eight newborns with genital herpes simples type 1 (HSV-1) infections after having undergone ritual circumcision.

Most oral herpes cases (cold sores or fever blisters on the mouth) are caused by HSV-1, according to the American Social Health Association, and most genital herpes cases (similar symptoms in the genital area) are caused by HSV-2. But both type 1 and type 2 can occur in the genital area, the oral area or both.

If a person with oral herpes has contact with another person's genital area, it is possible for the other person to get genital herpes, according to the association.

The herpes virus is transmitted through direct skin-to-skin contact. Symptoms such as sores, blisters, bumps or a rash, as well as flu-like symptoms, can occur within days of transmission, but the intensity of symptoms vary greatly from person to person.

In the study, the average interval from the circumcision to the onset of symptoms was about seven days. In all cases, the mohel had performed the ancient practice of orally suctioning the blood after the foreskin was cut.

Six infants needed intravenous therapy with acyclovir (Zovirax), a medication used to treat herpes of the genital and mouth areas. Four had recurrent episodes of genital herpes infections. One developed neurological problems. All four mohels who performed the circumcisions tested positive for herpes antibodies in the blood.

The authors emphasize that they support ritual circumcision but without the oral metzitzah because it might endanger newborns. And, they point out, the oral metzitzah is not part of the religious procedure.

The findings, said Kaplan, "come as no surprise." The recommendation to use the modified ritual, making use of a mucus extractor, is an ideal solution, he added.

More information

To learn more about circumcision, visit the American Academy of Pediatrics.

SOURCES: George Kaplan, M.D., pediatric urologist and clinical professor, surgery and pediatrics, University of California, San Diego, and former member, Task Force on Circumcision, American Academy of Pediatrics; August 2004 Pediatrics

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