Herpes risk from ancient form of circumcision

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Eight infants developed genital herpes following an ancient Jewish ritual of circumcision, highlighting the dangers associated with this procedure, researchers report.

All of the infants underwent a form of circumcision in which the circumciser, or mohel, takes wine in his mouth and sucks the blood from the newly created wound, then spits the blood and wine mixture into a receptacle. The circumciser repeats this procedure, known as metzitzah, until the bleeding stops. 

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Currently, only a minority of mohels practice metzitzah, with most now opting for a suction device to remove blood from the wound, according to the report in the journal Pediatrics.

The eight infants developed genital herpes between 4 and 11 days after the procedure. Of four mohels who performed the circumcisions and agreed to be tested, all carried antibodies to herpes simplex virus type 1, indicating they were infected.

Herpes simplex virus type 1 is the strain that’s the usual cause of oral herpes sores, but it can also cause genital infections.

These findings suggest that circumcisions that include metzitzah carry a “serious risk” for transmission of herpes from the mouths of circumcisers to the genitals of infants, lead author Dr. Benjamin Gesundheit of Ben-Gurion University in Israel and his colleagues write.

“The cultural process of replacing ancient customs by modern wound care has to be encouraged by a heightened awareness of this potentially life-threatening medical complication,” they add.

After they developed genital herpes, 6 of the 8 infants received an intravenous infusion of acyclovir, an antiviral drug that is commonly used to treat herpes. Nonetheless, four of the infants experienced recurrent outbreaks of genital herpes.

In one infant, the herpes virus spread to the brain, causing long-term brain damage

The authors note that the virus can be secreted in saliva for several days to weeks and can appear in the saliva of people who show no symptoms of infection, or cold sore on the mouth, they note.

“We suspect, therefore, that this entity is underreported for cultural reasons and that the studies described here are only the ‘tip of the iceberg’ of the true incidence of the disease,” they write.

Gesundheit and his colleagues add that, in 2002, the Chief Rabbinate of Israel okayed the use of suction devices to remove blood from the circumcision wound in situations where there is a risk of spreading disease.

“We support ritual circumcision but without oral metzitzah,” the authors write.

SOURCE: Pediatrics, August 2004.

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