New Herpes Case because of Metzizah B'Peh in NYC

ALERT FROM THE NEW YORK HEALTH DEPARTMENT!

January 28, 2014

Direct orogenital suction during ritual Jewish circumcision (also known as metzitzah b’peh) has been documented to transmit herpes simplex virus (HSV) type 1 to newborn males (1-4). In January 2014, the New York City (NYC) Department of Health and Mental Hygiene received a report of a new case of HSV-1 infection in a newborn male infant following direct orogenital suction. To date, a total of 14 laboratory-confirmed cases of HSV-infection attributable to direct orogenital suction have been reported to the Health Department since 2000. Two of these infants died, and at least two others suffered brain damage (4).

In the most recent case, the infant was the term product of a full-term pregnancy and normal vaginal delivery. 

He had ritual Jewish circumcision including direct orogenital suction on day of life 8. On day of life 13, at a well-child visit, a rash was noted on and around genitals. 

The baby was treated with topical antibacterial ointment. 

On day of life 16, the baby returned to his provider for worsening rash, and a topical anti-fungal was added to the regimen. 

On day of life 18, lesions progressed to include the perineum and the right foot. HSV infection was suspected, and the infant was referred to a pediatric dermatologist. 

The next day, upon evaluation of the baby, the dermatologist, also suspecting HSV, collected specimens for direct visualization and for viral culture, and the baby was admitted to a hospital for treatment. 

The location of herpes lesions (on the genitals and on the foot, a dermatomal distribution reflecting involvement of sacral nerves), viral type (HSV type 1, which is commonly found in the mouth of adults), and timing of infection (5 days after circumcision) are consistent with transmission during direct contact between the mouth of the ritual circumciser (mohel) and the newly circumcised infant penis.