Neonatal Genital HSV-1 After Jewish Circumcision:

Neonatal herpes simplex virus (HSV) infection incidence has increased in the past decade to 8 to 60 per 100 000 live births in the United States.1 In Israel, the current incidence is estimated to be 8.4 per 100 000 live births2. In 85% of the cases, the infection is transmitted vertically during the passage in the birth canal, the minority of the cases are acquired intrauterine, and in 10% of the cases, the infection is acquired in the postnatal period, from oral HSV shedding of a caregiver or postcircumcision.3 Ritual circumcision is a common custom in many cultures. In the Jewish tradition, there is an ancient custom of orogenital suctioning of the penile blood (metzitza), which is currently done by a minority of traditional circumcisers (mohels). Part of the ultraorthodox population adheres to this custom because it is considered glorified, without knowing the hazardous potential of it. The aim of this study is to describe a cluster of cases of postcircumcision neonatal genital HSV infection in a single medical center serving an ultraorthodox population.