By NewsDesk @infectiousdiseasenews
New York City health officials are reporting a case of a baby with neonatal herpes following direct orogenital suction (DOS) during ritual Jewish circumcision. This is the first case of neonatal herpes related to DOS during ritual Jewish circumcision reported to the Health Department since March 2017.
Direct orogenital suction (DOS) during ritual Jewish circumcision (also known as metzitzah b’peh) is a practice during which a mohel (religious circumciser) uses his mouth to suck blood away from the penile circumcision wound. DOS can transmit herpes simplex virus (HSV) to newborn males which can cause severe infection, resulting in brain damage, and death.
According to health officials, the infant was circumcised on the eighth day of life by a mohel who performed DOS. Ten days later, the infant developed a rash on his genitals, groin, and buttocks. A specimen taken from one of the child’s lesions tested positive for herpes simplex virus type 1 (HSV-1) by polymerase chain reaction (PCR). The infant was hospitalized to complete a 14-day course of intravenous acyclovir and is doing well.
In this case, the child’s caretakers were not aware of the signs and symptoms of neonatal herpes nor the risk of herpes transmission associated with DOS, resulting in a delay in the child presenting for care.
Signs and symptoms may include: a vesicular or pustular rash (following DOS, these lesions typically appear on the genitals, groin, buttocks and ankle (related dermatomes)); fever; poor feeding; irritability; and lethargy. Fever and rash are not always present so, a historical exposure such as DOS should raise suspicion for an atypical presentation of neonatal herpes.
Since April 2006 (when neonatal herpes reporting became mandatory in NYC), there have been a total of
164 laboratory-confirmed babies with neonatal herpes. Of these cases, 19 (12%) developed their infections following ritual Jewish circumcision.