In November 2014, the New York City Department of Health and Mental Hygiene received a report of a new case of HSV type 1 (HSV-1) infection in a newborn male infant following direct orogenital suction during ritual Jewish circumcision, also known as metzitzah b’peh.

New York City map/Public domain image/Franklin Baldo via Wikimedia Commons

Including this case, there have been a total of 17 laboratory-confirmed cases of HSV infection attributable to direct orogenital suction reported to the Health Department since 2000. Of these 17 cases, four were reported in 2014. Two of the 17 infants died, and at least two others suffered brain damage.

Prior to this case, the most recent cases were reported in July 2014.

According to health officials, an infant boy was born at term by spontaneous vaginal delivery to a multiparous woman and underwent ritual Jewish circumcision including direct orogenital suction on day of life eight.

Twelve days after circumcision, the baby was brought to the pediatrician’s office due to parental concerns about fussiness after feeding. The pediatrician noted a “cluster of papules” on the lateral shaft of the penis and, concerned about the possibility of herpes infection, referred the infant to a dermatologist the same day. The dermatologist recognized the lesions as vesicular and sent the infant to an emergency department.

The baby was admitted to a hospital and treated with acyclovir. Swab specimens from the penile lesions were positive for HSV-1 by both culture and PCR. The location of the lesions, timing of signs and symptoms, and laboratory identification of HSV-1 are consistent with transmission of HSV during direct contact between the mouth of the ritual circumciser and the newly circumcised infant penis.

Neonatal herpes simplex is a relatively rare but very serious disease that can range in severity from localized infections of the skin or eyes to life threatening disseminated infections of the organs and central nervous system.

A 2012 Morbidity and Mortality Weekly Report (MMWR)  describes the out-of-hospital, ultra-Orthodox Jewish practice as follows: the circumciser (mohel) places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound, also called direct orogenital suction.

The reported risk of an infant becoming infected with herpes simplex-1 or herpes simplex-2 who undergone direct orogenital suction is 3.4 times greater than an infant who did not go through the ritual procedure. For more infectious disease news and information, visit and “like” the Infectious Disease News Facebook page