Fourteen New York infants have contracted a sexually transmitted disease, neonatal herpes, two have died and two have suffered brain damage since 2000, following Jewish ritual circumcisions known as metzitzah b’peh, or MBP. In New York there have been three such infections in two years associated with the rite, and in January 2012 New York City established a required consent form for parents to sign prior to the procedure that outlines the risks of having MBP performed on their child.
The practice of MDP, or direct oral suctioning, is sometimes performed during religious circumcisions (bris). It is an ancient religious ritual, dating back some 5,000 years and seen primarily in ultra-Orthodox communities. With this practice the mohel, who is a religious circumciser, suctions the blood from the circumcision wound with the mouth. Direct oral suctioning is considered the only acceptable way to draw blood away from the cut by some religious authorities. Some parents have said they did not know in advance that the mohel would use this method, and even those who were aware it would be done were often unaware of the risks. The New York City Health Code now requires the written parental consent, which must include the name of the mohel.
Herpes, or oral HSV-1, infections are common, causing cold sores in most people. The virus can be transmitted to others even if no cold sores are present. Infants are at risk for severe infections if exposed, since their immune systems have not developed enough to fight off infections. HSV-1 spreads through saliva, particularly when the saliva encounters a cut or other break in the skin. If present in the mouth of the mohel, the sexually transmitted disease can easily be transferred to the infant during the ritual part of the circumcision where the mohel’s mouth directly contacts the baby’s wound. Even when the mohelim rinse their mouths with a disinfectant mouthwash or take antiviral medications the risk remains.
The New York City health department has not attempted to forbid MDP ritual circumcisions, as this would violate religious freedom. The health department has not attempted to monitor compliance with use of the consent form, although they did say they would investigate if parents complained. At least two infants have contracted the sexually transmitted disease during the circumcision ritual since the consent regulations were implemented.
According to Dr. William Schaffner, Vanderbilt University’s chair of preventive medicine, neonatal herpes is nearly always a fatal infection. Although infections are rare, the New England Journal Of Medicine cites a fatality rate of 64 percent, even with antiviral treatment. Less than 20 percent of infected infants who survive infection with the sexually transmitted disease herpes develop normally. HSV-1 is common, and by the age of 50 about 90 percent of Americans have experienced infections, most without symptoms.
When new mayor Bill De Blasio took office this January he promised to work with the Jewish community to find a better alternative to the consent forms, but left the requirement in place. Ultra-Orthodox Jewish leaders adamantly oppose the consent form, which they say exaggerates the risk or infecting an infant with the sexually transmitted disease during ritual circumcisions.
By Beth A. Balen