Herpes simplex virus (HSV) is what commonly causes cold sores (HSV-1) and genital herpes (HSV-1 and HSV-2), and the cold sore type is ever-present in the mouths of a large portion of adult society, often without symptoms. Adult wellness is largely only affected by an occasional open sore on the mouth, but for babies it can mean permanent disability or death. According to a Morbidity and Mortality report from the CDC, a study has found that between November 2000 and December 2011, 11 newborn males in New York were diagnosed with an HSV infection that led to 10 hospitalisations and two deaths, owing to the ultra-Orthodox Jewish circumcision ritual metzitzah b’peh.
The oral contact aspect of the ritual means a 3.4 times greater risk of and infant contracting an HSV infection in New York, and the researchers note that this aspect not only increases the risk of HSV, but also numerous other pathogens, hence the researchers urged that circumcision should be considered to be a surgical procedure requiring aseptic conditions. However, though Health-care professionals are advising Jewish parents that the oral-genital suction part of the ritual should be avoided, this is a problematic recommendation as they are essentially asking ultra-Orthodox Jews to change a religious rite that has been specially significant and in practice for many years.
Therefore, scientists are offering another life-saving compromise – prophylactic treatment with an antiviral medication such as acyclovir. According to researchers from the Children’s Hospital of Philadelphia, early treatment, within one day of hospital admission, with acyclovir therapy decreases infant mortality from 9.5% to 6.6%. The study’s authors wrote ‘Delayed initiation of acyclovir therapy was associated with in-hospital death among neonates with HSV infection. Our data support the use of empiric acyclovir therapy for neonates undergoing testing for HSV infection.’ The treatment is usually delayed because ‘symptoms upon presentation may be non-specific and testing may take several days’ but if, as in the case of the Jewish circumcision ritual metzitzah b’peh, there is a known risk of a newborn infant contracting an HSV infection from the mohel, this might be a respectful and helpful compromise to make.