The New York City Department of Health and Mental Hygiene received reports of two new cases of HSV infection in newborn male infants following direct orogenital suction during ritual Jewish circumcision, aka metzitzah b’peh in July 2014.

According to a New York City Health Alert Network (HAN) released today, in both of the cases reported in July, the infant boys were born to mothers with full-term pregnancies, had normal vaginal deliveries, and underwent ritual Jewish circumcision including direct orogenital suction on day of life 8.

In the first case, the baby was evaluated as an outpatient on day of life 16 for pustular lesions on the penis and genital area. HSV infection was suspected, and a genital specimen collected for viral culture. The baby was admitted to the hospital and treated with acyclovir and clindamycin. Additional specimens were collected at the hospital for HSV testing, including CSF, blood, and swabs of lesions; all were negative for HSV,

and the baby was discharged on day of life 19. On day of life 22, the initial viral culture taken as an outpatient was positive for HSV (non-typable). The baby was re-admitted to the hospital for intravenous acyclovir treatment.

Related: The magnitude of risk for neonatal herpes from Jewish circumcision not well defined: Study

In the second case, the baby developed lesions on his penis, left thigh, and left foot beginning on day of life 17. On day of life 19, the baby’s pediatrician collected specimens for bacterial culture, which came back negative. The next day, after the appearance of new vesicular lesions, the pediatrician suspected HSV, and the baby was admitted to the hospital. Two swabs of genital lesions and one swab of a foot lesion were positive for HSV-1 by PCR. In both cases, the location of lesions, timing of signs and symptoms, and laboratory identification of HSV are consistent with transmission of HSV during direct contact between the mouth of the ritual circumciser and the newly circumcised infant penis.

Since 2000, a total of 16 laboratory-confirmed cases of HSV-infection attributable to direct orogenital suction have been reported to the Health Department; three of these cases were reported in 2014 alone. Two of the 16 infants died, and at least two others suffered brain damage.

Health care providers are required to report diagnoses of neonatal herpes (with or without laboratory confirmation) to the New York City Department of Health and Mental Hygiene.

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