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Daniel Berman, Brenda Breuer, Awi Federgruen, Response to Recent Review of Literature on Transmission of Neonatal Herpes Through Ritual Circumcision With Oral Suction, Journal of the Pediatric Infectious Diseases Society, Volume 4, Issue 3, September 2015, Pages 284–285, https://doi.org/10.1093/jpids/piu111
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To the Editor—A recent review [ 1 ] suggests a relationship between neonatal herpes and Jewish ritual circumcision. Its lead author Mr. Leas—from UPenn Medicine's Center for Evidence-Based Practice—was the lead analyst in an Evidence Review on that subject. It echoes that review's conclusion by summarizing as follows: “The evidence base is limited by the small number of infections and incomplete case data,” adding the deficiencies of the only statistical study ever attempted, and “only genetic testing of HSV isolates can confirm transmission.”
Supporting their claim, the authors mention case studies “ consistent with transmission … from mohel to infant, including the location of lesions, timing of symptoms, and disease typology.”
However, the UPenn review considered both location and timing of lesions insignificant: “Diapers are changed very frequently in infants, … increas[ing] potential exposure to infection in the genital areas.” Additionally, it is well documented that neonatal herpes often presents in traumatized areas (eg, circumcision sites).
