Newborn Hospitalized with Herpes After Ritual Circumcision Using Direct Oral Suction Method

A two-week-old infant is fighting for his life in Israel after contracting a rare but devastating herpes infection during a Jewish ritual circumcision that involved direct oral suction—a practice known as metzitzah b’peh. The baby, admitted to Wolfson Medical Center in Holon, developed severe lesions at the circumcision site and tested positive for herpes in his cerebrospinal fluid, indicating the virus had penetrated his central nervous system. Medical experts describe the case as a medical emergency with potential lifelong consequences, underscoring a longstanding public health controversy that pits religious tradition against infection control protocols.

• A two-week-old infant was hospitalized with herpes transmitted during a circumcision using direct oral suction (metzitzah b’peh).
• Doctors confirmed the virus reached the baby’s cerebrospinal fluid, posing a life-threatening risk due to an immature immune system.
• The Israeli Health Ministry prohibits direct oral suction during ritual circumcisions, but enforcement remains inconsistent in some communities.

Why Direct Oral Suction in Circumcision Poses Deadly Risks to Newborns

Herpes simplex virus type 1 (HSV-1), the same strain responsible for cold sores in adults, becomes a catastrophic threat when introduced into the bloodstream of a newborn. Unlike older children or adults, infants under three months of age lack fully developed immune defenses and a mature blood-brain barrier, which normally protects the central nervous system from pathogens. When HSV-1 enters an open wound—such as one created during circumcision—it can rapidly travel through the bloodstream and invade brain tissue, leading to herpes simplex virus meningoencephalitis. This condition often results in seizures, permanent neurological damage, developmental delays, or death, even with aggressive antiviral treatment.

The Medical Timeline: From Ritual to Critical Condition

The infant was circumcised at two weeks old using the metzitzah b’peh method, in which the mohel (ritual circumciser) uses his mouth to draw blood from the wound. Within days, the baby developed visible lesions near the circumcision site and exhibited signs of systemic infection, including fever and irritability. His condition deteriorated rapidly, prompting urgent transfer to Wolfson Medical Center. There, pediatric infectious disease specialists performed a lumbar puncture, confirming HSV-1 in the cerebrospinal fluid—an alarming sign that the infection had breached the central nervous system. The infant was immediately started on intravenous acyclovir, the antiviral drug standard for neonatal HSV, alongside intensive supportive care.

How Public Health Authorities Have Tried to Stop This Practice

The Israeli Ministry of Health explicitly prohibits direct oral suction during ritual circumcisions under guidelines first issued in 2007 and periodically reinforced. Officials mandate that mohels use sterile glass tubes or other mechanical devices to achieve suction, eliminating direct contact between the mohel’s mouth and the infant’s wound. The ministry also requires that parents be informed of the risks associated with metzitzah b’peh and consent to its use if it cannot be avoided. Additionally, an Interministerial Oversight Committee of Mohalim monitors compliance and conducts educational campaigns targeting religious leaders and communities.

Despite Bans, Enforcement Remains Inconsistent

While the legal framework exists, enforcement has proven challenging, particularly in ultra-Orthodox Jewish communities where the practice remains culturally entrenched. Reports indicate that some mohels continue using direct oral suction despite the ban, sometimes without obtaining informed consent from parents. In 2016, Schneider Children’s Medical Center in Petah Tikva reported two similar cases of neonatal herpes linked to ritual circumcision, underscoring that the risk persists despite public health warnings. In New York City, a 2012 outbreak of five confirmed cases led to a citywide moratorium on the practice by the Department of Health and Mental Hygiene, setting a precedent for regulatory action.

“It is important to avoid this practice because of the medical risks involved. Parents must be aware of the issue and make sure the suction stage is not performed by mouth.” — Dr. Diana Tasher, head of pediatric infectious diseases, Wolfson Medical Center

Tasher emphasized that even asymptomatic carriers of HSV-1 can shed the virus in saliva, making the practice inherently risky. “In such cases, herpes passes from the mouth directly into the wound and from there into the central nervous system, and this can end in disability, developmental impairment, or death,” she warned. The infant in this case is currently receiving a three-week course of intravenous acyclovir, with ongoing monitoring for potential kidney complications—acyclovir can cause renal impairment in newborns.

The Religious and Halachic Debate: Tradition vs. Medical Safety

Metzitzah b’peh is rooted in Jewish law (halacha) and has been practiced for centuries as part of the traditional brit milah (covenant of circumcision). Some rabbinic authorities argue that the practice is not mandatory but rather a custom, and that mechanical alternatives (like glass tubes) are acceptable. Others contend that the suction step is integral to the ritual and must be performed orally. This theological divide has fueled ongoing controversy, with some religious leaders encouraging the use of sterile devices while others insist on maintaining the traditional method to preserve authenticity.

Historical Precedents and International Responses

The conflict between public health and religious practice is not unique to Israel. In 2012, New York City health officials linked five cases of neonatal herpes to metzitzah b’peh, prompting the city to require parental consent forms acknowledging the risks and banning the practice in 2013. The city’s Board of Health argued that the public health risk outweighed religious exemptions, a stance that sparked legal challenges from Jewish advocacy groups. In Israel, a 2017 Supreme Court ruling upheld the legality of the Health Ministry’s ban but left enforcement to local authorities, which has led to uneven implementation.

What Parents Need to Know Before a Religious Circumcision

Parents considering a brit milah for their son should be fully informed about the risks associated with metzitzah b’peh and insist on alternative suction methods. The Israeli Health Ministry recommends asking the mohel whether he will use a sterile glass tube or mechanical device instead of oral suction. Parents should also verify that the mohel has reviewed the ministry’s guidelines and is aware of the legal requirement to obtain informed consent. In cases where oral suction is insisted upon, parents may choose to decline or seek a different mohel who follows safer practices.

The Medical Road to Recovery: What to Expect

The infant in this case is receiving acyclovir intravenously for a minimum of three weeks, a standard protocol for neonatal HSV infections. Doctors will closely monitor kidney function and neurological status throughout treatment. Even after completing the antiviral course, the child will likely require follow-up evaluations for developmental delays or neurological deficits. Tasher cautioned that while early treatment improves outcomes, “this case could end in disability even in the best-case scenario,” highlighting the irreversible nature of neonatal HSV infections.

A Call for Systemic Change: Can Israel Enforce Its Own Guidelines?

The recurrence of these cases raises questions about Israel’s ability to enforce its own public health regulations within religious communities. Unlike secular medical procedures, ritual circumcisions often occur in private homes or synagogues, outside the direct oversight of hospitals or health inspectors. Experts suggest that stronger collaboration between the Health Ministry, local councils, and religious leaders is needed to ensure compliance. Some advocate for mandatory reporting of all ritual circumcisions to health authorities, similar to vaccination tracking systems, to monitor adherence to safety protocols.