Response to Recent Review of Literature on Transmission of Neonatal Herpes Through Ritual Circumcision With Oral Suction

Neonatal Herpes Infection Associated With Direct Orogenital Suction During Ritual Jewish Circumcision

“…We also strongly disagree with the assertion of Leas and Umscheid [2] and of Berman et al [1] that only DNA evidence can prove a causal relationship between DOS and neonatal HSV infection. DNA evidence is not necessary to document the risk of DOS.…”

“…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.…”

“…The timing of infection is also consistent with transmission via DOS. The neonatal HSV incubation periods cited by Dr. Berman et al [1] refer to infants who acquire HSV perinatally and are not relevant to transmission of HSV by direct oral-genital inoculation. Indeed, the median number of days between circumcision and the appearance of HSV lesions (median 8, range 5-20) cited in the New York City Department of Health and Mental Hygiene's (NYC DOHMH) summary of their years-long investigation into 11 such cases is highly consistent with inoculation at the time of circumcision [4].…”

“…Dr. Berman et al [1] make the unsubstantiated claim that there is an "absence of any attention" to cases of neonatal herpes not associated with DOS and that scrutiny of this practice will distract physicians from identifying neonatal herpes infections in babies who are not ultraorthodox Jewish males. This claim is contradicted by the preponderance of peerreviewed literature and practice guidelines from professional medical organizations addressing neonatal HSV infection prevention and management.…”

“…Rebecca Pellett Madan, 1 Betsy C. Herold, 1 Adam J. Ratner, 2 Lisa Saiman, 2 Anne A. Gershon, 2 and Lawrence R. Stanberry…”