Department of Health on Metzitzah B'Peh

My daughter got terribly sick as a baby when she was kissed by someone with herpes. Am I now going to banish this person from my home from now on and forbid her from kissing my child? No, I'll just make sure that she doesn't kiss my baby when she's having an outbreak. If you are really concerned then ask the mohel if he has herpes or cold sores. People can even insist that their mohel get tested and if enough people requested it I'm sure they would. Our mohel did metzizah b'peh and I see no reason to get all hysterical and get rid of this minhag (or is it halacha?). From what I understand, many groups don't consider it a proper milah without it.
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Diamond Member Joined: Mar 11 2010 Posts: 3090

I never knew about this part of a bris until I heard about the whole Tendler business last time they tried to stop it. I almost threw up the first time I heard about it and it still brings up my bile. But dh says it's what is done at every bris and according to many poskim it's a major part of the milah.

ETA: Dh just told me that he knows a famous mohel that has issues like this so he has a partner that helps him at brissim and does the metzitza b'peh for him.

Platinum Member Joined: May 22 2005 Posts: 13795

Platinum Member Joined: Oct 14 2009 Posts: 5894

Personally, I think it is probably simple enough to get tested for herpes and if there's even the remotest chance that it could pose a problem, why not just have the mohel swab some saliva just to be sure? And, like the one groisamomma mentioned, if it is a problem it doesn't need to be a career killer because someone else can do that part.

However, from a more theoretical point of view, this is an issue that comes up periodically (at least over the past decade or two). A few years ago (not sure exactly how many, but I think recent enough that there hasn't been much new data since) DH himself was present at a big meeting that took place between major rabbanim, doctors, and researchers to try to get to the bottom of the situation (DH is neither a doctor nor rabbi himself but at the time was serving as a gabbai to one of the more with-it gedolei hador). Having no research background in the subject, he was unable to convey the details clearly to me years later when the issue came up again (the meeting he attended was before we met) but he told me that both the doctors and rabbanim came to the conclusion that someone out there has a vendetta against milah because the data do not support a real risk. They are not sure where the agenda is coming from or what exactly it is, but it seemed that the information was being presented to the public in a skewed way while it didn't hold up under professional scrutiny.

I wish I had more details because my mentality just can't be comfortable with this practice until I see some proof (ok, evidence. I don't think this can actually be PROVEN) for myself.

Platinum Member Joined: Oct 14 2009 Posts: 5894

Yes I read that. That's the dept. of health official statement. It's not the source where they get their info (or is it "info"? I don't even know). It also doesn't compare to the incidence of herpes in non-metzitza'd (and uncircumcised) babies, which is not at all unheard of. It doesn't explain what studies have supported the claim that metzitza was the cause of those cases.

I do think it makes a tremendous lot of sense that putting one's mouth on an open wound would be extremely unsanitary and probably dangerous. But I still want better data. Especially since there was apparently this big conference of professionals who came to the conclusion that there isn't a problem, I'd love to hear their side as well.

Platinum Member Joined: May 22 2005 Posts: 13795

It seems that people don't understand the nature of the herpes virus. The vast majority of adults - over 90% - have HSV I, the type that causes "cold sores. Once you have it, you carry it forever. The problem is that you can transmit it even if you don't have an active lesion. There is no "just test their saliva" or "just don't do it if you have a cold sore". I'm sorry that it is not this simple.

Platinum Member Joined: Nov 04 2008 Posts: 7946

this always sat wrong with me, and always made me nauseous. if I ever have another boy I will make sure this is either done with a piece or not done at all. this is one of those things in religion that I do not understand, and do not agree with. there are way too many stories nowadays of infants dying from herpes and personally I dont think anyones mouths should be near my babies privates, nor do I think anyones saliva should be anywhere near an open wound. especially that of an infant.
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What is the reason for this practice? Is it just "the way it's always been done" or is there a specific gemarah that discusses why this is necessary?

It really does sound unsettling. And odd -- we Jews are so careful not to out blood anywhere near our mouths.

Platinum Member Joined: May 22 2005 Posts: 13795

IIRC, there is a gemara that says if you don't suck blood from the wound after a bris, the child will die. The question becomes - do you have to do it with your mouth? Obviously, poskim have come down on both sides on the issue.

Platinum Member Joined: Oct 14 2009 Posts: 5894

Platinum Member Joined: May 22 2005 Posts: 13795

Mishnah shabbos 19:2.

Platinum Member Joined: May 22 2005 Posts: 13795

"Holding" is not the issue, not even "putting her face near" your child. Putting your saliva which could carry HSV on an open wound is. I wouldn't recommend that you let your mother lick your child's open wounds no matter what the age of your child.

And the whole "know your status, get tested"? Soooo - what? You recommend the 6% or so of adult males who have never been infected with HSV are the only ones that can become mohelim? And how do you propose to make sure they don't get it and monitor that for the future?

sarahd, the methodology is explained in the MMWR report here:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a2.htm?s_cid=mm6122a2_e

Platinum Member Joined: May 22 2005 Posts: 13795

Hmmm - well the health dept. seems to notice that there are some religious issues here. That is why they didn't ban the practice and only put out guidelines so that people can make an informed decision. Bris milah is a minor surgery. Surgery is supposed to be done under sterile conditions. You can do what you want, but don't deny that they human mouth is filthy and doesn't belong on an incision. In what other context would ANY of us say "you know, I don't mind if my surgeon licks my wound"????

FTR - There are plenty of other pathogens in the mouth too - strep, staph - and yes, there have been cases of babies who got these on their groin after bris milah too. I'm surprised that someone who knows firsthand the very real dangers of neonatal HSV transmission wouldn't be more concerned.

[edited to fix typo]

Once upon a time it was the only way to get the blood out so that is what they did. Today we know that it can be done through a test tube with cotton and lots of other ways, using a mouth removed physically from the cut. Poskim have paskened that it is ok. If even one child gets sick or dies chas vesholom from something they received through metziza, is it safe to continue?

Not in my book. Hence our mohalim do it through a tube around here. No they are not charedi. they are dati leumi.
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