Dr. Gary Gelbfish presents the “medical facts” in the bris controversy (“In Debating Bris Controversy, Know The Medical Facts,” Opinion, March 16).
As an infectious-disease specialist in practice for almost 27 years, I can say that much of what was presented in the article was not “fact.” Many of the “facts” were omitted. Other “facts” do not have relevance to the present situation.
Dr. Gelbfish states, as a “fact” that metzitzah b’peh (MBP) — direct mouth-to-wound oral suctioning by the mohel — entails “a certain, yet at present, unquantified risk of herpes transmission.” The most important fact is that there has never been one single case of herpes infection proved to be caused by MBP.
Dr. Gelbfish states that there are “multiple case studies reported in the medical literature.” In fact, there are very few case reports in the medical literature. Dr. Gelbfish states that there are “many unreported cases.” How does he know about these cases if they are unreported?
There have been 76 cases of neonatal herpes reported in New York City from April 2006 through September 2010. There were 33 females among the 76. There were more deaths among females than males. There were only four that were suspected to be related to ritual circumcision. Only three were confirmed by the laboratory to have herpes simplex. In attributing the rare cases to ritual circumcision, one should take into consideration the fairly common occurrence of neonatal herpes contracted in other ways and consider the possibility that there was another form of acquisition.
Dr. Gelbfish writes that many rabbis restricted MBP, “most notably Rabbi Moshe Schreiber (the Chasam Sofer).” He states that “the custom of many Orthodox communities was changed as a result.” In fact, on reading the responsum of the Chasam Sofer, it is clear that it was an allowance for one individual mohel to refrain from MBP. There is no indication from his writing that it was intended as a general ruling.
To summarize, there has never been one single case of proved transmission of herpes simplex through MBP. If it does occur, it is quite rare. As to whether it should be continued or not, I leave it to the rabbis to decide based on their understanding of the nature of the ritual and factoring in the very small risk, if it exists, as we do in other areas of halacha.