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Sidebar to Metzitzah B’peh Controversy: The Truth About HSV |
By Dr. Yitzchak Ariel
Over one hundred years ago, tuberculosis and syphilis were associated with metzizah b’peh. Today, it is mostly viruses like herpes and HIV that are of concern to the Jewish public.
What is herpes?
While herpes simplex virus, otherwise known as HSV, was scientifically investigated and described in the twentieth century, the disease has been around for thousands of years. Indeed, the Greeks were the first to use the term herpes, meaning creeping or crawling, in describing a variety of skin lesions, both infectious and non-infectious. Herodotus (484-425 BCE), the Greek historian, associated mouth ulcers and lip lesions with fever, calling them herpes febrilis.
HSV is a part of the herpes virus family. There are over one hundred viruses in this family, including chickenpox (varicella), Epstein-Barr (EBV) and Cytomegalovirus (CMV). HSV can cause infections of the skin, the central nervous system and even organs.
Who is susceptible to contracting HSV? How it is transmitted?
Anyone can contract HSV, of which there are two types. During close contact, HSV-1 is transmitted from person to person via infected saliva. HSV-2 is transmitted though infected genital secretions. However, oral-genital contact may cause infection with either type in the oral or genital areas. About 80 percent of all adults in the United States are infected with HSV-1, and about 50 percent of children in the US are infected with HSV-1 by age five. HSV-2 affects approximately 20 percent of the US population.
HSV can infect newborn children (neonatal herpes) in a few ways. A fetus can be infected in utero if a mother who doesn’t have anti-bodies to HSV gets infected during pregnancy (5 to 8 percent of cases); infection may also occur as the infant passes through the birth canal and is exposed to infected secretions (90 percent of cases). The overall risk of neonatal HSV infection is about .03 percent or 1 in 3,000 deliveries.
In highly rare cases, a newborn may contract the infection after birth. HSV-1 can be acquired from exposure to infected family members, friends or hospital personnel. For instance, an older sister who has a skin lesion on her hands and decides to change the diaper of her newly circumcised baby brother might unwittingly infect the infant.
What are the symptoms?
As stated above, infected individuals can spread the disease via oral or genital secretions. To infect another individual, these secretions must come into contact with damaged or broken skin (or mucous membranes). The virus then multiplies at the site of the infection before heading to the spine, where it hibernates and enters a latent phase. At times, a stimulus may provoke it. The virus is then awakened from latency and travels back to the skin where it produces the characteristic skin lesion—a small, fluid-filled skin blister that breaks open, crusts over and then disappears. This virus is responsible for the lesions seen around the mouth, eye and genital areas.
Some people develop lesions around their lips while others never develop signs of infection. Once infected, an individual has HSV for life and can continue to shed the virus intermittently (although this probably declines with old age). Thus, one can be infected and not realize it and can transmit the infection and not know it.
How is it treated?
HSV cold sores in children and adults usually don’t need to be treated; however, there are creams or tablets with anti-viral medication that can be taken to alleviate the symptoms.
HSV in the newborn population
As opposed to the youth and adult populations, newborn HSV infection can be a devastating disease. Newborns nearly always require hospitalization and intravenous antibiotics.
1. In a third of cases, the disease localizes to the skin, eyes or mouth.
2. In a third of cases, the diseases enters the central nervous system. (Thus, HSV can cause encephalitis.)
3. In a third of cases, HSV infects multiple organs (brain, lung, liver, et cetera.)
Babies with widespread infection have the worst prognosis; 60 percent die before their first birthday, regardless of treatment. Nearly 50 percent of babies with herpes encephalitis will have impaired neurological function. Even in babies with localized infection where the mortality rate is zero, 9 percent of infants end up with neurological impairment. Once a baby is infected, one cannot predict if he will develop the worst clinical scenario. Clearly, neonatal HSV infection is not a benign illness.
How is it diagnosed?
HSV can be diagnosed by reliable blood tests. A viral culture can also be taken—that is, a sample from a herpes sore—and sent to the lab for testing. However, a viral culture can be misleading: Even if the result is negative, one could still have herpes since the virus survives in the blister for only a short time.
How is HSV prevented in the newborn?
A pregnant mother can protect her newborn child with her maternal HSV antibody for about six months (providing that the mother’s initial infection didn’t occur during that pregnancy). Hand washing with soap and water before touching a newborn is pivotal. The New York State Department of Health recommends not kissing a baby if one has cold sores on the mouth or lips.
A graduate of Yeshiva University, Dr. Yitzchak Ariel is board certified in internal medicine and infectious diseases. He practices in Manhattan and Brooklyn. He has lectured on this topic for the Association of Orthodox Jewish Scientists.
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