A costly covenant: ritual circumcision and urinary tract infection

Isr Med Assoc J. 2010 May;12(5):262-5.


Background: Ritual circumcision in neonates may cause a urinary tract infection within 2 weeks of the procedure.

Objectives: To evaluate the prevalence of urinary tract infection among Jewish male circumcised neonates < or = 28 days old) evaluated for fever in the emergency room.

Methods: All available medical records of neonates presenting to the pediatric emergency room for evaluation of fever over a 10 year period were reviewed. Data included gender, ethnic background, age (in days) on presentation to the emergency room, age (in days) when circumcision was performed (in males > or = 8 days of age), and results of urine, blood and cerebrospinal fluid cultures. Families of males older than 8 days of age who had a UTI were contacted by telephone to verify the circumcision status when the infant presented to the ER, to ascertain whether the circumcision had been performed ritually by a mohel* or by a physician, and, if not recorded in the chart, to verify the day of life on which circumcision was performed.

Results: Among neonates older than 8 days of age, 60 (24.7%) of the 243 febrile Jewish males had a UTI, as compared to 12 (8.4%) of 143 females (P < 0.0001). In 39 of 54 male neonates (72%) for whom circumcision was performed ritually on the eighth day of life, UTI occurred within 9 days of the circumcision. For females, there was no such clustering of UTI cases in the second week of life, nor during any other time period.

Conclusions: Febrile male neonates who have undergone ritual circumcision have a high prevalence of UTI and must be evaluated and treated accordingly.

MeSH terms

  • Causality
  • Ceremonial Behavior*
  • Circumcision, Male / adverse effects*
  • Circumcision, Male / methods
  • Circumcision, Male / statistics & numerical data*
  • Female
  • Fever / epidemiology
  • Humans
  • Infant, Newborn
  • Israel
  • Jews / statistics & numerical data*
  • Male
  • Postoperative Complications / epidemiology*
  • Prevalence
  • Urinary Tract Infections / epidemiology*
  • Urinary Tract Infections / etiology