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{{Construction Site}}[[File:Dit del peu gros infectat.jpg|thumb|Infection of an ingrown toenail; there is pus (yellow) and resultant inflammation (redness and swelling around the nail).]]'''Infection''' is invasion of the body by organisms (pathogens) that have the potential to cause disease. They The pathogen may be bacterial, fungal, or viral.<ref>{{REFweb
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Add section.
|url=https://medical-dictionary.thefreedictionary.com/infection
|title=Infection
|publisher=The Free Dictionary
|date=2012
|accessdate=2022-01-08
}}</ref>
The human [[foreskin]] has numerous functions that protect against infection.<ref name="cold-taylor1999">{{ColdCJ TaylorJR 1999}}</ref> Infection is a well-known possible complication of circumcision. [[Circumcised]] males have an increased risk of infection due to loss of the protective functions.
==Circumcision infection==
Neonatal [[circumcision]] is an elective, medically-unnecessary, non-therapeutic [[amputation]] of the healthy [[foreskin]] that is done only after parents sign a [[circumcision consent form]]. It exposes an infant to surgical risks, but does not treat or prevent disease.<ref name="deacon2022">{{REFjournal |last=Deacon |first=Matthew |init=M |author-link= |last2=Muir |first2=Gordon |init2=G |author2-link= |etal=no |title=What is the medical evidence on non-therapeutic child circumcision? |journal= Int J Impot Res |date=2022-01-08 |url=https://www.nature.com/articles/s41443-021-00502-y |pubmedID=34997197 |DOI=10.1038/s41443-021-00502-y |accessdate=2022-02-02}}</ref> Circumcision is a surgical operation and [[amputation]] that creates an open surgical wound on the [[penis]]. [[Rosemary Romberg]] (2021) described infection as a "fairly common complication."<ref name="romberg2021">{{REFbook |last=Romberg |first=Rosemary |init= |author-link=Rosemary Romberg |year=2021 |title=Circumcision — The Painful Dilemma |url=https://circumcisionthepainfuldilemma.wordpress.com/ |work= |editor=[[Ulf Dunkel]] |edition=Second Edition, Revised |volume= |chapter=Infection |scope= |page=266 |pages= |location= |publisher=Kindle |ISBN=23: 979-8683021252 |quote= |accessdate=2023-08-31 |note=}}</ref> The open wound does not heal immediatelyand is exposed to the feces (poop) in the diaper (nappie). For a period of time during and after the surgery it is subject to invasion by a wide variety of bacterial, viral, or fungal pathogens.<ref name="williams1993">{{REFjournal
|last=Williams
|first=
|etal=no
|title=Complications of circumcision
|journal=Brit J Surg
|location=
|DOI=10.1002/bjs.1800801005
|accessdate=2022-01-08
}}</ref> <ref name="krill2011">{{REFjournal |last=Krill |first=Aaron J. |init= |author-link= |last2=Palmer |first2=Lane S. |init2= |author2-link= |last3=Palmer |first3=Jeffrey S. |init3= |author3-link= |etal= |title=Complications of circumcision |trans-title= |language= |journal= ScientificWorldJournal |location= |date=2011-12-26 |volume=11 |issue= |article= |page= |pages=2458-68 |url=https://www.hindawi.com/journals/tswj/2011/373829/ |archived= |quote= |pubmedID=22235177 |pubmedCID=3253617 |DOI=https://doi.org/10.1100/2011/373829 |accessdate=2022-01-28}}</ref> Maternity hospitals gather together newborn infants into a hospital nursery where they are cared for, which increases the risk of passing infection from one to the others. If an infant is compromised by an open surgical wound, then that infant is at greater risk of becoming infected. Male infants in America, where non-therapeutic infant [[circumcision]] remains popular, are more likely to become infected than female infants. ''Staphylococcus aureus'' is a common infection and is worse when a methicillin resistant strain ([https://www.cdc.gov/mrsa/index.html MRSA]) is involved. Thompson et al. (1966) reported a higher risk of ''staphylococcus'' infection in newborn [[circumcised]] males.<ref name="thompson1966">{{REFjournal |last=Thompson |first= |init=DJ |author-link= |last2=Gezon |first2= |init2=HM |author2-link= |last3=Rogers |first3= |init3=KD |author3-link= |last4=Yee |first4= |init4=RB |author4-link= |last5=Hatch |first5= |init5=TF |author5-link= |etal=no |title=Excess risk of staphylococcus infection and disease in newborn males. |journal=Am J Epidemiol |location= |date=1966-09 |volume=84 |issue=2 |article= |page= |pages=314-28 |url=http://www.cirp.org/library/complications/thompson1965/ |archived= |quote= |pubmedID=5917608 |pubmedCID= |DOI=10.1093/oxfordjournals.aje.a120645 |accessdate=2022-01-09}}</ref> Nelson et al. (1976) reported a prolonged case of hospital nursery infection in which the pathogen was ''streptococcus''.<ref name="nelson1976">{{REFjournal |last=Nelson |first=JD |init= |author-link= |last2=Dillon, Jr. |first2= |init2=HC |author2-link= |last3=Howard |first3=JB |init3= |author3-link= |etal=no |title=A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus |journal=J Pediatr |location= |date=1976-11 |volume=89 |issue=5 |article= |page= |pages=792-6 |url=http://www.cirp.org/library/complications/nelson1/ |pubmedID=789841 |pubmedCID= |DOI=10.1016/s0022-3476(76)80809-8 |accessdate=2022-01-10}}</ref> [[Robert S. Van Howe|Van Howe]] & Robson (2007) examined reports of three outbreaks of community-associated methicillin-resistant ''Staphylococcus aureus'' (CA-MRSA) in American maternity hospital nurseries. They found that boys, with 73 percent of the cases, are at greater risk due to the prevalence of non-therapeutic [[circumcision]]. The authors, observed that CA-MRSA can progress to bacteremia, osteomyelitis, pyelonephritis, perinephric abscess, lung abscess, empyema, [[shock]], and [[death]]. They suggested minimizing newborn circumcisions to reduce the risk of infection.<ref name="vanhowe2007">{{REFjournal |last=Van Howe |first=Robert S. |init=RS |author-link=Robert S. Van Howe |last2=Robson |first2=Wm. Lane M. |init2=LM |author2-link= |etal=yes |title=The Possible Role of Circumcision in Newborn Outbreaks of Community-Associated Methicillin-Resistant ''Staphylococcal aureus'' |journal=Clin Pediatr |location= |date=2007 |volume=46 |issue=4 |article= |page= |pages=356-8 |url=https://www.researchgate.net/profile/Robert-Van-Howe/publication/6354204_The_Possible_Role_of_Circumcision_in_Newborn_Outbreaks_of_Community-Associated_Methicillin-Resistant_Staphylococcus_aureus/links/004635367c240d30cf000000/The-Possible-Role-of-Circumcision-in-Newborn-Outbreaks-of-Community-Associated-Methicillin-Resistant-Staphylococcus-aureus.pdf |archived= |quote= |pubmedID=17475996 |pubmedCID= |DOI=10.1177/0009922806294847. |accessdate=2022-01-14}}</ref> Infant non-therapeutic circumcisions do not cure disease and do not contribute to health. When infection occurs after a [[circumcision]] performed by a physician, then it may be considered to be [[iatrogenic]] as the infection would not have occurred if the circumcision had not been performed. In cases of [[adolescent and adult circumcision| adult circumcision]], erections may cause [[wound dehiscence]] (splitting open of the surgical wound) thereby increasing the risk of infection.<ref name="kaplan1983">{{REFjournal
|last=Kaplan
|first=George W.
|init=GW |author-link=George W. Kaplan
|title=Complications of circumcision
|journal=Urol Clin N Amer
===Case reports===
Rosenstein (1941) reported cases a case of diphtheria infection in the [[circumcision ]] wound of a three-year-old child who died on the eighth dayafter surgery.<ref name="rosenstein1941">{{REFjournal
|last=Rosenstein
|init=JL
|pages=657-8
|accessdate=2022-01-09
}}</ref>
Sauer (1943) reported a case of staphylococcus bronchopneumonia following infant circumcision in which [[death]] occurred on the 18th day of life.<ref name="sauer1943">{{REFjournal
|last=Sauer
|init=LW
|author-link=
|url=http://www.cirp.org/library/death/sauer1/
|title=Fatal staphylococcus bronchopneumonia following ritual circumcision
|journal=Am J Obstetr Gynecol
|date=1943
|volume=46
|issue=
|pages=583
|accessdate=2022-01-10
}}</ref>
Kirkpatrick & Eitzman (1974) reported two cases of septicemia (infection in the blood) after non-therapeutic neonatal circumcision in which the patients almost died.<ref name="kirkpatrick1974">{{REFjournal
|last=Kirkpatrick
|first=
|init=BV
|author-link=
|last2=Eitzman
|first2=
|init2=DV
|author2-link=
|etal=no
|title=Neonatal septicemia after circumcision
|trans-title=
|language=
|journal=Clin Pediatr
|location=
|date=1974-09
|volume=19
|issue=9
|article=
|page=
|pages=767-8
|url=http://www.cirp.org/library/complications/kirkpatrick1/
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|pubmedID=4414788
|pubmedCID=
|DOI=10.1177/000992287401300914
|accessdate=2022-01-10
}}</ref>
Meningitis is a serious inflammation of the meninges, the thin, membranous covering of the brain and the spinal cord. Meningitis is most commonly caused by infection (by bacteria, viruses, or fungi).<ref>{{REFweb
|url=https://medical-dictionary.thefreedictionary.com/meningitis
|archived=
|title=Meningitis
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|publisher=The Free Dictionary
|website=
|date=2008
|accessdate=2022-01-12
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}}</ref> Scurlock & Pemberton (1977) reported on four cases of meningitis which started with an infected circumcision wound that proceeded to septicemia and meningitis. One of the four patients died.<ref name="scurlock1977>{{REFjournal
|last=Scurlock
|first=
|init=JM
|author-link=
|last2=Pemberton
|first2=
|init2=PJ
|author2-link=
|etal=no
|title=Neonatal meningitis and circumcision.
|trans-title=
|language=
|journal=Med J Aust
|location=
|date=1977-03-05
|volume=1
|issue=10
|article=
|page=
|pages=332-4
|url=http://www.cirp.org/library/complications/scurlock1/
|archived=
|quote=
|pubmedID=323660
|pubmedCID=
|DOI=10.5694/j.1326-5377.1977.tb76718.x
|accessdate=2022-01-12
}}</ref>
Ritter's disease is now called ''Staphylococcal scalded skin syndrome''' (SSSS). It is caused by infection with ''Staphylococcus aureus'' bacteria. The infection causes large sections of skin to peel away as occurs after burns.<ref>{{REFweb
|url=https://medical-dictionary.thefreedictionary.com/Ritter%27s+disease
|archived=
|title=Ritter's disese
|trans-title=
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|last=
|first=
|author-link=
|publisher=The Free Dictionary
|website=
|date=2002
|accessdate=2022-01-13
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|quote=
}}</ref> Annuziato & Goldblum (1978) reported three cases of SSSS, which started with infected circumcision wounds. [[Death]] occurred with one case but the other two recovered.<ref name="annunziato1978">{{REFjournal
|last=Annunziato
|first=
|init=D
|author-link=
|last2=Goldblum
|first2=
|init2=LM
|author2-link=
|etal=no
|title=Staphylococcal scalded skin syndrome. A complication of circumcision
|trans-title=
|language=
|journal=Am J Dis Child
|location=
|date=1978-12
|volume=132
|issue=12
|article=
|page=
|pages=1187-8
|url=http://www.cirp.org/library/complications/annunziato1/
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|pubmedID=717333
|pubmedCID=
|DOI=10.1001/archpedi.1978.02120370035008
|accessdate=2022-01-13
}}</ref>
Cleary & Kohl (1979) reported the case of a six-week old infant boy who was circumcised in his mother's physician's office. Infection with streptococcus developed. The boy was hospitalized, but even with the best of antibiotic and other treatment, [[death]] resulted. The authors stated:
<blockquote>
Significant infection is rarely solely attributed to circumcision because a clear-cut cause and effect relationship is difficult to establish. There have been reports of newborns5-7 who have been circumcised and then developed life threatening infection within several days of this procedure. However, the fact that in these infants infection has occurred at an age when the incidence of infection is high due to other factors complicates interpretation of these reports.<ref name="cleary1979">{{REFjournal
|last=Cleary
|first=
|init=
|author-link=
|last2=Kohl
|first2=
|init2=
|author2-link=
|etal=no
|title=Overwhelming infection with group B beta-hemolytic streptococcus associated with circumcision
|trans-title=
|language=
|journal=Pediatrics
|location=
|date=1979-09
|volume=64
|issue=3
|article=
|page=
|pages=301-3
|url=http://www.cirp.org/library/complications/cleary/
|archived=
|quote=
|pubmedID=481971
|pubmedCID=
|DOI=
|accessdate=2022-01-13
}}</ref></blockquote>
Woodside (1980) reported the case of an infant boy who was circumcised with the Plastibell device. He developed necrotizing fasciitis after his non-therapeutic circumcision. His treatment required extensive debridement of tissue. The boy apparently survived.<ref>{{REFjournal
|last=Woodside
|first=Jeffrey R.
|init=
|author-link=
|etal=no
|title=Necrotizing fasciitis after neonatal circumcision
|trans-title=
|language=
|journal=Am J Dis Child
|location=
|date=1980-03
|volume=134
|issue=3
|article=
|page=
|pages=301-2
|url=http://www.cirp.org/library/complications/woodside2/
|archived=
|quote=
|pubmedID=6444778
|pubmedCID=
|DOI=10.1001/archpedi.1980.02130150055015
|accessdate=2021-01-11
}}</ref>
Curran & Al-Salihi (1980) reported an outbreak of staphylococcal scalded skin syndrome (SSSS) at the Margaret Hague Maternity Hospital in Jersey City, New Jersey. The outbreak affected 68 newborns over a 115 day period. The male to female ratio was 5.5 to one, which clearly indicated that the circumcision wound in boys was the entry point for the infection in most cases. The infants had generalized exfoliative disease with loses of large patches of skin. No deaths were reported.<ref name="curran1980">{{REFjournal
|last=Curran
|first=
|init=JP
|author-link=
|last2=Al-Salahi
|first2=
|init2=FL
|author2-link=
|etal=no
|title=Neonatal staphylococcal scalded skin syndrome: massive outbreak due to an unusual phage type
|trans-title=
|language=
|journal=Pediatrics
|location=
|date=1980-08
|volume=66
|issue=2
|article=
|page=
|pages=285-90
|url=http://www.cirp.org/library/complications/curran1/
|archived=
|quote=
|pubmedID=6447271
|pubmedCID=
|DOI=
|accessdate=2022-01-13
}}</ref>
Necrotizing fasciitis is a life-threatening skin infection.<ref>{{REFweb
|url=https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html
|archived=
|title=Necrotizing Fasciitis: All You Need to Know
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=Centers for Disease Control and Prevention
|website=
|date=2019-12-31
|accessdate=2022-01-14
|format=
|quote=
}}</ref> Bliss et al. (1997) reported two cases of necrotizing fasciitis after non-therapeutic infant [[circumcision]] with the Plastibell device. Extensive aggressive debridement of infected necrotic tissue was required.<ref name="bliss1997">{{REFjournal
|last=Bliss
|first=
|init=DP
|author-link=
|last2=Healey
|first2=
|init2=PJ
|author2-link=
|last3=Waldhausen
|first3=
|init3=JH
|author3-link=
|etal=no
|title=Necrotizing fasciitis after Plastibell circumcision
|trans-title=
|language=
|journal= J Pediatr
|location=
|date=1997-09
|volume=131
|issue=3
|article=
|page=
|pages=459-62
|url=http://www.cirp.org/library/complications/bliss/
|archived=
|quote=
|pubmedID=9329429
|pubmedCID=
|DOI=10.1016/s0022-3476(97)80078-9
|accessdate=2022-01-14
}}</ref>
==Ritual circumcision==
Professor [[L. Emmett Holt]] (1913) reported 41 cases of tuberculosis in ritually [[circumcised ]] boys who had been infected by tubercular [[Mohel| mohels]], of whom 16 had died at the time of writing.<ref>{{REFjournal
|last=Holt
|init=LE
|pages=99-102
|accessdate=2022-1-8
}}</ref> More recently, cases of infection of baby boys with herpes simplex have been reported. One death and brain damage in another has occurred.<ref name="frieden2005">{{REFdocument
|title=An open letter to the Jewish Community from the New York City Health Commissioner
|url=https://web.archive.org/web/20061214110055/http://www.nyc.gov/html/doh/downloads/pdf/std/std-bris-commishletter.pdf
|url=http://adc.bmj.com/cgi/content/abstract/adc.2008.144063v1
}}</ref>
==Treatment==
The usual treatment of infection is with antibiotics.
{{SEEALSO}}
* [[Jacob Sweet]]
{{LINKS}}
* {{REFweb
|url=https://www.doctorsopposingcircumcision.org/for-professionals/complications/#anchor-03
|archived=
|title=Infection
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=[[Doctors Opposing Circumcision (D.O.C.)]]
|website=
|date=2016
|accessdate=2022-01-15
|format=
|quote=
}}
{{REF}}
[[Category:TermMedical term]]
[[Category:Circumcision complication]]
[[Category:Parental information]]
[[de:Infektion]]