At the root of the issue is the gemara which mentions metzitzahi b'peh but isn't exactly clear if it's a third part to the actual act of the milah or part of the recommended anti-sepsis treatments mentioned after in the care of the penis. Traditionally it has been performed by the mohel pressing his lips to the incision and sucking blood out of it. The gemara says that this is necessary to prevent health complications to the baby but in recent decades it has become clear that at times it can have the opposite effect.
Now I'll state my bias up front. When I was in my final year of medical school this same thing happened to the baby of friends of mine. I got to watch as the poor little infant had a lumbar puncture to ensure that the herpes infection he had contracted hadn't entered his central nervous system. In the aftermath of his uneventful recovery (B"H he's a healthy young man today) terrible things happened to the family when they tried to protest that the mohel had been responsible for transmitting the virus. One thing it did for me was convince me that the traditional method for metzizah b'peh was now no longer the benign, life-saving procedure that it might have been in the times of the Sages.
As a result it seems quite a necessary thing to review how metzizah b'peh is done given that it has now become associated with the spread of a contagious, potentially lethal disease. Unfortunately there are those who view any attempt to begin such a discussion as an all-out assault on circumcision, Torah and Judaism in general.
Rav Zev Farber, writing on Morethodoxy.org has a comprehensive piece that outlines some great compromise positions.
Keeping in mind that the point of circumcision aftercare is to encourage a quick return to health, not introduce deadly viral diseases, some of these options seem to perfectly fit the need to both maintain the traditional place of metzitzah b'peh in bris milah while eliminating the contagious dangers that have come to be associated with it. What's more, these positions have the support of important poskim, not unknown random sources almost never heard of before or isolated positions that have been rejected by normative halacha.
Despite that there has been a backlash against this reasonable approach. It is important not to see this as just another example of some Chareidim fighting to maintain a status quo because they see any change as a wholesale sellout of Judaism. This is not a "We do this because this is how we have always done it" or "We do this because this is only way permitted by halacha". This is an example of some Chareidim fighting to maintain a status quo because they have rejected the idea of change of any kind, the kind of folks who would come out in favour of smoking if YU and YCT announced that it was now assur to do such a thing. (Halevai)
And this case it is even more. These are people who are fighting to maintain a practice that is potentially harmful to infants because in their mind not changing is more important than protecting lives. In their zeal to protect Judaism they have taken a position that violates it and created for themselves a state of denial to avoid realizing it. It seems some of them are even prepared to violate both Jewish and state law just to show their defiance.
Therefore Rav Farber's conclusions seem quite appropriate. It is no longer enough to see direct metzitzah b'peh as a "frummer" version of bris mila but as an inappropriate form of bris mila unacceptable in Torah observant congregations. It's not enough to listen to people talk about how important tradition is and how there's no good evidence that herpes and other diseases can be spread by direct metzitzah b'peh. Instead it has to be pointed out loudly that this is not true and that the Torah value of preventing danger to life trumps slavish adherence to a dangerous form of a procedure that could otherwise be safely performed.
1) The Clean Bill of Health Model
Proposed by R. Dr. Mordechai Halperin, M.D., first in Israel and then in an article in Jewish Action called: “Metzitzah B’peh Controversy: The View from Israel,” the suggestion is to devise a method to ensure that the mohalim who perform meẓiẓah be-peh do not have any illnesses, including sores in the mouth, that can transfer disease. (I have heard that this is the practice in England among mohalim that perform meẓiẓah be-peh.) The mohel would have to go through whatever testing deemed medically necessary to ensure the meẓiẓah is safe, and he would need to constantly renew this clean bill of health. Any mohel without this “license” would be barred from performing meẓiẓah be-peh, and any who did so anyway would be banned from practicing by the community.
Although Halperin’s suggestion is commendable, I am personally uncomfortable with it. Since meẓiẓah be-peh has no medical benefit and no halakhic basis nowadays, I see no reason to continue with a practice that reflects antiquated medicine in such a graphic manner. I feel that doing so, even if it weren’t dangerous, sends the wrong message (this, I hear, is R. Moshe Tendler’s argument as well). Furthermore, I can’t help worrying that even with safeguards, the practice may still pose some threat to the infant; one need only consider the amount of germs and bacteria found in a person’s mouth and the fact that illnesses often come about unexpectedly.
Nevertheless, since there are those that stridently disagree with me and believe meẓiẓah be-peh to be either a halakhic requirement or of paramount qabbalistic significance, I have included the clean-bill-of-health model in the hope that the opposition may at least adopt this, thereby protecting the lives of the infant boys who are otherwise in harm’s way.
2) The Meẓiẓah-Equivalent Model
R. Shlomo Ha-Kohen of Vilna (1828-1905) wrote in a responsum (Binyan Shlomo 2, YD 19) that there is no mitzvah to perform meẓiẓah. Instead, he argued, meẓiẓah should be viewed as part of the general requirement to keep the infant healthy. Therefore, he claims, whatever modern medicine determines to be the best medical practice for keeping the child healthy should be considered the equivalent of meẓiẓah.
According to R. Ha-Kohen, the practice he witnessed in his time period, where the mohel would wrap the penis in rags (smartutin), was the equivalent of meẓiẓah, and that he could not venture to say what the practice would look like in the future. This is because the practice is purely medical and, as he reminds the questioner, he is not a doctor.
Applying Ha-Kohen’s analysis to our times, the modern mohel should sterilize his equipment and use whatever bandages and antibacterial creams are necessary to reduce the risk of infection. In this way he has fulfilled the requirement that is at the root of the – now defunct – requirement to suck out the blood from the wound.
3) The Ritual-Meẓiẓah Model
Some authorities were less comfortable with cancelling the practice altogether, although they were certainly unwilling to risk the lives of Jewish infants to keep it. Hence the idea of a meẓiẓah performed without direct contact between the mohel’s mouth and the infant’s penis was suggested, and two basic forms of this practice were put forward. One idea, advocated by R. Moshe Schreiber (Sofer), known as the Ḥatam Sofer, was to use a sponge around the corona, with the mohel applying (slight) squeezing pressure to remove some blood.
Another method that is popular with a number of Modern Orthodox mohalim today was to use a glass pipet. The mohel would place the pipet upon the wound and suck from the other side, stopping when some blood would come out of the wound. This method was advocated (or at least permitted) by a number of halakhic authorities, such as R. Malkiel Tenenbaum, R. Elyakim Shapiro of Grodno and R. Avraham Kook. It also seems to be the preferred solution of R. Moshe Pirutinsky in his influential compendium, Sefer ha-Brit.