Warts and Herpes:
A Tale Of Two Sexually Transmitted Diseases
We are in the midst of a worldwide epidemic of sexually transmitted diseases. At
least two of its major diseases are helped by psychological techniques: twenty-six
to thirty-one million Americans have genital herpes; forty to fifty million
Americans have venereal warts.
We must carefully distinguish between having either the virus and having the
symptoms. The both creepy and reassuring reality is that we all swim in a sea of
viruses not only outside us but within us. If you have ever had chicken pox,
mononucleosis, or other such diseases, the virus is now in your body. Usually
its presence has no impact. Although recent figures are lower, at one time as
many as 90 percent of Americans had the herpes virus for cold sores in their
bodies. Perhaps two-thirds of the people who have the possibility of genital
herpes have had one or several outbreaks but do not have subsequent symptoms.
Warts are caused by forty or fifty variants of the human papilloma virus (HPV).
While its story is not as clear as herpes, a vast percentage of the world
population has had a wart at some time. A British study found that 16.2 percent
of schoolchildren had active warts (it is not clear how many had the virus in
their bodies but not active). As many as 30 percent of American women may have
the virus for venereal warts within their bodies.
Here enters the immune system. Its job is to maintain law and order. When it is
functioning well, all of these microscopic predators are kept in their place. It
puts an end to herpes recurrences and often produces the spontaneous remission
of warts. The emerging field of psychoneuroimmunology studies the impact of
psychological factors on the immune system's ability to function effectively.
Preventing transmission and knowing what to say to sexual partners require both
specific information and personal judgment. The guidelines are being updated as
new research comes in, so consult your health care provider. The key to avoiding
transmission is having the partner avoid contact with affected skin when the
virus is present. Condoms are effective if they cover the affected area, and
nonoxynol-9 spermicides also kill the virus.
A common rule for genital herpes was to avoid intercourse or other contact with
the affected skin from the start of the prodrome (tingling, muscle aches, or
other indications of a coming recurrence) until two days after the healing of
sores. This has been complicated by a growing awareness of the role of
asymptomatic transmission?that is, transmission with no visible sores. It is not
clear how common this is. One study concluded that it is quite rare yet another
called it the major source of transmission. The danger of asymptomatic
transmission appears to diminish sharply after the first six months. The clear
message is that there is no clear message.
Venereal warts present similar ambiguities. Warts seem to differ in their
incubation periods (how long after exposure you see them) and the presence of
virus after apparent clearing. One rule of thumb is to consider the virus as
possibly transmissible for six months after possible exposure and for the same
time period after visible symptoms have gone away.
Let's first cover some of the common non solutions to these ambiguities:
'Official or unofficial self-imposed celibacy: Avoid all encounters, flee
when sex is on the horizon, or just don't ever find anyone who turns you on.
'Limit yourself to a series of casual sexual partners, telling yourself that
they don't need to know.
'Only get involved with people whom you don't care about being rejected by.
'Find someone who is comfortable with the problem and stay with him or her, even
if you know the relationship is going nowhere.
Whom do you tell, what, when, and how? What information do you owe to a new
lover? Does using a condom change things? What if your herpes or warts are not
on the scene this week, this month, this year, this decade? These intensely
personal questions cannot be answered by formula or appeal to authority. Only you
can make the decision.
What I do offer as a guideline is one of the oldest approaches to moral
dilemmas: "Do unto others as you would have them do unto you" Imagine
that your positions were reversed; that your sexual partner was the one weighing
what to say and do. Consider each of the options with them in your shoes and
then act accordingly.
The Herpes Resource Center newsletter, The helper (Summer 1987), suggests
ways to make telling a partner easier:
'Try and develop a positive, self-accepting attitude toward the problem. (You
can't ask someone to accept something you haven't accepted yourself.)
'See the affirmative side of sharing this information. Remember, you are clearly
exhibiting trust in a new (or prospective) partner. That is the first step
'Be well-informed. The ability to answer your partner's questions thoroughly
goes a long way toward building mutual confidence.
'Use outside information sources. They can reinforce information and offset fear
'Try to avoid predicting or presuming a partner's reaction. To assume that he or
she will necessarily be upset can be a self-fulfilling prophecy.
Another good rule of thumb is to pick a low-key, neutral, nonsexual time and
place to raise the issue.
Both herpes and warts introduce extra complications in pregnancy. Neither of the
most useful drugs, acyclovir for herpes or podophyllum for warts, are approved
for pregnant women. Extra precautions are important to protect the baby from the
virus. The suspected link between herpes and cervical cancer has not been
supported. The links between genital and anal cancers and warts appear to be
All forms of warts and herpes raise the question of transmission from one part
of your body to another (autoinoculation). This is fairly hard to do, so while
it is important to exercise good hygiene, don't drive yourself crazy about it.
Ocular herpes does exist and is the most common infectious cause of blindness,
but it is rare and virtually never is transmitted from oral or genital
recurrences. Precautions: don't touch your eyes after touching active sores; don't
put contact lenses in your mouth if you have a cold sore, are worth observing
Increasing evidence suggests that any condition that produces breaks in the skin
of the genitals can increase vulnerability to any other sexually transmitted
diseases, including AIDS. Because herpes is a fast-spreading disease
involving the genitals and is recurrent, its psychological impact can be
devastating. In a survey conducted by the Herpes Resource Center,84 percent of
people with herpes reported depression, and 42 percent deep depression; 25
percent said they had self-destructive feelings; 35 percent reported diminished
sexual drive and 10 percent withdrew totally from sexual involvements; and 70
percent reported a sense of isolation. Work performance suffered for 40 percent.
Such turmoil may markedly turn the course of the disease for the worse.
Depression and other emotional upsets may impair the immune system that
otherwise keeps the virus in check.
Anxiety about recurrences may trigger what is feared? a phenomenon I call "avalanching."
When a Time cover story about herpes appeared, it aroused shame, anger,
and anxiety in people with the disease? and a number of my patients suffered
recurrences as a result.
Knowing that emotional turmoil triggers recurrences, people will unjustly
torment themselves for feeling tormented. Similarly, people need to identify and
reverse agglomeration, blaming the disease for everything wrong with
their lives, including sexual problems, depression, and social withdrawal, that
they may have needed help with even before they got herpes.
Not everyone with herpes reacts the same way, of course: like any disease,
it affects you most strongly where you're most vulnerable? your emotional
Achilles heel. The disease gets tangled up with unresolved issues that have lain
beneath the surface since childhood, creating a double dose of turmoil.
It is vital to ask yourself what the symptom is doing for you as well as to
you. I can cite many instances where recurrences played the role of sexual
policeman, inflicted self-punishment, or resolved conflicts. A twenty-eight-year-old
artist wanted to become a father, for example, but suffered a recurrence
whenever his wife was fertile: clearly, the virus was acting on behalf of his
doubts about parenthood. A twenty-six-year-old computer executive who harbored
deep fears of intimacy endured recurrences whenever he met a woman who
threatened to engage his affections by exciting him both sexually and
emotionally. A religious forty-two-year-old advertising executive found herself
drifting into an affair with a married man; she felt torn between passion and
principle, until her herpes resolved her dilemma.
Venereal warts also often play the role of sexual policeman. They orchestrated
one patient's ambivalence between his wife and girlfriend: whenever he was ready
to return home, warts on his penis flared up and made his wife reluctant to take
him back. With the hypnotic suggestion that he handle the situation directly,
the warts vanished within three weeks. A twenty-seven-year-old insurance
adjuster suffered from anal warts and a fear of anal intercourse. Once he
accepted the fact that he was in control--no one would subject him to anal rape
so the warts were unnecessary--they vanished in two sessions.
Our understanding of psychological treatment of genital herpes and venereal
warts has been helped by research on the nonsexually transmitted versions going
back to the 1920s. The viruses' responsiveness had been staked out well before
the sexually transmitted versions ever reached epidemic proportion.
Biological factors help determine why some people never have herpes recurrences
or warts while others have them ceaselessly. Different variants of the virus
seem to be more prone to create symptoms and to be better adapted to thriving in
one or another body part. For many people, emotional factors are critical in
determining the frequency and severity of recurrences.
In 1928, two Viennese physicians didn't stop with using hypnosis to alleviate
oral herpes symptoms. They also demonstrated that hypnotic suggestions could
experimentally trigger recurrences.
More reports appeared sporadically for the next fifty years. Then in 1981 at the
University of Bologna, Arone Di Bertolino used hypnosis for nine patients who
suffered genital herpes recurrences weekly or bimonthly. One and a half months
after treatment, six had no recurrences, three only one or two.
Early successful treatments of nonvenereal warts also date back to Europe in the
late twenties. The best controlled experimental demonstration of hypnotic
treatment of nonvenereal warts was done here in Boston in 1973.8 After five
weekly hypnotic sessions, 53 percent of patients were wart-free. The untreated
control group was unchanged.
A later study tried to pin down the "active ingredients" and
predictive factors in hypnotic wart treatment. As well as confirming the
effectiveness of hypnotic and self-hypnotic treatment, the study found that the
ability to form specific images vividly was more important than general measures
of hypnotic ability. Interestingly, people with more warts got better results. I
have found common warts to be the most responsive of all the problems that
people bring. They often arise at times of developmental challenges, transitions,
or blocks. Quite often people become able not only to make their warts disappear
but simultaneously to get their lives back into gear.
Nonsexual warts are probably the best researched and accepted application of the
techniques in all of dermatology, so it is puzzling that almost nothing is being
done to apply this to people with venereal warts. The two clinical reports that
have been published are very promising. I have had good results with the few
people who have come in, but there is some block in the minds of both physicians
Most people are looking for their warts or herpes to go away first, but real
gains can be made on other levels, too. I think of genital herpes as three
diseases: medical herpes, an infection caused by a virus; psychological
herpes, the emotional impact of the disease; and media herpes, the
burden of being a central player in a modern morality play, complete with the
wages of sin, lepers and whores, and scarlet letters.
A graphic demonstration of the pain of media and psychological herpes versus
medical herpes was provided by a woman in my group who had been infected some
years earlier. She had always dismissed the misdiagnosed outbreaks as a
nondescript, vague annoyance, but from the moment her herpes was correctly
diagnosed, she was plunged into turmoil and anguish.
Most people with venereal warts have to grapple mainly with the medical and
psychological versions, but especially in the era of AIDS, any sexually
transmitted condition can come with the extra baggage of fear and shame.
At the writing of this second edition, some of the herpes hysteria has settled
down, but it is not entirely clear that this has translated into a lessened
impact on individuals. I frequently hear, "I know I shouldn't be feeling so
upset about my herpes; after all, it's not a big deal medically and it isn't
AIDS." So now they suffer a double dose: they're not only upset about the
herpes but also because they "shouldn't" be so upset.
Support and mutual help groups have become an established approach for helping
people with genital herpes The Herpes Resource Center actively supports research
with direct support and congressional lobbying, it maintains a hot line, it
publishes The helper, an excellent newsletter, and it supports local help
groups and educational conferences.
There are now similar support groups for those afflicted with venereal warts.
The legal implications of sexually transmitted diseases are developing
rapidly. In some states, it is a criminal offense to transmit a sexually
transmitted disease (STD). A growing number of people have successfully sued the
person who infected them without informing them of the possible risk. This is a
very complicated matter legally, psychologically, and sociologically. I served
as an expert witness in a case that was successfully settled out of court. While
each instance needs to be examined individually, I came away convinced that
there are instances in which legal action, although quite demanding emotionally,
is ultimately therapeutic.
Two of your reasons for hesitation may be smaller obstacles than you imagine:
the case can be "sealed," with proceedings behind closed doors, and
your name not be used. You may imagine that your mental state either before or
after transmission, could be used to make you look bad. Quite the contrary, your
present turmoil may well be part of the damages for which you should be
compensated. If you were in rough shape before transmission that also may help
your case. The legal doctrine of the "eggshell plaintiff" states
clearly that damages resulting from preexisting vulnerability deserve
compensation. You were who you were at the time and that is no excuse.
No news is all good or all bad. We've looked at possible advantages of sexually
transmitted skin problems like the "sexual policeman." These are ironic
advantages: they give us things we may feel we need but are better off
without. There are also other more straightforward advantages. Certainly few
would argue that they are actually worth the aggravation of having the problem;
think of them more as a compensation or partial payback. Here are some in the
words of the people who discovered them:
'"I'd probably still be doing the bar scene if my STD hadn't brought me up
short and forced me to look at what I was running from."
'"When we couldn't have intercourse, my husband and I discovered a whole
wealth of sexual activities and subtleties that we'd lost."
'"I am now a better human being, more open, compassionate, caring, and
honest. Looking back, I used to be a real shit."
'"I'm much more in touch with my body's needs than I ever was before I got
it. 'Stress control'' used to be just a Yuppie cliché. No more."
'"It forced me to learn to talk honestly about sex, and that ability has
carried over to other areas."
'"Getting herpes heightened my self-hatred to the point that I had to
get into psychotherapy. It changed my life."
Tuning in to the upside (without whitewashing the downside) may increase your
body's ability to handle viruses. Silver linked active coping (versus
resignation or wishful thinking) to improved outcome for people with ten or more
herpes recurrences a year. Kemeny and associates linked depression, fewer
suppressor T cells, and more frequent herpes recurrences.
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