The silent threat of HPV and how to protect yourself

Dr Arlies Chua explains how human papillomavirus spreads, how it can go undetected for years, and why screening and vaccination matter.

Yet, both tested positive for human papillomavirus (HPV).

According to consultant obstetrician and gynaecologist Dr Arlies Chua, HPV may persist without symptoms or become detectable again years after the initial exposure. A positive HPV result, therefore, does not indicate when the infection was acquired or from whom.

“Without screening, you may never know you contracted it,” Chua, 37, told FMT Lifestyle.

HPV is primarily transmitted through intimate skin-to-skin contact during sexual activity, with its types classified as low-risk or high-risk.

This means anyone who has had intimate sexual contact can acquire HPV, even if they have had only one partner. The likelihood increases with a greater number of partners or exposure to a partner who has had previous partners.

According to Chua, her youngest patient to test positive for a high-risk HPV type was a 21-year-old woman.

Those living with HIV or weakened immune systems are more likely to develop persistent HPV infection or HPV-related diseases.

“Although most HPV infections clear or become undetectable, a minority of infections involving high-risk HPV types persist and may cause precancerous cellular changes,” Chua explained.

HPV is associated with cervical, vulval, vaginal, anal, penile and oropharyngeal cancers, among others.

According to the World Health Organization, cervical cancer was the fifth most commonly diagnosed cancer among women worldwide in 2024, with an estimated 604,000 new cases and 280,000 deaths.

Closer to home, the Malaysia National Cancer Registry Report 2017-2021 states that cervical cancer was the sixth most common cancer among women in the country. Some 2,654 cases were recorded, with 47.1% diagnosed at stages three and four.

Screening, Chua stressed, offers a valuable opportunity to detect and treat abnormal cervical cells before they become cancerous.

Cervical screening options include primary HPV testing and cervical cytology, commonly known as a Pap smear. According to Chua, the appropriate test and screening interval depend on a woman’s age, previous results, risk factors and applicable national guidelines.

Having both tests performed at the same time is known as co-testing, “which may be used in selected circumstances but is not necessary for every average-risk woman”, she said.

“If abnormal or precancerous cells are detected, management depends on the severity of the changes. Some low-grade abnormalities may be monitored, while higher-grade lesions may require ablative or excisional treatment, followed by HPV-based testing and/or cervical cytology.”

Ablative treatment destroys the abnormal tissue, while excisional treatment removes it for further examination.

While she generally advises women aged 25 to 65 to undergo cervical screening, Chua said age should not be the only consideration. Screening may be offered earlier to women who became sexually active at a younger age, following an individual assessment of their risk factors.

Women older than 65 who have rarely or never undergone cervical screening, or whose previous history is incomplete, may also benefit from continued testing.

Men, however, do not currently have an approved routine screening test for HPV.

Vaccination, Chua noted, is one of the best ways to prevent HPV. Under Malaysia’s school-based HPV vaccination programme, the vaccine has traditionally been offered to Form One female students.

From this year, Year Six girls – who are generally 12 years old – are also being vaccinated.

Chua supports HPV vaccination from age nine, as recommended internationally, because it provides the greatest benefit when administered before exposure and produces a strong immune response in younger adolescents.

“It prevents infection from the HPV types covered by the vaccine but does not treat an established infection. Vaccinated women should still undergo cervical screening at the recommended age and intervals,” she advised.

She also believes HPV vaccination should not be restricted to girls. “If boys are protected from HPV, it also reduces the risk for girls. I really hope that, in the future, vaccination will be offered to boys as well.”

This shared responsibility further extends to how couples respond to an HPV diagnosis. Chua said common misconceptions include the beliefs that HPV affects only women or that it can be contracted from public toilets.

Some couples, she observed, may blame public facilities because they fear the diagnosis means a partner has been unfaithful.

However, a positive result does not necessarily indicate recent infidelity, as HPV may have been acquired years earlier and only become detectable now. A test, she reiterated, cannot establish when the infection was acquired or from whom.

Chua encourages couples to discuss an HPV diagnosis openly instead of blaming each other. “There is no need to dig into where you got it. Once you have it, what you need to do is face it.

“HPV is more common than you may think. Vaccination, cervical screening at the recommended intervals, and open conversations with your partner are ways to help yourself and your loved ones,” she concluded.