HPV is one of the most common viral infections worldwide, yet it remains widely misunderstood. Many people are told that it will “clear on its own”, but few receive clear explanations about what that means in real life, why it sometimes does not happen, or how to interpret a positive test result.

As HPV screening becomes more widespread, more individuals are left with questions about cancer risk, immune health, relationships, and long‑term follow‑up — often with limited guidance beyond being told to wait for the next test.

This exclusive interview by PP Health Malaysia (PPHM) features Dr Hoo Mei Lin, Consultant Obstetrician, Gynaecologist & Fertility Specialist at Sunway Hospital, who shares practical insights drawn from her real‑world clinical experience.

This interview was facilitated by BREGO Life Sciences as part of an ongoing public education initiative on HPV screening and follow‑up pathways. BREGO Life Sciences is a Malaysia‑based healthcare company that works with clinicians and teaching institutions to advance patient‑centred, evidence‑based solutions across women’s health, musculoskeletal care, and related therapeutic areas. The doctor’s responses are provided independently and are intended for general educational purposes.

Education is key. I tell my patients that HPV is extremely common and 80% of sexually active people would have been exposed at some point in their lives. A positive HPV result does not mean someone has done something wrong, nor does it imply promiscuity or infidelity. The virus can remain silent for many years meaning exposure could have occurred decades before detection.  We need to treat HPV as a common virus associated with normal human intimacy to end the stigma — Dr Hoo Mei Lin

The discussion explores why HPV can persist or reappear years after initial exposure, how HPV and cervical screening results should be interpreted, the role of immune health, and the emotional impact an HPV diagnosis can have on patients and their relationships.

It also examines where current screening and follow‑up pathways serve patients well, where gaps remain, and why education, vaccination, and informed monitoring are essential to reducing HPV‑related cancers in both women and men.

Nearly 1,000 women die from cervical cancer in Malaysia each year, despite it being largely preventable. About 1,740 new cases are diagnosed annually, and between 2017 and 2021, half of affected women were diagnosed at advanced stages, when treatment is less effective. More than 95% of cases are caused by persistent infection with human papillomavirus (HPV), especially high‑risk strains such as HPV‑16 and HPV‑18. Regular screening and HPV vaccination can prevent most cases, showing that these deaths reflect gaps in information, access, and early detection rather than limits of modern medicine.

PP Health Malaysia (PPHM) asked Dr Hoo Mei Lin the following questions;

Q: Most people are told that HPV “clears on its own”. When it does not, what are the most common reasons you see in practice?

A: The most common reasons we see in practice relate to how the immune system interacts with the virus. Smoking, chronic stress, poor sleep, nutritional deficiencies, and medical conditions that weaken immunity can all make it harder for the body to clear HPV. 

Q: In your experience, are there early signs that abnormal cervical cells are more likely to progress rather than resolve on their own?

A: The persistence of HPV and the type of HPV that is present are 2 factors that we consider.  It is important to note that these changes usually occur gradually over many years, which is why regular screening is so effective — it allows doctors to detect and treat precancerous changes long before cancer develops.

Q: How reliable are HPV test results in predicting future cancer risk, and how should patients interpret a positive or negative result?

A: A negative HPV test is very reassuring, because it means the risk of developing cervical cancer in the next several years is extremely low. A positive HPV test does not mean someone has cancer, and in most cases, it does not even mean cancer will develop. It simply indicates that a virus known to be associated with cervical cancer is present. This helps doctors decide who needs closer monitoring. Many women who test positive will clear the infection naturally over time.

Q: Can HPV remain inactive for many years and then become detectable later? Why does this happen?

A: HPV can enter the cells lining the cervix and remain inactive for many years. In most people, the immune system suppresses the virus so effectively that it stops actively multiplying. When this happens, the amount of virus becomes so small that it may no longer be detected on screening tests, even though tiny amounts of the virus may still be present in the cells. Later on, if the immune system becomes less effective or if conditions in the cervix change, the virus may start multiplying again and become detectable on a test. This is why HPV can sometimes appear years after the original exposure. Because of this, a positive HPV test does not necessarily mean a recent infection. It may simply reflect the natural pattern of a very common virus that can remain quiet in the body for a long time before becoming detectable again. 

Q: How does HPV affect men differently from women, and which risks in men tend to be overlooked or misunderstood?

A: HPV affects both men and women, but the health consequences are often discussed more in women because of its association with cervical cancer. In men, HPV can cause genital warts and is increasingly linked to anal, penile and oropharyngeal (head and neck) cancers. Oropharyngeal cancers related to HPV are actually rising in many countries. One challenge is that there is no routine HPV screening test for men, so infections often go unnoticed. This is why vaccination for both boys and girls is so important in reducing transmission.

Q: Many patients try to “boost their immune system” to clear HPV. Which lifestyle changes genuinely help, and which are commonly overstated or unsupported?

A: Boosting and maintaining a healthy immune system plays an important role in clearing HPV. Lifestyle changes that help include stopping smoking, a healthy balanced diet rich in fruits and vegetables, regular physical activity, reducing stress. In addition, limiting the number of sexual partners can reduce exposure to new HPV strains, which may help lower the overall risk of persistent infection. 

Q: Is acquiring HPV multiple times more concerning than having one long‑term persistent infection?

A: In terms of cancer risk, persistent infection with the same high-risk HPV type is generally more concerning than acquiring HPV multiple times. Persistence is most associated with progression to abnormal cells. Repeated exposure to different HPV types can happen because the virus is very common. However, most new infections still clear naturally.

Q: HPV diagnoses often cause anxiety, shame, or relationship stress. How do you approach these conversations with patients?

A: Education is key. I tell my patients that HPV is extremely common and 80% of sexually active people would have been exposed at some point in their lives. A positive HPV result does not mean someone has done something wrong, nor does it imply promiscuity or infidelity. The virus can remain silent for many years meaning exposure could have occurred decades before detection.  We need to treat HPV as a common virus associated with normal human intimacy to end the stigma.

Q: Based on your real‑world experience, are there aspects of current HPV screening or follow‑up guidelines that you feel do not fully serve patients?

A: The anxiety caused by a positive HPV result is not addressed, especially when patients feel they are told to simply “wait and repeat the test later.” Many patients want to know if there are supportive measures they can take during this period. There are clinically studied vaginal gels available in the market now that can help to support cervical epithelial healing and improve the local cervical environment while the body clears the virus in women with low grade lesions or with HPV presence without cell changes. Clear communication and patient education are essential so patients understand why monitoring is recommended and repeat testing is crucial to enable early detection of cell changes.

Q: What major questions about HPV remain unanswered, and why are they important for future patient care?

A: Why do some people clear the virus quickly while others develop persistent infection?

What factors trigger the reactivation of dormant HPV years later? 

There are theories but no definitive answer.  This uncertainty and fear make it difficult to reassure our patients.

Q: How effective is the HPV vaccine in real‑world use, and what should people understand about what “protection” truly means?

A: HPV vaccination has been one of the most successful cancer prevention strategies developed in recent decades. Studies from countries with high vaccination rates have shown dramatic reductions in HPV infections, genital warts, and precancerous cervical changes. The vaccine protects against the HPV types responsible for around 90% of cervical cancers.  

The 9-valent HPV vaccine protects against 9 types of HPV that together cause approximately:

~90% of cervical cancers

~90% of anal cancers

~90% of HPV-related oropharyngeal cancers

~90% of genital warts

~80–90% of vaginal and vulvar cancers

However, vaccination does not eliminate all HPV risk (as it does not cover all high risk HPV types). Vaccinated women should still undergo regular cervical screening.  HPV is not a woman problem, it is a human problem. We should vaccinate both boys and girls.

The medical information from this interview is contributed by Dr. Hoo Mei Lin, Consultant Obstetrician, Gynaecologist & Fertility Specialist at Sunway Hospital.