Prevention starts with screening
Three questions every woman should ask her doctor when receiving a HPV-positive result
By Dr Jamil Omar
At this stage, instead of asking, “Why did this happen?”, a more helpful approach is to ask three practical questions that restore clarity and control:
1.“Based on my results, what is my actual risk now — and what is the next step?” – Not every HPV infection is dangerous, and not every abnormal result means cancer. Your doctor should be able to explain clearly whether your risk is low, moderate, or high — and what the specific plan is moving forward. Certainly, it will reduce fear.
2.“Has the virus cleared, and how will we monitor it?” – After treatment such as LLETZ or LEEP, most women are effectively cured. The key marker of long-term safety is whether the HPV infection clears. A negative follow-up HPV test is highly reassuring. Regular surveillance after that is not a sign that something is wrong; it is to detect any new infection and serves as a safety net.
3.“What can I do to reduce my future risk?” – Attending follow-up appointments, considering HPV vaccination (even after treatment), and maintaining overall health all play a role. Cervical cancer prevention is one of the few cancers where women have significant control over outcomes. The most important message is that an HPV-positive result is not a diagnosis of cancer. With appropriate treatment and follow-up, the vast majority of women remain healthy. Screening works. Treatment works. Follow-up works.
It remains a taboo to speak about sexual health; however, it is also a fact that the more we hide it, the greater the risk. In Malaysia, infections such as Human Papillomavirus (HPV) continue to affect thousands of women, often undetected until it is too late.
In a report by the Ministry of Health, in 2025, over 10,500 Malaysian women tested positive for HPV through nationwide screening programmes over the past five years. Although early screening is better than detecting the disease at an advanced stage, many women continue to believe that it is unnecessary, either due to fear of diagnosis, the belief that it is not needed after marriage or menopause, or because screening can be painful.
Nevertheless, Institut Kanser Negara Obstetrics & Gynaecology Specialist Dr Jamil Omar stressed that cervical cancer, developed from HPV, remains one of the most preventable cancers affecting women.
“With vaccination, screening, and timely treatment of precancerous changes, it is a disease we have the tools to control. An HPV-positive result is not a verdict. It is an early warning to prevent tragedy. For most women, it leads to reassurance. For a few, it leads to early treatment. For all, it offers protection if we act on it. Screening is not something to fear. It is something to use,” he added.
Behind HPV-positive
Upon receiving a diagnosis of being HPV positive, a string of words often lingers — virus, cancer, and fear. This is common among patients who receive bad news from their doctors. Explaining further, Dr Jamil said that an HPV-positive result is not a diagnosis of cancer, but rather information that could protect lives.
HPV is commonly transmitted through intimate skin-to-skin contact.
“Eighty per cent of sexually active men and women will be exposed at some point, often without knowing it,” said Dr Jamil.
“When your test shows HPV positive, it simply means the virus is present on the cervix at the time of testing.”
However, it does not mean that a patient is diagnosed with cervical cancer, has already developed it, has unfaithful spouses, was recently infected, or needs immediate surgery. Dr Jamil further explained that HPV can remain dormant for many years before being detected.
“In many cases, it clears naturally within one to two years without causing any harm. The immune system is usually very capable of managing it. The issue is not the presence of HPV alone, but persistent high-risk HPV infection over many years that may eventually lead to precancerous changes and, finally, cancer. That distinction is critical.”
Understanding this, Dr Jamil shared that HPV infection is common, whereas cervical cancer is uncommon. The progression from infection to cancer usually takes around 10 to 15 years. However, it might be shorter for immunocompromised patients, such as those with HIV/AIDS or patients on long-term steroid or immunotherapy treatments for chronic diseases. That is why early screening is important, as HPV can be detected long before cancer develops.
HPV/Cervical screening pathway
Depending on the result of the screening, Dr Jamil said that the next step depends on two main factors:
- The type of HPV detected — especially whether it is high-risk types 16 or 18
- Whether the Pap smear (cytology) shows abnormal cells
Common pathways include:
- HPV negative – Repeat HPV testing in 5 years
- HPV positive with normal cytology – Repeat HPV testing in 12 months
- HPV 16 or 18 detected – Referral for colposcopy (a detailed cervical examination under magnification)
- HPV positive with abnormal cytology – Colposcopy assessment
Immediate treatment is usually not required unless significant abnormalities are confirmed. The goal is careful monitoring, not rushing into procedures unnecessarily.
Beyond the test: Preparation and support
According to Dr Jamil, even for those on regular follow-up, medical attention should be sought if there is bleeding after intercourse, between periods, or after menopause, as well as persistent foul-smelling vaginal discharge or unexplained pelvic pain. While these symptoms do not necessarily indicate cancer, they warrant further evaluation.
As HPV screening results can be affected by certain factors, Dr Jamil advises patients to avoid vaginal intercourse prior to the test, as semen and lubricants may interfere with the accuracy of cervical cell samples.
“Patients should avoid vaginal douching, as it washes away exfoliated epithelial cells and alters the vaginal microbiome and pH. Avoid using vaginal medications, for example, antifungal pessaries, antibiotic cream, or oestrogen pessaries, as they can cause chemical interference with molecular testing.
“It is also advisable to avoid repeating the test during menses, as blood can reduce specimen adequacy, and excess red blood cells may interfere with cytology (reading of Pap smear). Generally, patients should avoid or stop intravaginal medications or activity 48 hours before the test, unless medically necessary,” he added.
The interview, facilitated by BREGO Life Sciences as part of a public education initiative, also highlighted the importance of early screening and informed decision-making. Dr Jamil emphasised that in Malaysia, health decisions often involve family discussions, and support from loved ones plays a crucial role.
An HPV-positive result, he stressed, should not lead to suspicion or blame, as it is a common and manageable medical condition. Instead, emotional support can encourage women to attend follow-up appointments and complete treatment if necessary, reinforcing that prevention is a shared responsibility.
