Vital Signs Asia speaks to Prof Dr Jamiyah Hassan, Feto-Maternal Consultant, Obstetric & Gynaecology, Hospital Al-Sultan Abdullah (HASA), Universiti Teknologi MARA on HPV Awareness in conjunction with International HPV Awareness Day 2026.
What is HPV?
HPV, or human papillomavirus, is a very common virus with nearly 200 known subtypes. Not all HPV types cause cancer. However, certain strains are classified as high-risk HPV because of their strong link to cancer, particularly cervical cancer, where more than 99% of cases are caused by HPV.
HPV infects the skin and moist surfaces of the body, including the cervix, vagina, anus, penis, and the mouth and throat (oropharynx). This means HPV does not affect women alone. The same virus that causes cervical cancer in women can also lead to penile, anal, and oropharyngeal cancers in men.
This is why HPV prevention must be gender inclusive. HPV has been framed as only a women’s issue, and this creates a stigma that overlooks the fact that men are not just carriers-they are also affected by HPV-related diseases. Including men in prevention strategies is essential for effective public health control.
While vaccination is the most effective protection against HPV-related cancers, it is important to understand that prevention works best when multiple strategies are combined. HPV is transmitted through intimate skin-to-skin contact, so sexual abstinence eliminates exposure entirely, while condom use can reduce — though not fully prevent — the risk of transmission. Lifestyle factors also play a role. Smoking, for example, is known to weaken the immune system and increase the likelihood of persistent HPV infection and progression to cervical pre-cancer and cancer. Together, these measures complement vaccination and screening, strengthening overall protection.
Can HPV be screened for? If so, how does screening work?
For women, yes-HPV can be screened effectively. Traditionally, cervical cancer screening was done using a Pap smear, which detects abnormal cell changes caused by HPV. However, this method does not detect the virus itself. Today, screening has shifted towards a more accurate approach: HPV DNA testing, which identifies the presence of the virus directly.
It’s possible for a woman to test positive for HPV while still having a normal Pap smear. This doesn’t mean cancer is present-as it takes many years to progress into cancer, if it does at all.
The advantage of HPV DNA screening is that it allows healthcare providers to identify HPV infections early, allowing monitoring of patients closely, and intervening before serious disease develops. Many women feel anxious about cervical screening because they associate it with cancer. In reality, HPV screening is about detecting HPV infection, not a cancer diagnosis.
What about screening for men-is that available?
At the moment, routine HPV screening for men is not available as a public health strategy. There is no standard screening test for men equivalent to cervical screening for women. In research settings, HPV can be detected through methods like oropharyngeal rinses or anal swabs, but these are not offered as public screening programmes.
Because of this limitation, vaccination becomes the most effective preventive measure. Rather than waiting to detect disease, vaccinating boys and men helps prevent HPV infection in the first place-protecting both men themselves and their partners.
If someone is infected with HPV, what treatment options are available?
In most cases, no treatment is needed for the virus itself. The body’s immune system is usually able to clear HPV naturally. Around 80% of men and women will clear the infection on their own within two years, often without any symptoms. This is why maintaining good overall health through nutrition, exercise, and healthy habits is important. However, about 10% of individuals develop persistent HPV infection. This is the group that requires closer medical follow-up, as persistent infection increases the risk of long-term complications, including cancer.
Who should receive the HPV vaccine?
HPV vaccination is often associated solely with cervical cancer, which understandably receives a lot of attention because the disease burden is high, particularly in Malaysia. More than 900 women die annually from the disease.
Because of this focus, many people mistakenly believe HPV only affects women. In reality, HPV also infects men. Around 80% of sexually active people will be exposed to HPV at some point in their lives. Ideally, vaccination should be given before any sexual exposure, which is why HPV vaccines are best introduced through national immunisation programmes and offered to adolescents. Even if someone has been exposed to one HPV subtype, vaccination can still offer protection against other high-risk strains. It may also reduce the risk of reinfection or recurrence. For this reason, HPV vaccination should be offered to both men and women, regardless of marital status, relationship status, or sexual history. In principle, everyone is a candidate for vaccination.
What HPV vaccines are available?
There are three main types of HPV vaccines, each designed to protect against different HPV subtypes:
The bivalent vaccine - targets HPV types 16 and 18, which are responsible for more than 70% of cervical cancers worldwide. These two strains carry the highest cancer risk, which is why they were prioritised in early vaccine development.
The quadrivalent vaccine - protects against four HPV types: 6 and 11, which cause about 90% of genital warts, and 16 and 18, the high-risk cancer-causing strains. This vaccine, therefore, protects against both cancer caused by HPV 16 and 18, and genital warts.
The nonavalent vaccine, which covers nine HPV subtypes. In addition to 6, 11, 16 and 18, it includes 31, 33, 45, 52 and 58. Together, these seven high-risk subtypes account for over 90% of HPV-related cervical cancers, and they also protect against HPV-related cancers in men.
Importantly, the virus targeted by these vaccines is the same in both men and women.
With three types available, which one is most suitable for those not yet exposed?
When we talk about vaccination before sexual exposure, the choice of vaccine depends on what a country aims to prevent and its public health priorities.
From a cervical cancer perspective, about 90% of cases are caused by HPV types 16, 18, 31, 33, 45, 52 and 58. Of these, HPV 16 and 18 alone account for roughly 70% of cervical cancers worldwide, a pattern that has remained consistent across countries.
There is another important consideration: genital warts. While they are not cancerous, they are a significant public health issue. Genital warts can recur, cause long-term symptoms, and carry a substantial healthcare burden. Because 90% of genital warts are caused by HPV 6 and 11, vaccines that include these types, namely the quadrivalent and nonvalent vaccines, offer broader protection beyond cancer prevention.
Ultimately, vaccine selection depends on country-specific data, disease patterns, and policy decisions, particularly when cost is taken into account. In Malaysia, for instance, data show not only a high prevalence of HPV 16 and 18, but also increasing rates of HPV 52 and 58, which strengthens the case for broader vaccine coverage.
How often does someone need to take the HPV vaccine? Is it once in a lifetime?
The standard recommendation for the HPV vaccine is three doses over a lifetime.
The usual schedule is:
First dose: at any chosen time
Second dose: 1–2 months later
Third dose: 6 months after the first dose
If someone misses a dose, there is no need to restart the entire series. The vaccine works through a booster mechanism, the first dose “primes” the immune system, while subsequent doses strengthen and sustain antibody protection. Even if there is a long gap between doses, the remaining doses can still be given.
At present, no additional booster doses are required later in life. Long-term data from early HPV vaccine studies, now spanning more than 20 years show sustained protection with no breakthrough infections, which is why boosters are not currently recommended.
At what age can the HPV vaccine be given?
From 9 years old. While early clinical trials focused on individuals aged 9 to 45, there is no upper age limit in current medical practice. This is because evidence shows that even older adults can still mount a strong immune response to the vaccine. From a preventive standpoint, vaccination is offered to anyone who may benefit from protection, regardless of age.
For adolescents below 15 years old, studies have shown that two doses are not inferior to three in terms of immune protection. As a result, many countries-including Malaysia—use a two-dose schedule for school-based vaccination under the National Immunisation Programme (NIP), which provides HPV vaccination to school-aged girls. Since 2025, Malaysia has been using a single-dose strategy, which has been one of the strategies recommended by WHO in the effort to increase global uptake of the HPV vaccine.
For individuals 15 years and older, the recommendation remains three doses to ensure long-term protection.
If a child received two doses under the NIP, should parents consider a third dose later?
This depends on which vaccine was initially given and whether the family wishes to expand protection.
For example, a child who received a bivalent or quadrivalent vaccine may later opt for a nonavalent vaccine for broader coverage. In this situation, vaccination would typically need to start anew, especially if the individual is now above 15 years old. Receiving overlapping vaccine types does not cause harm. Re-exposure to HPV types 16 and 18 simply acts as a booster, while providing additional protection against the five extra high-risk subtypes included in the nonavalent vaccine.
Where is the HPV vaccine available in Malaysia?
The HPV vaccine has been part of Malaysia’s National Immunisation Programme since 2010, delivered primarily through school-based programmes. Uptake has been excellent, exceeding 90%, making it one of the strongest HPV vaccination programmes in the region. Outside the NIP, the vaccine is available through:
Private clinics and hospitals
University hospitals, clinics and other academic centres
At present, expanding access across the public sector remains a long-term goal.
If vaccination is far cheaper than cancer treatment, why isn’t it more widely promoted? What are the challenges?
There is strong evidence that vaccination is far more cost-effective than treatment. Studies examining the economic burden of cervical cancer consistently show that late-stage disease is significantly more expensive to treat. One study from the UK, which analysed hospital admissions for cervical cancer over nearly a decade, found that treatment costs-especially for advanced-stage disease—could exceed £10,000 per patient, not including indirect costs such as loss of income, long-term disability, or the impact on families.
By comparison, HPV vaccination is considerably cheaper. However, the challenge lies in upfront costs. In Malaysia, HPV vaccination in the private sector can cost RM500–700 per dose, and multiple doses may be required. When people hear this figure, they tend to focus on the immediate expense rather than the long-term savings.
Many individuals also struggle to think in terms of preventive care. They may not consider the hidden costs of illness-time away from work, loss of financial stability, caregiving responsibilities, or the emotional toll on families. These indirect costs are often invisible until illness occurs.
How can vaccine uptake be improved?
Education remains the most important tool. Preventive healthcare strategies reduce both disease burden and national healthcare costs, but this message needs to be communicated consistently and clearly.
Another key factor is accessibility. Vaccine uptake improves significantly when vaccination is free or subsidised. Malaysia’s NIP is a strong example, but it only covers a limited segment of the population. Many others must still pay out of pocket. Interestingly, conversations around vaccination have become easier after COVID-19. There is greater acceptance that vaccines protect against disease rather than cause it. Cost, however, remains the main barrier.
And HPV does not discriminate by gender. Including men in vaccination strategies increases overall protection, reduces transmission, and helps prevent HPV-related cancers in both sexes. A gender-neutral approach offers equal protection and strengthens herd immunity. If the goal is to reduce—or eventually eliminate-HPV-related diseases and cancers, vaccination must be offered equitably to both men and women.
Any last words?
HPV is common, but cancer doesn't have to be. So that means implement a vaccination strategy with HPV vaccinations. Screening for HPV is a powerful tool that protects everyone, especially women. Prevention is power, and together we can eliminate HPV-related disease and cancers for both men and women. Every step we take today builds a healthier tomorrow.
HPV prevention is not built on a single intervention. Besides vaccination, regular health check-ups, screening, safer sexual practices, avoiding smoking, and broader health awareness all play supporting roles. When these measures work together, they reduce infection, improve early detection, and lower the long-term risk of HPV-related cancers for both women and men.
Prof Jamiyah Hassan is a consultant obstetrician and gynaecologist and Head of the Clinical Skills Unit at the Faculty of Medicine, University of Malaya. She advocates strongly for women’s health, preventive care and HPV vaccination.
