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Recurrent Respiratory Papillomatosis

A Possible Consequence of HPV and Oral Sex

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Updated February 03, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

What Is Recurrent Respiratory Papillomatosis?

Recurrent respiratory papillomatosis, or RRP, is a type of HPV infection in which warts grow within a person's airway. Although a relatively rare condition, RRP can cause significant health problems for sufferers. It can even be fatal if warts grow so large that they block the airway or if the benign HPV infection becomes cancerous.

RRP is not the same as throat cancer caused by HPV, although RRP can lead to throat cancers. Most HPV-related throat cancers are caused by oncongenic variants of the virus, but RRP is usually caused by HPV-6 or HPV-11. These two types of HPV generally only cause warts and other benign infections in the rest of the body, including the genital tract.

RRP can cause growths anywhere within the human airway - from the nose to the lungs - but growths are most common in the larynx, particularly around the vocal chords. Because of this, the earliest signs of RRP are often hoarseness and other vocal changes. There is also the possibility of shortness of breath and other airway symptoms depending on where the tumors are located.

The time course of the tumors associated with RRP varies from person to person. For some, the growths will disappear with a single treatment; in others, they will return multiple times. Such recurrences can occur over weeks, months or years.

Types of Recurrent Respiratory Papillomatosis

There are two types of RRP -- juvenile onset (JO-RRP) and adult onset (AO-RRP). RRP is considered to be juvenile onset as long as symptoms begin to appear before puberty; however, most JO-RRP infections are diagnosed in children five years and under.

The risk factors for AO-RRP are different than those for JO-RRP, where most infections are thought to be acquired perinatally. In contrast, the risk factors for AO-RRP remain largely unknown, although there is some evidence of an association with oral sex. Although there is relatively little research on AO-RRP, it would not be surprising if that association was borne out by future studies, particularly given the growing evidence of an association between HPV, oral sex and oral and throat cancer.

The U.S. government estimates that RRP occurs in 1.8 of every 100,000 adults and 4.3 of every 100,000 children.

Long-Term Consequences of Recurrent Respiratory Papillomatosis

The severity of RRP varies. In some people, RRP will resolve with one or two surgical treatments to remove the benign tumors it causes. In other people, repeated treatments will be necessary to remove the warts as they recur. To date, there is no accepted medical treatment for RRP, although several drugs are currently being investigated that might be able limit the progression of the disease in combination with surgery.

In people where RRP remains undetected or is improperly treated, there is a possibility of partial or full airway blockage and even death. In rare circumstances, the lesions caused by RRP can also become cancerous, although this appears to be more common when RRP is caused by HPV variants other than HPV-11 or 6.

Dating with Recurrent Respiratory Papillomatosis

There have been very few studies to examine whether having RRP puts a person's sexual or romantic partners at risk for the disease. Although there is some evidence that children and partners of people with RRP do not have an increased risk of developing RRP themselves, more data are definitely needed before firm conclusions can be drawn about the risk of a person with RRP transmitting HPV. This is particularly true as the existing research has only looked for clinical manifestations of RRP in partners rather than other signs of HPV infection.

Recurrent Respiratory Papillomatosis and the HPV Vaccine

Because RRP is most often caused by HPV-6 and HPV-11, the two genital warts viruses that are preventable by Gardasil, there have been suggestions that widespread use of the HPV vaccine could also help prevent RRP. Furthermore, vaccination with Gardasil might provide not only direct protection against AO-RRP acquisition through oral sex or other exposures but future protection against JO-RRP in the next generation by reducing the risk of genital warts during pregnancy.

Note: Cervarix would not be recommended for preventing RRP, since it is targeted at only two cancer-causing varieties of HPV and not the varieties that cause RRP and genital warts.

Sources:

Chesson HW et al. The potential health and economic benefits of preventing recurrent respiratory papillomatosis through quadrivalent human papillomavirus vaccination. Vaccine. 2008 Aug 18;26(35):4513-8.

Derkay CS & Wiatrak B. Recurrent respiratory papillomatosis: a review. Laryngoscope. 2008 Jul;118(7):1236-47.

Gerein V et al. Children and partners of patients with recurrent respiratory papillomatosis have no evidence of the disease during long-term observation. Int J Pediatr Otorhinolaryngol. 2006 Dec;70(12):2061-6.

Kashima HK et al. A comparison of risk factors in juvenile-onset and adult-onset recurrent respiratory papillomatosis. Laryngoscope. 1992 Jan;102(1):9-13.

Kashima HK et al. Recurrent respiratory papillomatosis. Obstet Gynecol Clin North Am. 1996 Sep;23(3):699-706.

Kimberlin DW & Malis DJ. Juvenile onset recurrent respiratory papillomatosis: possibilities for successful antiviral therapy. Antiviral Res. 2000 Feb;45(2):83-93.

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