Recurrent Respiratory Papillomatosis

A Possible Consequence of HPV and Oral Sex

HPV vaccine Gardisil
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Recurrent respiratory papillomatosis, or RRP, is a type of HPV infection. RRP is characterized by the growth of warts 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. RRP can also be very dangerous if the benign HPV infection becomes cancerous.

RRP is not the same as throat cancer caused by HPV. However, RRP can lead to throat cancers. The main difference is the presence of low-risk instead of high-risk virus. Most HPV-related throat cancers are caused by oncogenic (high-risk) variants of the virus, but RRP is usually caused by HPV-6 or HPV-11. These two types of HPV are considered low risk, because they generally only cause warts and other benign infections in the rest of the body, including the genitals.


RRP can cause growths anywhere within the human airway, from the nose to the lungs. 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. The specific symptoms of RRP depend 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.


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.

Risk Factors

The risk factors for AO-RRP are different than those for JO-RRP. Most JO-RRP infections are thought to be acquired perinatally. In other words, around the time of birth. 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. That's particularly true 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

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. In other words, all currently available treatments involve surgery. However, 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. This appears to be more common when RRP is caused by HPV variants other than HPV-11 or HPV-6.

Dating Precautions

There have been very few studies to examine whether having RRP puts a person's sexual or romantic partners at risk for the disease.There is some evidence that children and partners of people with RRP do not have an increased risk of developing RRP themselves. However, 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 because the existing research has only looked for clinical manifestations of RRP in partners, rather than other signs of HPV infection.

Prevention With 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 and Gardasil 9, there have been suggestions that widespread use of the HPV vaccine could also help prevent RRP. Furthermore, vaccination with Gardasil might not only provide direct protection against AO-RRP acquisition through oral sex or other exposures. It might also provide 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. It is targeted at only two cancer-causing varieties of HPV and not the varieties that cause RRP and genital warts.

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