What risk factors, if any, are strongly associated with adult-onset recurrent respiratory papillomatosis (AO-RRP)?
Background: Recurrent respiratory papillomatosis (RRP), caused by human papillomavirus (HPV) infection, is characterized by exophytic, benign papillary lesions of the upper aerodigestive tract. Although benign and relatively rare, RRP has a wildly variable disease course and can cause significant morbidity in both children and adults; there is no cure. AO-RRP has a limited body of literature regarding HPV transmission mechanisms or pertinent host risk factors.
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October 2014Study design: Prospective, age- and sex-matched case control; 121 AO-RRP patients across three institutions who were treated within the last five years (accrual between December 2012 and October 2013) filled out a computer-based, 89-item questionnaire.
Setting: New York University School of Medicine, New York City; New York Eye and Ear Infirmary, New York City; Weill Cornell Medical College, New York City.
Synopsis: The median onset age for AO-RRP patients was 38 years, although initial diagnosis was reported at all life stages. In both the control and AO-RRP groups, subjects were predominantly white, had a high economic and socioeconomic status (almost 33% with an annual household income greater than U.S. $200,000), and were highly educated (more than 70% with at least a college degree). Both groups reported similar levels of depression and anxiety and low overall comorbidity rates, and, on average, were in good health. AO-RRP patients reported less difficulty physically functioning than controls. There were no statistically significant differences with regard to alcohol, tobacco, and/or recreational drug use between the two groups, and both were similar in reporting previous gastroesophageal reflux disease and laryngopharyngeal reflux diagnoses and active heartburn symptoms. Lifetime number of vaginal/anal sex partners was the only statistically significant variable; the median number of lifetime vaginal/anal sex partners was 15 for AO-RRP subjects and 10 for controls. No significant median difference in the lifetime number of oral sexual partners was noted between the groups. Limitations included data that are entirely dependent on participant accuracy and interpretation.
Bottom line: AO-RRP may be associated with an increased number of lifetime sexual partners; however, a larger sample is required to determine which sexual practices are specifically associated with it.
Citation: Ruiz R, Achlatis S, Verma A, et al. Risk factors for adult-onset recurrent respiratory papillomatosis. Laryngoscope. 2014;124:2338-2344.
—Reviewed by Amy Eckner