RRP is caused by HPV infection — an acquired viral infection, not an inherited genetic condition. It does not run in families. Juvenile-onset RRP is typically acquired during passage through the birth canal when the mother has active genital HPV infection; most children born to infected mothers do not develop RRP, and the factors determining susceptibility are not fully understood. Adult-onset RRP is generally associated with oral HPV exposure. Why some HPV-infected individuals develop recurrent papillomatosis while most do not remains under investigation.

Diagnosis is established through direct visualization of papillomas during laryngoscopy or endoscopy, with biopsy and pathological confirmation. HPV typing may be performed as type 11 is associated with more aggressive disease. Evaluation should assess extent of disease beyond the larynx and guide surgical planning. Care by an otolaryngologist experienced in airway disease, often with pulmonology and speech-language pathology involvement, is recommended.

Zopapogene imadenovec-drba (PAPZIMEOS) is an FDA-approved treatment for RRP in adults, approved in August 2025. Surgical removal of papillomas remains foundational to maintain airway patency and voice function, and is required repeatedly as papillomas regrow. Adjuvant therapies may be used in clinical practice to reduce surgical frequency, guided by specialist assessment. Interferon alfa-2b was historically used adjunctively but is no longer considered standard and has been withdrawn. Several additional therapies are under investigation in clinical trials, including HPV vaccine-based approaches and immunotherapy. Consult a healthcare provider for treatment guidance.

RRP is a chronic condition defined by recurrence. Prognosis varies considerably. HPV type 11, juvenile onset, and spread beyond the larynx are associated with more aggressive disease and greater morbidity. Some individuals experience spontaneous reduction in recurrence, particularly around puberty in juvenile-onset cases; others require treatment throughout adulthood. Malignant transformation of papillomas is an uncommon but serious complication. Long-term specialist follow-up is important.

Research in RRP is active. Clinical trials are underway evaluating HPV vaccine-based therapies, immunotherapy combinations, and retreatment protocols for the newly approved therapy. The published literature includes substantial review and meta-analysis publications alongside biomarker investigations and case reports. Individuals interested in clinical trials can search ClinicalTrials.gov or contact the Recurrent Respiratory Papillomatosis Foundation (RRPF).