Recurrent respiratory papillomatosis (RRP) is a condition where small, wart-like growths (papillomas) form in a child’s airway. These growths most often form on the vocal cords. But they may also appear in the windpipe (trachea) or lungs.
Human papillomavirus (HPV), a common sexually transmitted infection (STI), causes RRP. HPV is a family of viruses that can cause different types of warts. The types linked to RRP usually have a low risk of cancer.
Even though the growths are non-cancerous, they can lead to voice and breathing issues. The condition is “recurrent” because the growths typically come back after treatment.
RRP is rare. It most often appears in young children ages 2 to 4, but it can happen at any age. RRP is more aggressive in children.
We classify RRP based on where the growths appear in the airway:
RRP normally links to HPV types 6 and 11. In children, babies may get the virus from their mother during pregnancy or childbirth. This doesn’t mean the parent has symptoms or knows they have HPV. In adults, the condition can develop after exposure to HPV later in life.
Parents often ask if RRP is an STI. The answer is yes and no. HPV spreads through sexual contact, but RRP itself is not contagious.
HPV can stay in the body for a long time. It may become inactive (dormant) and then active again later.
Symptoms depend on where the growths are and how large they are. For example, laryngeal papillomatosis often affects the voice. Tracheal and bronchial papillomatosis are more likely to cause breathing issues. A specialist can verify the type through diagnostic tests.
Ear, nose and throat (ENT) doctors may use a combination of tests to diagnose RRP. They start with an upper airway exam. While your child is awake, they place a small, flexible camera (scope) through the nose and throat. This lets them check for papillomas in the vocal cords.
If doctors need to look deeper into the airway, they may recommend a microscopic laryngoscopy and bronchoscopy (MLB). During this procedure, your child is asleep under general anesthesia. The care team uses special tools to examine the voice box and lower airway. They may take a small sample of the growths (biopsy) to confirm the diagnosis and identify the HPV type.
Over time, children may need more tests, such as:
There is no cure for RRP. Treatment focuses on managing symptoms and keeping the airway open. Often, experts in head and neck surgery and voice disorders work together to create a personalized care plan.
Surgery is the main treatment for RRP. The goal is to keep your child’s airway open and safe. Doctors do this by removing the growths as they appear.
Because growths can come back, many children need repeated procedures. Some children need surgery every few weeks. Others can go months between treatments. Care teams work to space out procedures as much as possible.
Doctors perform surgery by inserting small tools through the mouth, so there are no cuts on the outside of the body. They may use lasers or mechanical shavers (microdebriders) to destroy and remove the papillomas.
In severe cases, children with a blocked airway may need a tracheotomy (trach). During this procedure, care teams place a tube in the neck to help with breathing.
Doctors may recommend other treatments specific to each child. These options can slow the buildup of growths and extend the time between surgeries. They may be especially helpful for children with more severe disease or growths that return quickly.
One option is a medication called bevacizumab (Avastin). It works by blocking blood vessel growth factors that help papillomas grow. If the disease spreads to the trachea and lungs, care teams may give this treatment through an IV (intravenous) line.
Cidofovir is an antiviral medication that targets certain viruses, including HPV. Care teams may inject this medication directly into papillomas. Researchers are still studying its safety and effectiveness. It is not yet FDA-approved for RRP.
Some children with RRP also have gastroesophageal reflux (GER). Treating this condition may help reduce symptoms and slow virus activity.
Clinical trials offer access to other new treatment options. These include therapeutic vaccines that target active RRP infections.
RRP is a long-term condition that needs ongoing care and monitoring. In many children, the disease becomes less active after puberty, and they may need fewer surgeries as they get older. Sometimes, treatment is no longer needed at all. However, it isn’t always easy to predict how the condition will progress.
With the right treatment, about 95% of people with RRP live full, active lives. Still, problems may happen, especially in cases linked to HPV type 11. These include:
The best way to reduce the risk of RRP is through HPV vaccination. The vaccine doesn’t treat papillomatosis that are already in the body, but it can help prevent HPV infection before exposure. Staying up to date on vaccines is an important step in protecting your child’s health. The Centers for Disease Control and Prevention (CDC) recommends receiving the HPV vaccine at 11 or 12 years old.
Pregnant women with genital warts should let their obstetrician know as soon as possible. They can recommend safe treatment options to avoid transmission to the baby.
For teens and adults, the HPV vaccine can lower the risk of developing RRP later in life. Safe sex practices reduce the risk of HPV exposure even more. This includes testing for STIs before having sex with any new partners.
Our Aerodigestive and Esophageal Center features specialists from different disciplines, including otolaryngology, pulmonology, pediatric surgery, gastroenterology, nutrition services and speech pathology services.
Last Updated 03/2026
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