Prevention of juvenile-onset recurrent respiratory papillomas

Juvenile-onset recurrent respiratory papilloma (JO-RRP) is a rare disease, but it takes a heavy toll on the young patient and the patient's family. It is caused by infection with human papillomavirus (HPV) types 6 and 11, which are also responsible for condylomas (genital warts) in men and women. Most cases of JO-RRP result from intrapartum transmission of HPV-6 and HPV-11 during fetal passage through an infected birth canal. We suggest that maternal condylomas (rather than subclinical infection with HPV-6 and -11) are the major risk factor for the disease and that the risk of JO-RRP is highest for the first child born to a young infected mother. The location of condylomas on the cervix or in the vagina (in the path of the fetus) and premature rupture of amniotic membranes may be additional risk factors. It should be possible to reduce the incidence of JO-RRP by the following measures: 1) recognition by health care professionals that condylomas in pregnancy have serious consequences; 2) treatment of condylomas during pregnancy; and, most importantly, 3) consideration of the cesarean delivery option for women at high risk. Cesarean delivery is credited with the prevention of many neonatal infections with herpes simplex virus (HSV) type 2 in infants of mothers who have primary symptomatic HSV disease at the time of delivery. Similar consideration should be given to the mother with condylomas at the time of delivery. The mother should be made aware of the risks and benefits of the cesarean delivery option in order to obtain a truly informed consent.