Etiology

HPV-6 and 11 are the most frequent genotypes associated with RRP as well as solitary papillomas {10,848,1484, 1788,2074,2101,2411}. Rarely, HPV 16,

18, 31, 33, 35 and 39 have been identified in RRP {389,2004,2074,2173,2461}. The mode of HPV infection in children is perinatal vertical transmission related to maternal genital infection {178,586, 2311}. An epidemiological triad has been identified: the first-born child, vaginal delivery and teen-aged mother correlating with juvenile RRP {1282}. Caesarean delivery has not been found to be entirely protective against the disease {2357}. Factors that influence the conversion of HPV exposure to active HPV infection resulting in epithelial proliferation are not known {944}. The mode of HPV infection in adults remains unclear. The reactivation of a latent infection acquired perina-tally or adult acquired infection with oro-genital contacts have been suggested {10,1281}.

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