title: Laryngopharyngeal reflux and herpes simplex virus type 2 are possible risk factors for adult-onset recurrent respiratory papillomatosis (prospective case-control study).
abstract: OBJECTIVE
  The human papillomavirus (HPV) causes recurrent respiratory papillomatosis (RRP). Although HPV prevalence is high, the incidence of papillomatosis is low. Thus, factors other than HPV infection probably contribute to RRP. This study investigated whether patients with papillomatosis are more often infected with herpes simplex virus type 2 and chlamydia trachomatis (ChT) and whether laryngopharyngeal reflux (LPR) occurs in this group of patients more often.
  
  
  METHODS
  Prospective case-control study.
  
  
  METHODS
  Department of Otorhinolaryngology of University Hospital.
  
  
  METHODS
  The study included 20 patients with adult-onset RRP and 20 adult patients with vocal cord cyst and no pathology of laryngeal mucosa (control group).
  
  
  METHODS
  Immunohistochemical analysis of pepsin, HPV, herpes simplex virus type 2 and ChT was performed in biopsy specimens of laryngeal papillomas and of healthy laryngeal mucosa (control group) obtained from medial part of removed vocal cord cyst during microlaryngoscopy procedures.
  
  
  RESULTS
  Pathologic LPR (pepsin in tissue) was diagnosed in 8/20 (40.0%) patients with papillomatosis and in 0/20 control patients (P = .003). Herpes simplex virus type 2 was present in 9/20 (45.0%) patients with papillomatosis and in 0/20 control patients (P = .001). Five specimens were positive for both pepsin and herpes simplex virus type 2. No samples were positive for ChT. There were no significant differences between groups for age, body mass index, diabetes mellitus and gastrooesophageal reflux disease. Tobacco exposure was not more frequent in RRP group either (P = .01).
  
  
  CONCLUSIONS
  Results show that LPR and herpes simplex virus type 2 are significantly more often present in patients with RRP. LPR and herpes simplex virus type 2 might activate latent HPV infection and thereby be possible risk factors for RRP.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.|Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-5759-2073
authors.initials: M
authors.lastname: Formánek
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.|Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors.forename: D
authors.initials: D
authors.lastname: Jančatová
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.|Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Komínek
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.|Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Matoušek
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.|Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors.forename: K
authors.initials: K
authors.lastname: Zeleník
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000032:analysis; D016022:Case-Control Studies; D018153:Czech Republic / Q000453:epidemiology; D006561:Herpes Simplex / Q000150:complications* / Q000453:epidemiology; D018258:Herpesvirus 2, Human / Q000276:immunology*; D006801:Humans; D015994:Incidence; D057045:Laryngopharyngeal Reflux / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D027383:Papillomaviridae / Q000276:immunology*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral