ObjectivesThe present study aimed to evaluate human papillomavirus (HPV) occurrence in sinonasal inverted papilloma (SNIP), and to assess factors associated with HPV positivity and SNIP recurrence.Study DesignProspective study.MethodsWe prospectively collected clinical data and fresh tissue specimens from 90 consecutive patients treated for SNIP at Helsinki University Hospital, between 2015 and 2019. Fourteen patients with recurrent SNIP underwent repeated tumor sampling. All tissue specimens were analyzed for the presence of HPV. Factors associated with SNIP recurrence and HPV positivity were assessed.ResultsAmong 107 SNIP specimens, 14 (13.1%) were positive for low‐risk HPV and 6 (5.6%) were positive for high‐risk HPV. HPV positivity was associated with an increased risk of recurrence (P = .004). Smoking was significantly associated with HPV positivity in SNIP (P = .01), but a history of HPV‐related diseases or patient sexual habits did not correlate with HPV positivity. The recurrence rate was lower among patients with SNIP that underwent an attachment‐oriented resection, compared to patients treated without attachment‐oriented resections (78.6% vs 25.8%, P < .001).ConclusionsThe risk of SNIP recurrence was highly associated with 1) HPV positivity and 2) surgery without an attachment‐oriented resection. Oncogenic HPV was rare in SNIP.Level of Evidence3 Laryngoscope, 132:1714–1718, 2022