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PENYAKIT MENULAR SEKSUAL

Dr. Hydrawati Sari, SpOG

Sexually Transmitted Infections/PMS

Infeksi yg ditularkan mll aktivitas seksual

Importance of STIs
Penyebab

utama infertilitas pada perempuan dan laki-laki

Account for up to 40% of gynecologic hospital admissions Kofaktor transmisi HIV dan HBV 340 juta kasus baru / tahun
Source: Lande 1993; WHO 1996.

STDs are a Significant Problem


Konsekuensi PMS yg tidak diterapi:
Ectopic

pregnancy

risiko cervical cancer Chronic abdominal pain (18% of females with a history of PID)
Meningkatkan

Source: Lande 1993.

STDs are a Significant Problem


Konsekuensi lain Beberapa PMS blm ada tx Banyak kasus dapat menyebabkan masalah sepanjang hidup Menyebabkan stress on relationships Dpt menyebabkan penyakit berat atau kematian
Cancer AIDS

STIs are a Significant Problem


Infertilitas: 20-40%: laki-laki dg infeksi chlamydia dan gonorrhea yg tdk diterapi 55-85%: perempuan dgn PID yg tdk diterapi (8-20% of females with untreated gonorrhea

develop PID)

Risiko

HBV dan transmisi HIV/AIDS meningkat

Source: Lande 1993.

STIs are a Significant Problem

Bayi:
Dapat

terinfeksi saat persalinan: menyebabkan kebutaan krn infeksi dan pneumonia (chlamydia, genital herpes and gonorrhea) SSP atau kematian (syphilis or genital herpes)

STIs - classification

BACTERIAL
VIRAL

PROTOZOAL
FUNGAL ECTOPARASITES

BACTERIA

Neisseria gonorrhoeae gonorrhea Chlamydia trachomatis chlamydia Treponema pallidum


Syphilis

Hemophilus ducreyi Chancroid Klebsiella granulomatis Donovanosis (granuloma inguinale)

VIRUSES
Herpes

herpes) Human papilloma virus Hepatitis B virus HIV (AIDS) Cytomegalovirus Molluscum contagiosum virus

simplex virus tipe II (genital

PROTOZOAL
Trichomonas

vaginalis: Trichomonal

vaginitis

Entamoeba histolytica: Amebiasis pd homoseksual Giardia lamblia: Giardiasis pd homoseksual

FUNGI
?Candida albicans Vulvovaginitis, balanitis

ECTOPARASITES

Phthirius pubis Pubic lice infestation Sarcoptes scabiei Scabies

Bacterial STDs

Chlamydia
Bacteria

- Chlamydia trachomatis Tpt infeksi: serviks Kebanyakan wanita asimtomatik Jk simtomatik - discharge, nyeri saat miksi, nyeri perut bawah, perdarahan, demam Komplikasi: servisitis, infertilitas, chronic pain, salpingitis, ectopic pregnancies, stillbirths

Chlamydia
Urethritis Epididymitis Proctitis Cervicitis Endometritis Salpingitis Perihepatitis

Otitis media in infants Inclusion conjunctivitis Sterility

Chlamydia

1.

Diagnostic Methods :
Direct fluorescent antibody Enzyme immunoassay Nucleic acid hybridization (DNA probe) Cell culture DNA amplification

2.
3. 4. 5.

Recommended Treatment

Doxycycline 100 mg /oral, 2 x sehari selama 7 ahri atau Azithromycin (Zithromax) 1 g /oral

abstain

hari sex partners hrs diperiksa dan diterapi

dr sexual intercourse selama 7

Symptoms Among Males Diagnosed With Chlamydia


Dysuria 16%

Discharge 13%

No Symptoms 71%

Symptoms Among Females Diagnosed With Chlamydia


Dysuria 2% No Symptoms 86% Abdominal Pain 6% Vaginal Discharge 6%

Gonorrhea
Females: Male:

gonococcal cervicitis: discharge kuning kehijauan atau iritasi vulva gonococcal urethritis: discharge berbau, rasa panas saat miksi bengkak, limfadenopati pd inguinal

GONORRHEA

Membr mukosa yg terken: cervix, anus, throat, eyes Serviks uteri: organ yg terinfeksi

10

to 40 percent women develop PID

Gonorrhea
Urethritis Epididymitis Proctitis Cervicitis Endometritis Salpingitits Perihepatitis Pharyngitis

Conjunctivitis (new born & other) Amniotic infection syndrome Disseminated gonococcal infection

Gonorrhea Diagnostic Methods


Gram stain of endocervical smear Culture DNA probe

Tx: Antibiotika

SYPHILIS

Penyebab: treponema pallidum Penularan: seksual intercourse, jg dari ibu ke janin Gambaran: luka berwarna merah atau coklat, tidak nyeri pada mulut, tangan, dan alat reproduksi (primary syphilis(CHANCERS))

SYPHILIS
Gambaran:

rash pd telapak tangan, telapak kaki, mirip eczema, psoriasis, measles or sunburn and flu like symptoms or mononucleosis in

secondary syphilis

(maximum infectivity)

Syphilis Diagnostic Methods


Clinical appearance Dark-field microscopy Nontreponemal serologic test Rapid plasma reagin VDRL Treponemal test

Recommended Treatment
Antibioika:

Penisilin

Viral STDs
Herpes

simplex Genital Warts (HPV) Hepatitis B virus HIV ( AIDS virus)

Herpes
Recurrent, incurable viral disease HSV-2 menyebabkan genital herpes 80%: simtomatik atau tdk diketahui simtomnya

HERPES SIMPLEX VIRUS


Infeksi

virus yg menular dari kontak kulit terutama di daerah mulut dan genital

HSV-1: terutama mengenai mulut HSV-2: genital herpes

HSV 2

Fase aktif: gatal, rasa terbakar, bengkak, dan

flu like symptoms

Gambaran: small painful blisters on genitals rupture, crust over and heal Tidak ada terapi utk HSV2, acyclovir hanya utk mengurangi ketidaknyamanan Sexual activity: sebiknya dihindari saat luka masih aktif

HUMAN PAPILLOMA VIRUS

Genital warts atau condyloma: biasanya tjd krn kontak langsung vagina dan/atau anal area

Female HPV

Human Papillomavirus (HPV)

Tdp > 70 tipe HPV 30 tipe dapt menginfeksi genital Cervical CANCER and HPV

HPV-16 HPV-18, 31 and 45

(HPV) - Treatments
Patient

applied
0.5% solution or gel

Podofilox

Provider

applies Cryotherapy Podophyllin resin 10-25% Surgery, intralesional interferon, laser

VAGINITIS
> 90% vaginitis diklasifikasikan sebagai 1. Trichomoniasis - disebabkan oleh protozoa 2. Bacterial vaginosis 3. Candidiasis

TRICHOMONIASIS

Parasit Menyebabkan iritasi vagina, gatal dan discharge yg bau pd wanita yg simtomatik Dpt terlihat bintik merah (red spots) pd dinding vagina

Most men are a symptomatic Kedua pasangan hrs diterapi antibiotik

PENCEGAHAN

Sexual abstinence (oral, vaginal, anal sex): mrp cara yg 100% efektif utk mencegah PMS Mlkk sexual intercourse dlm jangka wkt lama, monogami dan dg partner yg tidak terinfeksi Male condoms mrp salah 1 cara yg paling efektif utk mencegah PMS

THANK YOU