FLUOR ALBUS
Nurrachmat Mulianto,
SpKK
Pemeriksaan IMS
ANAMNESIS
Keluhan saat datang
Riwayat seksual ( coitus suspectus ) :
a. kontak seksual, di dlm/luar nikah, gonta- ganti
pasangan (kontak seksual multipel)
b. kontak dg pasangan setelah gejala
c. frekuensi hub sex dan jenis
(homo/hetero)
d. cara hub (genital, anal, oral)
e. apakah psngan jg menderita
keluhan sama.
Pemeriksaan Fisik
INSPEKSI dan PALPASI
Pada pria :
Lbih mudah krn terdpt 1 kesatuan salu
ran genital & organ mudah diraba
Pada wanita :
Harus dg spekulum krn organ
Genital tdp di rongga pelvis
Gonnorhea
Pada laki-laki Uretritis GO, pd wanita Cervicitis GO
Penyebab
kumanNeisseria Gonorrhoea, disebut juga gonokokus, berb
entuk diplokokus.
Kuman ini menyerang selaput lendir dari :
Vagina, saluran kencing dan daerah rahim/ leher rahim.
Saluran tuba fallopi.
Anus dan rektum.
Kelopak mata.
Tenggorokan.
Neisseria gonorrhoeae
Clinical Manifestations
Urethral infection in men
Urogenital infection in women
Rectal infection
Pharyngeal infection
KOMPLIKASI GO
Bila GO tidak diobati maka 1% dari lel
aki dan wanita, akan terjadi DGI atau
Dessiminated Gonorrhoe Infection . Ta
nda dan gejalanya berupa demam, be
rcak di kulit, persendian bengkak dan
nyeri (FRANK ATHRITIS), peradangan p
ada dinding rongga jantung, peradang
an selaput pembungkus otak serta me
ningitis.
Treatment : Uncomplicated GO
Plus
Coinfection with C. Trachomatis
Doxycycline 100 mg orally 2 times a day for 7
days
Alternative regimen :
azythromicyn 1 gr SD
Treatment
Disseminated Gonococcal Infectio
n:
Hospitalization
Ceftriaxone 1 gr/24 hours for 7 days
Or
Cefotaxime 1 gr/8 hours i.v
Ceftizoxime 1gr/8 hours i.v
Spectinomycin 2 gr/12 hours
for a week
Treatment
Gonococcal Meningitis :
Ceftriaxone 1 2 gr/12 h
ours for 14 days
Gonococcal Endocarditis :
At least 4 weeks
Etiologic agent :
Chlamydia trachomatis strain D K
Obligate intracelluler
An unique growth cycle :
Elementary body
Reticulate body
Clinical Manifestations
Men :
1. Disuria ringan
2. Polakisuria
3. Discar seropurulen
a)
b)
c)
d)
Reiters syndrome :
Uretritis
Conjunctivitis
Arthritis
Mucocutaneous lesion
Clinical Manifestations
Women :
1. Asimptomatik
2. Disuria ringan
3. Sering kencing
4. Nyeri di daerah pelvis
5. Disparenia
Treatment
Recomended regimen :
Doxycycline 100 mg twice for 7 da
ys
Azithromycin 1 gr orally once
Alternative regimen :
Ofloxacin 200 mg twice for 7 days
Erythromycin base 500 mg q.i.d fo
r 7 days
Erythromycin ethyl succinate 500
mg q.i.d for 7 days
FLUOR ALBUS
KANDIDIASIS VULVOVAGINA
TRICHOMONAS VAGINALIS
BACTERIAL VAGINOSIS
Vulvovaginal Candidiasis
Etiologic agent :
Yeast family : Candida spp.,
C. Albicans
Predisposing factors :
Pregnancy
Oral contraceptives
Diabetes mellitus
Antibiotics
Clinical Manifestations
Acute pruritus and vaginal di
Treatment
Recomended treatment :
Miconazole nitrat (vaginal supp) 200
mg at bed time for 3 days
Clotrimazole (vaginal tab) 200 mg at
bed time for 3 days
Bufoconazole (2% cream 5 gr) intrav
aginally at bed time for 3 days
Terconazole (80 mg supp) at bed tim
e for 3 days
Treatment
ORAL :
Fluconazole 150 mg orally single d
ose
Itraconazole 400 mg orally single
dose
Itraconazole 100 mg b.i.d for 3 da
ys
Trichomoniasis
Penyebab : T. vaginalis
Keluhan
1. Tdk ada
2. Discar berbau,
iritasi/gatal.
3. Dispareunia
4. Disuria
5. Rasa tdk enak
perut bawah
Gejala
1. Tdk ada
2. Eritema vulva
difus
3. Discar >>
kuning, hijau,
berbusa
4. Inflamsi dind
vag
5. Strawberry
Cervix
Foamy discharge
Strawberry cervix
Jenis pemeriksaan
pH 4,5 - 7
Sniff test positif
Dg sediaan basah (NaCl) pergerakan t
richomonas khas
Fluorescent antibodi
Pap smear
Terapi
Metronidazol 2 gram dosis tunggal
Metronidazol 2 x 0,5 gr selama 7 hari
Klindamisin 2 x 300mg slm 7 hari
Bakterial Vaginosis
Penyebab : Gardnerella vaginalis, Bactero
ides Spp, Mycoplasma hominis
Dpt tanpa gejala
Tes amin dg KOH 10% Bau spt ikan (ami
n yg menguap)
pH > 7,2
Sekret menggumpal wrn putih atau keab
u-abuan melekat pd dinding vag.
Clue cells pd mikroskop
Diagnostic
Criteria
Normal
Bacterial
Vaginosi
s
Vaginitis
Cand.
Trichomo
Vulvov
nas
ag
< 4.5
(usually
)
Vaginal pH
3.8 - 4.2
> 4.5
4.5
Discharge
White,thin,
flocculent
Thick, white
(milky),
gray
Yellow,
green,
foamy
Amine
odor
"whiff"
test
Absent
fishy
fishy
White,
curdy
, "cotta
ge chees
e"
Absent
Lactobacilli,
epithelial
cells
Clue cells,
adherent
cocci, no
WBC's
Trichomonad
s
, WBC's
Budding yea
st, hyphae,
Miroscopic