(IMS )
Oleh : dr Kristina Nadeak SpKK ( K )
Sifilis
Gonore
Uretritis non spesifik
Trikomoniasis
Chancroid
Lymfogranuloma venereum
Donovanosis
Herpes genital
Vaginosis Bakterial
Kandidosis /Kandidiasis vulvovaginal
Kondiloma Akuminata
Hepatitis-B
Sitomegalovirus
Epstein-Barr Virus Infeksi
Pedikulosis pubis
Scabies
Intestinal Protozoa
HIV
Molluscum kontangiosum
Nama penyakit
Jlh
persen
Jlh
persen
Jlh
persen
sifilis
31
11,83
10
7,94
6,86
gonore
42
16,03
31
24,60
23
22,55
UNS/IGNS
55
20,99
19
15,08
17
16,67
Kondiloma Akuminata
43
16,41
27
21,43
23
22,55
chancroid
1,91
1,59
1,96
Herpes genital
15
5,73
3,18
1,96
Trikomonisasis
Vaginalis
2,67
2,38
2,94
Moluskum kontangiosum
1,15
1,59
1,96
HIV+ s
O,76
2,38
1,96
HIV + KA
1,91
6,35
6,86
Bakterial vaginosis
15
5,73
6,35
2,94
KVV
39
14,89
7,14
11
10,78
total
262
126
102
GONORE
Etiologi: Neisseria gonorrhoeae
:
Pria 1- 5 hari
Wanita sulit diketahui oleh
Masa inkubasi
Gejala klinis
Pria
Komplikasi :
Pria epididimitis infertilitas.
Wanita adneksitiskehamilan
Ektopik,infertilitas.
Lab :
PriaGramlekosit > 5/ Lpd.
wanitaGramlekosit> 30/Lpd.
( -) N.Go,Trich,C.Vag atau negatif
Kuman penyebab.
SIFILIS
Lab :
Peng Gram,Wright,Unnapapanheim atau Giemsa.
Test ELISA.
Limfogranuloma venereum(LGV)
Mengenai sistim saluran pembuluh
limfe dan kelenjar limfe( genital,
inguinal, anus dan rektum).
Etiologi : C.trachomatis serovars
L1,L2dan L3.
Masa inkubasi : 3-20 hari .
Gambaran klinis :Limfadenitis
inguinal yang unilateral, nyeri
Didahului lesi primer( erosi atau
ulkus dangkal atau vesikel atau
papel ).
Greeblatts sign,ettage bubo.
Gejala sistemik :demam,anoreksia.
Komplikasi:
Sindrom anorektal.
Sindrom genital
( Esthiomene).
Lab: Pengecatan Giemsa
dari pus
bubo.
serologi :complement
fixation
test,titer 1:1024
kultur jaringan.
Herpes genital
Etiologi : Herpes simplex virus,
umumnya tipe 2.
Masa inkubasi :
Biasanya 2-10 hari,dapat sampai
3 minggu .
Gejala klinis :
Herpes genital primerdiawali
dengan papul vesikel ulkus/
erosi multiple berkelompok,
diatas dasar eritematosa,sangat
nyeri dan edema di inguinal,
limfadenopati bilateral,dan kenyal
,disertai gejala sistemik.
Cytomegalovirus ( CMV)
Twentieth centuryhistologic appearance fatal
infection newborns
Enlarge cells with viral inclusion
> 50% of individual in most populations
throughouts the world demonstrate serological
evidence of prior CMV infection.
Morphology
Morphology
Epidemiology
Is a ubiquitous virus,as evidence infection :
*person of all ages ( u.s) 5-30 %children will be CMV seropositif by
5 0r 6 years age.
- adolesnce 40% & increase by 1% per year .
*socioeconomic group
* geographic locales
Transmissi
sexually transmissible infection based on several lines of
evidence : heterosexuals
* CMV seroprevalence among male partners of CMV
seropositive women than of CMV seronegative women ( 74% vs
31%) .
* Prevalence of CMV seropositivity in sexually active women ( age
of 15-30 years) was greater than than in celibate women
HOMOSEXUAL MEN
* first documentation San francisco ( 1970-early 1980 )
STDclinic,the
rate of CMVseropositivity in homoseksual men was 93,5% :54,3 % in
heteroseksual.
* Urinary excretion of CMV was found > in homoseksual men than
heterosexual,( 7,4% vs 0%).
* infection wiith multiple strains of CMV has been documented in homo
sexual men with and without HIV/AIDS
Excretion of CMV was found > in semen (34,6) :urine (7,7) and
semen harbored virus for longer periods of time than urine ( 22
months vs 9 months).
Transmission
Via BLOOD PRODUCTS and TRANSPLANTED ORGANS
CONGENITAL AND NEONATAL INFECTION
* three different routes : . Transplacentalreactivation
( 20-40%).
. Intrapartumlokal viral shedding.
50% of infant born to the 2-28 % 0f women who shedCMV
from vagina or cervix at time of delivery will become infected.
. Breast milk ( 30-70% of seropositive
women).
Clinical manifestations
Infection in immunocompetent
Symtomatic disease in otherwise healthy individual is
uncommon .
Primary infection can result in a mononucleosis like
syndrome :
Fever
lymphadenophaty
Pharingitis
Peripheral blood lymphocytosis
Clinical manifestation
Infection in the immunocompromised
In immunocompromised individual, primary infection or reactivation
of latent virus can be life-threatening .
. Retinitis
.polyradiculopathy :ascending lower-extremity
weakness
.meningoencephalitis
.esophageal ulceration .colitis
.sclerosing cholangitis
Neonates
Cytomegalic inclusion disease fatal
( jaundice,hepato splenomegaly,trombositopeni and CNS
involvement ).
Sensorineural hearing
lDiagnosis
* Cultur
* Antigen detection peripheral blood leukocytes detection of the
CMV pp65 tegumen protein.
* Polymerase chain reaction.
* Histopathology
owl eye nuclear inclusion.
Treatment
Antiviral agents :
Ganciclovir
a nucleoside analogue of guanosine.
as a competitive inhibitor of deoxyguanosin
triphosphate.
Valganciclovir
Valine ester of ganciclovir.
much greater bioavalaibility compare to oral ganciclovir.
Foscarnet
Cidofovir
Cytogam : high-titer CMV-immune globulin
Fomivirsen.
Implicated in oncogenesis :
( Transforming cells)
*Burkitts lymphoma
*Nasopharyngeal Ca.
*Hodgkins disease]
*B-Lymphoproliferativ
disorders
Virus classification :
Epidemiology
Epidemiology
In healthy,sexual active uncircumcised men, EBV DNA was
detected from coronal sulcus of the gland penis in 13% of study
participants.
Forty-eight percent of EBV seropositive men with uretral discharges
secondary to gonococcal infection had EBV DNA detected in their
genital tract secretions.
Transmission
Transmission EBV :
Kissing
sexual transmission : number of sexual partner.
after acquisition of a new
sexual partner .
blood transfusion
tissue transplantation
Clinical manifestation
Clinical manifestation
Serologic test
*normal to moderatedly elevated white blood cell count.
*Increased total number of lymphocytes,greater than 10 %
atypical lymphocytes.
*Positive reaction to a monospot test
*Positive paul-Bunnell heterophile antibody
KONDILOMA AKUMINATA
Etiologi :Human papilloma
virus.
Masa inkubasi :1-8 bulan,
rata-rata 2-3 bulan.
Gejala klinis:
Ada tiga bentuk :
1.Bentuk datar ( flat )
2.Bentuk papul
3.Bentuk verukosa
Terutama pada daerah yang
lembab.
Pada wanita dapat menimbul
kan kanker mulut rahim .
Pem penunjang :
Test asam asetat 5%
Kolposkopi
Histopatologi
MOLUSKUM KONTAGIOSUM
Etiologi : virus moluskum
kontagiosum
(VMK).
Masa inkubasi :1 migg-6 bulan,ratarata 2-3 bulan .
Lab : histologi
Trikomoniasis
Etiologi :Trichomonas vaginalis
Masa inkubasi :3-28 hari.
Gejala klinis :
Duh tubuh vagina homogen,
banyak,purulen,kadang-kadang
berbusa,mukosa vagina eritema,
berbau seperti ikan busuk, PH
vagina 5,0
Komplikasi :
Pada wanita hamil dapat
menyebabkan partus prematur,
bayi berat badan lahir rendah.
Kandidosis vulvovaginal
Etiologi :Candida albicans.
Gejala klinis :
Pruritus vulva, inflamasi pada
introitus dan labia, disertai
edema atau fisura,duh tubuh
vagina berdumpal,putih,kadangkadang dapat kental, atau
kekuningan,PH vagina 4,5.
Vaginosis Bakterial
Etiologi :pergantian Lactoba
sillus Spp dengan bakteri
anaerob dalam konsentrasi
tinggi(Bacteriodes,Mobiluncu
s),Gardnerella vaginalis dan
Mycoplasma hominis.
Masa inkubasi :belum pasti,
Diperkirakan beberapa hari
sampai 4 minggu .
Gejala klinis :
Vagina berbau amis terutama
setelah senggama, duh tubuh
vagina tidak terlalu banyak,
Homogen,putih keabu-abuan,
Skabies
Etiologi : Sarcoptes scabies Var
hominis.
Masa inkubasi :2-4 minggu .
Gambaran klinis :
Pruritus pada malam hari merupakan
gejala skabies utama,dan adanya
terowongan ( kunikuli). Lesi berupa
Vesikel,papel urtika dan dan lain-lain,
pada penis bentuk khas berupa nodul
coklat kemerahan yang gatal pada
daerah tertutup dan sering disertai lesi
ulseratif dan pioderma.
Komplikasi :
Infeksi sekunder,spt : lesi ulseratif
dan pioderma.
Pedikulosis Pubis
Intestinal Protozoa
Manifestasi klinis
Diare
Perut bagian atas kram dan sakit
Bloating (gembung)
Flatulence ( perut gembung )
Berat badan menurun
Jarang : vomiting ,nausea dan fever
Dilaporkan : Vaginits
Proctitis
HIV
HIV adalah Human Immunodeficiency Virus .
Di klasifikasi dalam famili Retroviridae ,sub family Lentiviridae
Terdiri : Inti dan Envelop .
Inti : Enzim reverse transcriptase,RNA
protein P7,P8,enzim
Capsid : P24,25 dan P17,18.
Envelop:Gp120 dan Gp 41 .
. Dalam RNA ada Gen Utama : GAG
,Pol,dan Env
Gen tambahan : Tat,Rev, Vpr, Nef,Vpu, Vif.
Tropisma
Penularan
Manifestasi klinis
Kedua
Ketiga
Daftar Kepustakaan