GONORHEA

Hervina*

*Departement Of Dermatology and venereolgy

Faculty of Medicine Muhammadiyah University of North Sumatera
** Departement Farmacology Faculty of Medicine Muhammadiyah University of
North Sumatera

ABSTRAK

Uretritis gonore merupakan penyakit kelamin terbanyak dewasa ini dan dapat ditemukan
diseluruh dunia. Ketepatan waktu pengobatan, pemilihan obat yang benar dengan dosis yang
adekuat dapat mengeliminasi infeksi yang berdampak pada individu, mencegah terjadinya
pengembangan komplikasi, mencegah transmisi lebih lanjut serta menghindari resistensi kuman.
Tulisan ini melaporkan, pasien pria usia 24 tahun dengan diagnosa uretritis gonore yang datang
ke poliklinik Kulit dan Kelamin Rumah Sakit Syaiful Anwar Malang. Penderita datang dengan
keluhan keluar nanah dari kemaluan tanpa disertai rasa gatal. Pasien juga mengeluh nyeri saat
berkemih, serta kencing dalam volume sedikit dan sering. Pada pemeriksaan daerah urifisium
uretra eksterna didapatkan ektropion, discharge purulen, dan makula hiperemi. Terdapat benjolan
dan duh pada ujung kemaluan akibat radang pada kelenjar parauretra. Dari pemeriksaan
penunjang ditemukan bakteri diplokokus Gram negatif intrasellular PMN. Terapi kausatif yang
diberikan adalah Sefiksim 400mg dosis tunggal secara oral. Evaluasi dilakukan 3 hari setelah
pengobatan dan didapatkan perbaikan.
Kata Kunci : Nesseiria Gonorheae; uretritis gonore; terapi oral uretritis; uretritis gonore komplikasi

ABSTRACK

Urethritis gonorrhea is the most prevalent venereal disease today and can be found all
over the world. Timeliness of treatment, correct selection of drugs with adequate doses can
eliminate infections that affect the individual, prevent the development of complications, prevent
further transmission and avoid germ resistance. This article reports, 24-year-old male patient
with a diagnosis of gonore urethritis who came to polyclinic Skin and Veneral at Hospital
Syaiful Anwar Malang. Patients come with complaints of pus out of the genitals without itching.
Patients also complain of pain during urination, as well as urinating in small volume and often.
On examination of external urethra urifisium area obtained ectropion, purulent discharge, and
hyperemia macula. There is a lump and duh at the tip of the genitalia caused by inflammation of
the paraurethral glands. From the investigation found diplococcus bacteria Gram negative
intrasellular PMN. The causative therapy given is a single oral dose of Oral 400mg. Evaluation
was done 3 days after treatment and improvement was obtained.
Key Word : Gonorrhea Urethritis; Oral Urethritis Therapy; Uretritis Gonorrhea Complications
PRELIMINARY
Gonorrhea is a sexually transmitted
disease caused by gram-negative diplokokus
Neisseria ghonorhoeae bacteria that infects
the inner urethral lining, cervix, rectum,
throat, and conjunctiva.1 Spread of
gonorrhea in the body can be through the
bloodstream, especially the skin and joints.
In women, gonorrhea can spread to the
genital tract and then infect the membranes
that are inside the hip so that it causes hip
pain and reproductive disorders. 1 In general,
gonorrhea is a disease that has the highest
incidence among other sexually transmitted
diseases. sexual intercourse, namely genito-
genital, oro-genital, and ano-genital, but can
also be transmitted manually through
intermediaries that have been used by
sufferers such as clothing, especially
underwear, hats, thermometers, and etc.1
Gonorrhea disease is spread
throughout the world.11 In Africa, the
average prevalence of gonorrhea in pregnant
women is 10%.11 The incidence of
disseminated gonococcal infection DGI
varies with the local incidence of
gonococcal strains from DGI. The highest
incidence occurs in developing countries.11
The prevalence of DGI in pregnant women:
10% in Africa, 5% in Latin America, 4% in
Asia.11 The incidence of gonorrhea in the
United States increased dramatically in the
1960s and early 1970s to more than 1
million cases are reported annually.11 It is
estimated that less than one third of new
cases were reported.10 In 1980, there was a
slow decline in cases reported to around
700,000 per year.11 A gradual decline
continued with fewer than 400,000 cases of
gonorrhea reported in 2000.10 Declining
trend the infection slowed, but continued
until 1997.11\
DEFINITION
Gonorrhea is a venereal disease
which at the outset is thick white fluid in the
form of pus from OUE (external urethral
orifice) after sexual intercourse.5
Gonorrhea is a bacterial infection
caused by Neisseria gonorrhoeae, a gram
diplococcus whose reservoir is human.5 This
infection is almost always contracted during
sexual activity.11
ETIOLOGY
The cause of gonorrhea is Gonococci
found in 1982.11 After it was discovered, the
germs were entered into the Neisseria group
and in this group there were 4 species and
among them were N. gonorrhoeae, N.
meningitidis where both species were
pathogenic.3 Then 2 other species that were
commensel among them are N. catarrhalis
and N. pharyngis sicca
EPIDEMIOLOGY
Gonorrhea is everywhere throughout the
world and is the most sexually transmitted
disease today. There is no innate immunity,
even for people who have had this disease.
There is also no difference regarding
immunity between various ethnic groups,
gender or age.5 WHO estimates that no
fewer than 25 million new cases are found
every year in the world. According to the
CDC, it is estimated that around 820,000
people in the US have new gonorrhea
infections every year.5 Several strains of
gonococcal bacteria throughout the world
are currently resistant to thinning,
tetracyclines, and other old antimicrobial
agents, causing changes in treatment.5
 DIFERENTIAL DIAGNOSE

DIAGNOSE 1. Trikomoniasis
a. Pruritus, Urinary Pain
The definitive diagnosis of gonorrhea b. OUE Hiperemis
depends on the identification of organisms c. Sekrect Mukopurulensia
with Gram stain and / or culture.6

Gram negative Gonococci (-) was
found in disseminated gonoccocal infection
(DGI) in the blood, and skin lesions in
patients who were positively affected by the
disease.5
Gonorrhea patients will find
symptoms such as itching, heat in the distal
urethra and around OUE, dysuria,
polacisuria, out of the body from the tip of
the urethra which, sometimes accompanied
by blood, pain during erection.11
PATHOPHYSIOLOGY
Gonococcus has an affinity for
columnar epithelium; multilevel squamous
epithelium and more resistant to attack.2 The
epithelium is penetrated between epithelial
cells, causing polymorphonuclear (PMN)
submucocytes (leukocyte reaction) with the
release of purulent fluid produced.2
Gonococcus strain that causes DGI tends to
cause little genital inflammation and thus
avoid detection. Some of the signs and
symptoms of DGI are manifestations of
complex immune formation and
precipitation. Some episodes of DGI may be
related to abnormalities of terminal
complement component factors.10
2. Klamidiasis
a. Pruritus, Urinal Pain
b. OUE Hiperemis
c. Edema
d. Sekret Seropurulen
TREATMENT
 Cefixime 400 mg, Single Dose, PO,
or
 Levofloxacin 500 mg,Single Dose.7
Another Treatment :
o Kanamisin 2 g, Injection IM or7
o Tiamfenikol 3,5 g Single Dose PO
o Ceftriaxone 250 mg Single Dose
PO.7
PROGNOSE
The prognosis and prevention of
gonorrhea complications depend on
early diagnosis and appropriate
treatment with antibiotics.3
With fast and proper handling, this
infection can be treated properly.3
Generally, gonococcal infections have a
good response to the recommended
cephalosporin group antibiotics.3
CONCLUSION
Gonorrhea transmission is not only
transmitted by sexual intercourse, namely
genito-genital, oro-genital, and ano-genital.1
But it can also be transmitted manually
through intermediaries that have been used
by sufferers such as clothing, especially
underwear, hats, thermometers, and so on. 7
Diagnosis of gonorrhea (at most
acute anterior gonorrhea urethritis) from
history obtained complaints of itching and
heat in the distal urethra, especially around
the external urethral orifice, then followed
by dysuria, polacisuria, out of the body
sometimes accompanied by blood from the
urethra and accompanied by taste pain
during erection.8 At the time of examination,
it appears the erythematous, edematous and
ectropion external urethral orifice.
Investigation: direct preparation, culture,
thomson test, definitive test11
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