PENYAKIT

RADANG
PANGGUL

Dr. dr. Andi Mardiah Tahir, SpOG-K

Mentor: A. Žmegač Horvat
PENYAKIT RADANG PANGGUL
 Infeksi yang mengenai uterus, tuba fallopi, dan
sekitar rongga pelvik, yang tidak berhubungan
dengan operasi atau kehamilan
 Etiologi dan Patogenesis
 2 stadium PRP (PID):Akut dan Kronis
-berasal dari infeksi vagina atau infeksi serviks
-penjalaran mikro-organisme dari vagina dan
serviks ke rongga pelvik

ORGANISME PENYEBAB TERBANYAK :

• Neisseria gonorrhoeae dan Chlamydia trachomatis

• Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma

urealyticum, herpes simplex virus-2 (HSV-2), Trichomonas
vaginalis, cytomegalovirus, Haemophilus influenzae, Streptococcus
agalactiae
 Faktor risiko

 Usia muda
 Berganti-2 pasangan seksual
 Metode kontrasepsi tertentu
 Riwayat menderita chlamydia atau penyakit
menular seksual lainnya
 Terlambat dan sulit mendapat akses untuk
pengobatan
 GEJALA KLINIK
 Sakit perut bahagian bawah
 Vaginal discharge yang abnormal
 Perdarahan uterus abnormal
 Disuria
 Dispareunia
 Mual
 Muntah
 Demam

PRP Gonococcal - gejala klinik berupa demam dan

iritasi peritoneum (nyeri)
 Diagnosis

 Pemeriksaan fisis: nyeri perut bagian bawah, nyeri daerah

adneksa, nyeri pada pemeriksaan serviks
 Laboratorium: Darah lengkap, CRP, Urine lengkap, DNA gonorrhea
probes and culture, DNA clamydia probes and culture, test hepatitis dan HIV
 Pencitraan: transvaginal ultrasonography , CT scan
 Tindakan: biopsi endometrium
laparoskopi
 KOMPLIKASI
SCARRING INSIDE THE REPRODUCTIVE
ORGANS
ECTOPIC
CHRONIC PELVIC INFERTIL- PREGNANCY
PAIN ITY

SPREAD TO IN THE PERITONEUM

& FITZ-HUGH-CURTIS SYNDROME
Penanganan
 Obati keluhan utama
 Eradikasi dari penyebab infeksi
 minimalisasi efek jangka panjang
 antibiotik
 operatif (hilangkan atau drainase tubo-ovarial
abses)
Antibiotics
 Inpatient treatment
 Regimen A: Administer cefoxitin 2 g IV q6h or
cefotetan 2 g IV q12h plus doxycycline 100
mg PO/IV q12h.. Continue this regimen for 24
hours after the patient remains clinically
improved, and then start doxycycline 100 mg
PO bid for a total of 14 days. Administer
doxycycline PO when possible because of
pain associated with infusion. Bioavailability is
similar with PO and IV administrations. If tubo-
ovarian abscess is present, use clindamycin
or metronidazole with doxycycline for more
effective anaerobic coverage.
 Regimen B: Administer clindamycin 900 mg IV
q8h plus gentamicin 2 mg/kg loading dose IV
followed by a maintenance dose of 1.5 mg/kg
q8h. IV therapy may be discontinued 24 hours
after the patient improves clinically, and PO
therapy of 100 mg bid of doxycycline should
be continued for a total of 14 days. If tubo-
ovarian abscess is present, use clindamycin
or metronidazole with doxycycline for more
effective anaerobic coverage.
Outpatient treatment
Regimen A: Administer ceftriaxone 250 mg IM
once as a single dose plus doxycycline 100
mg PO bid for 14 days, with or without
metronidazole 500 mg PO bid for 14 days.
Metronidazole can be added if there is
evidence or suspicion for vaginitis or
gynecologic instrumentation in the past 2-3
weeks.
Regimen B: Administer cefoxitin 2 g IM once
as a single dose and probenecid 1 g PO
concurrently in a single dose or other single
dose parenteral third-generation cephalosporin
(ceftizoxime or cefotaxime) plus doxycycline
100 mg PO bid for 14 days with or without
metronidazole 500 mg PO bid for 14 days.
Metronidazole can be added if there is
evidence or suspicion of vaginitis or
gynecological instrumentation in the past 2-3
weeks.