CASE REPORT

Laporan Kasus
FLUOR ALBUS

Pembimbing: dr. Fadil Hidayat SpOG

Disusun Oleh:
Gracelya Esther Liwanto 406192023

PJJ STASE OBGYN PERIODE 11 Mei – 24 Mei 2020 FAKULTAS KEDOKTERAN UNIVERSITAS TARUMANAGARA
Identitas Pasien

• Nama : Nn. X
• Jenis Kelamin : Perempuan
• Tgl Lahir : 18/04/1995
• Usia : 25 tahun
• Alamat : Jl. Melati, No. 9E
• Pekerjaan : Karyawan
• Pendidikan : SMA
• Status Perkawinan : Belum menikah
• Agama : Islam
Anamnesa

Tanggal : 13/04/20 jam: 12.30

• Keluhan Utama :
Pasien mengeluhkan keputihan sejak 1 minggu lalu.

• Riwayat Penyakit Sekarang :

Pasien datang ke poli rumah sakit mengeluhkan keputihan sejak 1
minggu lalu, keputihan dirasa gatal dan berbau amis.
Pasien mengaku tidak merasakan adanya demam, pusing, mual,
muntah, dan lemas.
• Riwayat Penyakit Dahulu :
Riwayat alergi, hipertensi, DM, asma, penyakit jantung, penyakit infeksi
genital disangkal

• Riwayat Penyakit Keluarga :

Riwayat alergi, hipertensi, DM, asma, penyakit jantung disangkal
 
• Riwayat asupan nutrisi :
Porsi makan pasien cukup, makan 3x sehari , makan nasi, daging,
sayur, dan buah.
• Riwayat lingkungan dan kehidupan sosial :
Pasien mengaku memiliki riwayat sering berganti-ganti pasangan seksual

• Riwayat menstruasi
Menarche usia 14 tahun, siklus teratur 28 hari, lamanya haid 1 minggu,
dengan jumlah darah sekitar 2-3x ganti pembalut sehari

• Riwayat kehamilan, persalinan atau keguguran :

Pasien mengaku belum pernah hamil, dan belum pernah mengalami
keguguran
 Pemeriksaan
Pemeriksaan Fisik
Tanggal : 13/04/20 jam: 13.00
• Keadaan Umum : Baik
• Kesadaran : Compos Mentis (GCS 15)
• Kepala : konjungtiva anemis (-/-), sklera ikterik (-/-), edema
wajah (-), epulis (-)
• Leher : tidak teraba pembesaran kelenjar tiroid
• Payudara : simetris, payudara tegang, puting susu runcing,
kolustrum (-)
• Thorax : suara nafas vesikuler (+/+), rhonki (-/-), wheezing
(-/-), bunyi jantung I & II normal
• Abdomen
Inspeksi : Perut tampak datar, striae (-), bekas luka (-)
Auskultasi : Bising usus (+) normal
Perkusi : Timpani, nyeri ketok (-)
Palpasi : Abdomen supel, nyeri tekan (-)

• Anus : tampak normal, perineum tidak menonjol, fissura ani (-),

benjolan (-)
• Vulva/vagina : tampak tenang, tidak ada benjolan, fluor (+), fluksus (-).
Pemeriksaan inspeculo : cervix
tampak hiperemis, dengan sekret
vagina berwarna kekuningan.
• Ekstremitas : akral hangat, varises (-), edema tungkai (-),
luka (-)
• Kulit : striae (-)
• KGB : tidak teraba pembesaran kelenjar getah bening
• Pemeriksaan neurologis tidak dilakukan

Pemeriksaan Penunjang
Tanggal : 13/04/20 jam: 13.30
• Pemeriksaan KOH : (+)
Resume

 Telah diperiksa pasien perempuan 25 tahun dengan keluhan

keputihan sejak 1 minggu lalu.
 Dari anamnesa didapatkan pasien mengeluhkan keputihan
sejak 1 minggu lalu, keputihan dirasa gatal dan berbau amis.
Pasien mempunyai riwayat berganti-ganti pasangan.
 Dari pemeriksaan fisik, pada pemeriksaan inspeculo didapatkan
cervix tampak hiperemis, dengan secret vagina berwarna
kekuningan.
 Dari pemeriksaan penunjang didapatkan pemeriksaan KOH (+).
 Diagnosis
Diagnosis Kerja:
Trichomoniasis
DD/: Bacterial Vaginosis

Rencana Diagnosis:
• Pemeriksaan mikroskopik
• Kultur
 Terapi

Terapi Farmakologis (alternatif) Terapi Non- Farmakologis

Metronidazole 2 g oral Metronidazole 500 mg

oral 2x1, selama 7 hari,
dosis tunggal atau atau Metronidazole 250
Tinidazole 2 g oral dosis mg oral 3x1, selama 7
hari.
tunggal
Rencana Terapi Non-
Farmakologis
• Pasien jangan berhubungan seksual
dulu selama pengobatan sampai
selesai.
• Pasien disarankan untuk tidak
bergonta-ganti pasangan.
• Jika ingin berhubungan seksual
diharuskan menggunakan kondom.
• Menjaga kebersihan area genital
agar tidak mudah terkena infeksi
sekunder.
Rencana evaluasi
Follow up pasien dalam 2 minggu (sampai 3 bulan) setelah
pengobatan, untuk melihat hasil terapi & memastikan pasien tidak
terinfeksi kembali.
 Kesimpulan
Pasien perempuan, 25 tahun, dari anamnesa, pemeriksaan
fisik, dan pemeriksaan penunjang didiagnosa menderita
trichomoniasis.
Trichomoniasi
s
 Definisi
● Trichomoniasis adalah infeksi menular seksual (IMS) yang disebabkan oleh
protozoa Trichomonas vaginalis yang menyerang saluran urogenital.

● Parasit ditularkan melalui kontak seksual.

Traktus urogenitalis Urethra,

bawah: vulva, vagina, prostat.
cervix, urethra.
 Etiologi

● Parasit penyebab adalah

Trichomonas vaginalis.
● Trichomonas vaginalis
merupakan protozoa flagellata
yang mempunyai 4 flagella di
bagian anterior yang membuat
parasit ini motile.
 Epidemiologi

Tingkat
infeksi: 170
Wanita juta pertahun

Prevalensi ↑> 2x
11% pada usia lebih sering pada
pasien dengan
>40 tahun (40-
HIV
49 tahun)
Di US, diperkirakan
3.7 juta orang
terinfeksi T. vaginalis
 Patofisiologi

Epitel vagina Asam Laktat Mengontrol &

(kaya pH vagina: 3.8-4.5 mencegah
glikogen) Flora normal terjadinya infeksi.
(Lactobacillus)

Wanita dalam
kondisi yang normal
 Patofisiologi

T. Vaginalis masuk
melalui hubungan seksual
❏Inkubasi T. vaginalis (penile-vaginal sex)
3 hari – 4 minggu
❏Asimptomatis  ½
T. Vaginalis mengadhesi
wanita terinfeksi epitel skuamosa &
bermultiplikasi

Suplai glikogen ↓ Keasaman vagina ↓

(pH naik di atas 5.0)
Lactobacillus ↓↓

Infeksi bakteri patogen

 Manifestasi Klinis
Foul Odor Stawberry Cervix/Colpitis
Macularis

Duh vagina berbau Vulva vagina eritema,

busuk, berwarna edema, dan ekskoriasi.
kuning kehijauan, Tampak subepithelial
berbusa, pH > 4.5 hemorrhages pada
vagina & cervix
 Disuria

Dispareunia
Manifestasi Klinis
Pruritus vulva

Vaginal Spotting
 Diagnosis
 Mikroskopik. Highly spesific  sediaan basah saline
 dilihat di mikroskop dalam waktu 20 menit  T.
vaginalis: bentuk oval, ukuran > dari leukosit, flagella
bergerak aktif. Disertai pH > 4.5.
 Diagnosis

 KOH 10-20%  bau yang tajam dan amis (fishy odor)

pada 75% trichomoniasis dan infeksi bacterial vaginosis.
 Kultur. Most sensitive  Diamond media
 Serologis  OSOM Trichomonas Rapid Test (sensitifitas
88%, spesifitas 99%)
 Trichomonal DNA (NAAT)  tidak tersedia secara luas.
 Tatalaksana
Recommended Metronidazole 2 g
regimens oral, single dose

Tinidazole 2 g oral,
single dose atau
Metronidazole 500
Alternative mg oral, 2 kali
regimens sehari, selama 7
hari

Pasien dilarang mengonsumsi alkohol 24 jam setelah

mengonsumsi metronidazole / 72 jam setelah
mengonsumsi tinidazole  disulfiram-like reaction
Tatalaksana Non-Farmakologis

Tidak berganti pasangan seksual,

01 menggunakan kondom saat
berhubungan seksual

Mengobati pasangan pasien, dan

02 tidak melakukan hubungan seksual
dulu selama masa pengobatan

Melakukan pemeriksaan untuk

03 kemungkinan penyakit infeksi
menular seksual lainnya.
Diagnosis Banding
● Bacterial Vaginosis
● PID
Komplikasi
1. Morbiditas↑  Kehamilan:
 Kelahiran premature
 Berat Badan Lahir Rendah pada
bayi
 Ketuban Pecah Dini (KPD)
2. ↑ resiko HIV, dan IMS lainnya.
 Daftar Pustaka
● Schwebke JR, Burgess D. Trichomoniasis. Clin Microbiol Rev.

2004;17(4):794–803. doi:10.1128/CMR.17.4.794-803.2004

● Schumann JA, Plasner S. Trichomoniasis. [Updated 2019 Jan 13]. In:

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.

Available from: https://www.ncbi.nlm.nih.gov/books/NBK534826/

● Meites E. Trichomoniasis: the "neglected" sexually transmitted disease. Infect

Dis Clin North Am. 2013;27(4):755–764. doi:10.1016/j.idc.2013.06.003

● Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JL, Corton

MM. Williams Gynecology. 3rd ed. New York: McGraw-Hill; 2016. p. 63-64.
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