PERAN SpOG DALAM TATALAKSANA IBU

HAMIL DENGAN INFEKSI HIV, SIFILIS DAN

HEPATITIS B GUNA MENDUKUNG TRIPLE
ELIMINASI

POKJA INFEKSI SALURAN REPRODUKSI POGI

2019
TUJUAN PEMBELAJARAN
 Mampu melakukan tata laksana ibu hamil terinfeksi HIV, sifilis dan hepatitis B
sesuai standar.

POKOK BAHASAN
• Analisis situasi
• Program triple eliminasi
• Diagnosis infeksi HIV, sifilis, hepatitis B
• Penatalaksanaan ibu hamil terinfeksi HIV, sifilis, hepatitis B
 INDONESIA

SDG 3 = Promosi hidup sehat dan kesejahteraan bagi semua orang dari segala usia dengan
memperhatikan prioritas kesehatan sebagai wawasan pembangunan, termasuk kesehatan
reproduksi, kesehatan ibu dan anak dan penanggulangan penyakit menular.
2.50%

1.70%
 Resiko penularan dari ibu ke anak untuk HIV 20 – 45 %
 Resiko penularan dari ibu ke anak untuk sifilis 69 – 80 %
 Resiko penularan dari ibu ke anak untuk hepatitis B > 90 %
0.30%

HIV Sifilis Hepatitis B 2016 HIV Sifilis Hepatitis B

2016 HIV AIDS Ibu Hamil 5.354.594
usia <4th 4.965 Ibu Hamil dites 726.764 43.873 173.439
17.841 Ibu Hamil terinfeksi 4.389 4.169 4.418
usia 5-15th 2.273
est 2020 20.825 Ibu Hamil ditangani 1.234 n/a n/a
Januari - Juni 2017 HIV Sifilis Hepatitis B Januari-Juni 2017 HIV Sifilis Hepatitis B
Bayi lahir hidup 2.635.008 Ibu Hamil 2.662.163
Bayi lahir hidup dari ibu Ibu Hamil dites 618.651 39.660 213.632
396 N/A 2.497
terinfeksi Ibu Hamil terinfeksi 3.202 3.295 5.255
Bayi Penanganan dini 360 N/A 2.492 Ibu Hamil ditangani 740 344 N/A
Bayi tes PCR (EID DBS) 63 N/A N/A
Bayi terinfeksi 26 N/A N/A
 WHO Guidance 2014
• Antenatal care coverage (at
least one visit) of >95%
• Coverage of HIV and/or
syphilis testing of pregnant
women of >95%
• Antiretroviral treatment
coverage of HIV-positive
pregnant women of >90%
• Treatment of syphilis-
seropositive pregnant
women of >95%.
* Global AIDS Monitoring Report 2017
Current Situation in Indonesia*
• ANC coverage is 93.9% (DHS
2017)
• HIV testing coverage in
pregnant women doubling
from 2016 to 25%
• ARV coverage is still low (13%)
• Syphilis testing and treatment
in pregnant women requires
more attention with current
coverage for testing is only
1.6% and treatment 26%.
 ROADMAP
ELIMINASI PENULARAN
HIV, SIFILIS & HEPATITIS B
DARI IBU KE ANAK Di INDONESIA
(Permenkes No.52 Tahun 2017)

2018 - • Akses Terbuka

2019

2020- • Pra Eliminasi

2021

2022 • Eliminasi

2023- • Pemeliharaan
2025

Infeksi baru HIV, sifilis dan hepatitis < = 50 / 100.000 kelahiran hidup pada tahun 2022
 Indikator dan Target Ibu hamil
dalam ‘triple’ Eliminasi Penularan
Indikator HIV Sifilis Hepatitis B
Ibu hamil diperiksa, Cakupan 2018 : 60% dari ibu hamil K1
dites, dideteksi dini Cakupan 2019 : 70% dari ibu hamil K1
ANC 10T lengkap Cakupan 2020 : 80% dari ibu hamil K1
Cakupan 2021 : 90% dari ibu hamil K1
berkualitas Cakupan 2022 : 100% dari ibu hamil K1

Penanganan bagi 100% ibu hamil diobati 100% ibu hamil diobati 100% kasus
ibu hamil dengan ARV, berupa Kombinasi dengan Benzatin hepatitis B pada ibu
hasil positif Dosis Tetap (KDT) setiap Penicilin G 2,4 juta IU hamil dalam
hari sekali (tiap 24jam) IM sebagai program pengawasan,
seumur hidup dosis tunggal pada fase dirujuk ke rumah
dini, diulang 2 kali dgn sakit yang mampu
selang waktu 1 minggu tatalaksana
atau dirujuk hepatitis B

Ibu bersalin di 100% bersalin di 100% bersalin di 100% bersalin di

fasyankes fasyankes oleh nakes fasyankes oleh nakes fasyankes oleh
nakes
 Indikator dan Target Bayi
dari Ibu terinfeksi dalam Eliminasi Penularan
Indikator HIV Sifilis Hepatitis B
Penanganan anak 100% mendapat 100% mendapat 100% mendapat
dari ibu positif pelayanan standar pelayanan standar pelayanan standar
profilaksis ARV dalam 6 - pengobatan Benzatin imunisasi HB0 <24
12 jam sampai usia 6 Penicilin G 50.000 jam dan
minggu, selanjutnya IU/kgBB IM dosis HBIg <24 jam,
ditambahkan tunggal, pemeriksaan dilanjutkan dengan
kotrimoksazol profilaksis, titer RPR usia 3 bulan imunisasi HB1,2,3,4
pemeriksaan EID (PCR dibandingkan titer (vaksin DPT-HB-Hib),
kualitatif dgn DBS) dan ibunya, atau pemeriksaan
atau RNA/viral load mulai pemeriksaan lain atau serologis HBsAg
6 minggu atau pemantauan klinis saat bayi usia 9-12
pemeriksaan serologis sampai 2 tahun bulan.
pada usia 18 bulan
Anak negatif 95 - 100% anak dari ibu 95 - 100% anak dari ibu 95 - 100%
(keberhasilan HIV hasil pemeriksaannya sifilis hasil pemeriksaan
program 3E) negatif. pemeriksaannya negatif serologis HBsAg
,atau sama dengan titer negatif.
ibu anak sehat, tanpa
cacat atau kematian
 Pencegahan &
Pengendalian
HIV AIDS & PIMS Permenkes 97 thn 2014
pada Bag Kedua : pelayanan
KEHAMILAN masa kehamilan
Pasal 12 ayat 3
ANC Terpadu
(10 T)
PMK 51/2013 tentang
Pedoman PPIA
5 Juta Ibu 1. Timbang Badan dan Ukur Tinggi RUMAH SAKIT
Hamil Badan
2. Ukur Tekanan Darah

3. Nilai Status Gizi (ukur LiLA)

4. (ukur) Tinggi Fundus Uteri

Hb
5. Tentukan Presentasi Janin dan DJJ
Golongan Darah
6. Skrining Status Imunisasi TT (dan
Pusk ; Pemberian Imunisasi TT) Glukoprotein
Klinik ;Bidan ;RS 7. Pemberian Tablet Besi urine
8. Pemeriksaan laboratorium HIV
Fasyankes yang 9. Tata Laksana Kasus Sifilis
memiliki Hep B
10. Temu Wicara
layanan:
• HIV/PPIA
• IMS
• PUSKESMAS
ARV
3jk 10/06/2022
 2016 3E – MTCT / PPIA
ANC HIV Sifilis Hep B
Deteksi Tes HIV Tes Sifilis Tes Hep B
dini

+ + +
R1 (+), R2 (+), R3 (+) TP Rapid Rapid Hep B

Hasil

ARV Benzatin Penisilin G

ANC KDT 1 tab/24jam
seumur hidup
2,4 juta IU
boka-boki
Pengawasan
ketat

ARV profilaksis Trias Hutchinson, Pengawasan ikterik

BBL Cotrim profilaksis
PCR EID usia 4-6 mgg
Snuffle,
Penicillin Aqueous IV
HB0 < 24 jam
HBIg < 24 jam
 DEFINISI
HIV adalah virus yang menyerang sistem imun dan jika tidak
diterapi dapat menurunkan daya tahan tubuh manusia hingga
terjadi kondisi Acquired Immuno Deficiency Syndrome (AIDS).
Sifilis adalah salah satu jenis infeksi menular seksual yang
disebabkan oleh bakteri Treponema Pallidum.
Hepatitis B adalah penyakit menular dalam bentuk peradangan hati
yang disebabkan oleh virus hepatitis B.
PMTCT SYPHILIS INFECTION
Klasifikasi SIFILIS (WHO)
Perjalanan penyakit SIFILIS
 Skin lesions of secondary syphilis

Red to violet raised papules on the palms (A) and

soles (B) are characteristic of secondary syphilis.
([A and B] Courtesy Dr. Stanton Wesson,
Department of Dermatology, University of Florida
College of Medicine, Gainesville, FL.)
Duff. P. Maternal and Fetal Infections. In: Resnik R, editor. Creasy and resnik's maternal-fetal medicine : principles and
practice. 8th edition. ed. Philadelphia, MO: Elsevier; 2018. p. 862-919.e8,.
 Congenital Syphilis Case Definition
Presumptive Case Confirmed Case
Any infant whose mother had untreateda Infant in whom Treponema
or inadequately treated syphilis at palladium is identified by darkfield
delivery, regardless of signs or microscopy, fluorescent antibody,
symptomsb or other specific stains in
or specimens from lesions, placenta,
Any infant who has a reactive umbilical cord, or autopsy material
treponemal test for syphilis and any one
of the following:
• Evidence of congenital syphilis on
physical examination
• Evidence of congenital syphilis on long-
bone radiography
• Reactive CSF VDRL test
• Elevated CSF white blood cell count
(>5/mm3) or protein concentration (>5
mg/dL)
Duff. P. Maternal and Fetal Infections. In: Resnik R, editor. Creasy and resnik's maternal-fetal medicine : principles and
practice. 8th edition. ed. Philadelphia, MO: Elsevier; 2018. p. 862-919.e8,.
 Congenital Syphilis
Infants should be treated for presumed congenital syphilis if they were born to mothers in
the following categories:
• Mothers who have untreated syphilis at delivery
• Mothers who have serologic evidence of relapse or reinfection after treatment (i.e., a
fourfold rise in titer)
• Mothers who were treated for syphilis during pregnancy with nonpenicillin regimens
• Mothers who were treated for syphilis less than 1 month before delivery
• Mothers who do not have a well-documented history of treatment of syphilis
• Mothers who do not demonstrate an adequate response (fourfold decrease of
nontreponemal antibody titers) despite appropriate penicillin treatment
• Mothers who were treated for syphilis appropriately before pregnancy but had
insufficient serologic follow-up to ensure response to treatment.

Any child with symptomatic congenital syphilis should undergo a lumbar puncture, complete
blood count, and long-bone radiography before treatment. If these results are normal, a
single intramuscular dose of benzathine penicillin G (50,000 units/kg) should be given. With
abnormal results or if compliance is not ensured, the infant should be given a 10-day course
of either aqueous crystalline penicillin G (50,000 units/kg IV every 12 hours for the first 7
days of life, and then every 8 hours for the next 3 days) or procaine penicillin (50,000
units/kg/d IM).
Duff. P. Maternal and Fetal Infections. In: Resnik R, editor. Creasy and resnik's maternal-fetal medicine : principles and
practice. 8th edition. ed. Philadelphia, MO: Elsevier; 2018. p. 862-919.e8,.
 The natural history of untreated syphilis
in pregnancy

Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives Saved Tool supplement detection and treatment of syphilis
in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health. 2011;11 Suppl 3:S9.
 The course of untreated syphilis.

Dobson SR. Syphilis. In: Cherry JD, Harrison GJ, Kaplan SL, Hotez PJ, Steinbach WJ, editors. Feigin and Cherry's Textbook
of Pediatric Infectious Diseases 8th edition. ed. Philadelphia, PA: Elsevier/Saunders; 2019. p. 1268-84.e3.
Algorithm for evaluation and treatment of infants born to
mothers with reactive serologic tests for syphilis

TREATMENT:
(1) Aqueous penicillin G 50,000 U/kg IV q 12
hr ( 1 wk of age), q 8 hr (>1 wk), or procaine
penicillin G 50,000 U/kg IM single daily
dose, x 10 days
(2) Benzathine penicillin G 50,000 U/kg IM x 1
dose
Dobson SR. Syphilis. In: Cherry JD, Harrison GJ, Kaplan SL, Hotez PJ, Steinbach WJ, editors. Feigin and Cherry's Textbook
of Pediatric Infectious Diseases 8th edition. ed. Philadelphia, PA: Elsevier/Saunders; 2019. p. 1268-84.e3.
Treatment Guidelines for Congenital Syphilis
Scenario Maternal Stage/Treatment Evaluation Antimicrobial Regimen
Infant age ≤28 d with proven or highly Any or none CSF analysis: VDRL, cell count, and Aqueous penicillin G 50,000 U/kg IV q12h
probable disease: protein; CBC and platelet count; other (≤1 wk old), q8h (>1 wk old, ≤4 wk old),
(a) Abnormal physical examination tests as clinically indicated (e.g., long q6h (>4 wk old) × 10 d, or
(b) Abnormal evaluationa bone radiographs, liver function tests, Procaine penicillin G 50,000 U/kg IM × 10
(c) Serum nontreponemal titer ≥4 times ophthalmologic examination, hearing d (≤4 wk old)
maternal titer evaluation, neuroimaging)
(d) Visualization of spirochetes in clinical
specimen

Infant age ≤28 d with possible congenital Any stage of infection and: mother CSF analysis for VDRL, cell count, and If complete evaluation normal:
syphilis: normal physical examination and (a) was not treated, inadequately protein; CBC and platelet count; long (a) benzathine penicillin G 50,000 U/kg
serum quantitative nontreponemal titer treated, or has no documented bone radiographsb IM
the same or less than fourfold the treatment; (b) was treated with × 1c or
maternal titerb erythromycin or other nonpenicillin (b) aqueous penicillin G 50,000 U/kg IV
regimen; or (c) received appropriate q12h (≤1 wk old), q8h (>1 wk old, ≤4 wk
treatment but ≤4 wk before delivery old), q6h (>4 wk old) × 10 days, or
(c) procaine penicillin G 50,000 U/kg IM ×
10 d (≤4 wk old)

Infant age ≤28 d with congenital syphilis
less likely: normal physical examination
and serum quantitative nontreponemal
titer the same or less than fourfold the
maternal titer
Mother with: No evaluation Benzathine penicillin G 50,000 U/kg IM ×
(a) adequate therapy >4 wk before 1 (preferred), or
delivery, and appropriate for stage of Clinical, serologic follow-up
infection; or
(b) nontreponemal titers remained stable
and low for late syphilis and no evidence
of reinfection or relapse

Infant age ≤28 d old with congenital
syphilis unlikely: normal physical
examination and serum quantitative
nontreponemal titer the same or less
than fourfold the maternal titer
Mother with adequate therapy before None None
pregnancy and nontreponemal serologic titer
remained low and stable during pregnancy
and at delivery

Congenital syphilis in infant age >28 d
Any or none CSF analysis: VDRL, cell count, protein; Aqueous penicillin G, 50,000 units/kg q4–
CBC and differential; platelet count. 6h × 10 dd
As clinically indicated: radiographs of
long bones, liver function tests,
neuroimaging (cranial ultrasonography),
eye examination, hearing evaluation

Dobson SR. Syphilis. In: Cherry JD, Harrison GJ, Kaplan SL, Hotez PJ, Steinbach WJ, editors. Feigin and Cherry's Textbook
of Pediatric Infectious Diseases 8th edition. ed. Philadelphia, PA: Elsevier/Saunders; 2019. p. 1268-84.e3.
 Natural course of untreated syphilis

Radolf JD. Syphilis (Treponema pallidum). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases.
8th Ed, Updated Edition ed2015. p. 2684-709.e5.
Stage of syphilis

POKJA Infeksi Saluran Reproduksi PB POGI

 Stages of syphilis

Cohen SE, Engelman J, Klausner JD. Syphilis (Treponema pallidum). Netter’s Infectious Diseases2012. p. 351-
61.
 Study-specific and summary estimates of the proportion (%) of all
adverse pregnancy outcomes (APOs) among women with untreated
syphilis and women without syphilis

Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of
pregnancy: a systematic review and meta-analysis. Bull World Health Organ. 2013;91(3):217-26.
 Study-specific and summary estimates Study-specific and summary estimates of
of the proportion (%) of selected the proportion (%) of selected adverse
adverse outcomes among women outcomes among women with
WITHOUT syphilis UNTREATED SYPHILIS

Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of
pregnancy: a systematic review and meta-analysis. Bull World Health Organ. 2013;91(3):217-26.
 Neonatal Premature birth/
Stillbirth
death low birth weight
n n % 95% CI n % 95% CI n % 95% CI
2013 233 5 2.15 [0.70– 4.94] 3 1.29 [0.27– 3.72] 22 9.82 [6.01– 13.95]
2014 350 4 1.14 [0.31– 2.90] 1 0.29 [0.72– 1.58] 25 7.25 [4.68– 10.36]
2015 2330 5 2.15 [0.70– 4.94] 0 0 [0–1.57] 26 11.40 [7.42– 15.92]
Total 8160 14 1.72 [0.94– 2.86] 4 0.49 [0.13– 1.25] 73 9.16 [7.08– 11.12]

APO (excluding
Neonatal Congenital premature or low
asphyxia syphilis
birth weight)
n n % 95% CI n % 95% CI n % 95% CI
2013 233 2 0.89 [0.10– 3.07] 3 1.34 [0.27– 3.72] 13 5.63 [3.00– 9.35]
2014 350 3 0.87 [0.18– 2.48] 3 0.87 [0.18– 2.48] 11 3.17 [1.58– 5.55]
2015 2330 0 0 [0–1.57] 1 0.44 [0.01– 2.37] 6 2.62 [0.95– 5.52]
Total 8160 5 0.63 [0.20– 1.42] 7 0.88 [0.35– 1.76] 30 3.72 [2.49– 5.21]
 Quality assessment of evidence for treatment with at least 2.4MU
penicillin for women with active syphilis in pregnancy to prevent
adverse pregnancy and neonatal outcomes

Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives Saved Tool supplement detection and treatment of syphilis in
pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health. 2011;11 Suppl 3:S9.
 Sensitivity and Specificity of Serologic Tests for Syphilis
        Sensitivity during stage of infection, % (range)     Specificity, %
  Primary Secondary Latent Late (range)

Nontreponemal tests          
VDRL 78 (74–87) 100 96 (88–100) 71 (37–94) 98 (96–99)
TRUST 85 (77–86) 100 98 (95–100) NA 99 (98–99)
RPR 86 (77–99) 100 98 (95–100) 73 98 (93–99)
Early treponemal tests          
MHA-TP 76 (69–90) 100 97 (97–100) 94 99 (98–100)
TPPA 88 (86–100) 100 100 NA 96 (95–100)
TPHA 86 100 100 99 96
FTA-ABS 84 (70–100) 100 100 96 97 (94–100)
Enzyme immunoassays
IgG-ELISA 100 100 100 NA 100
IgM-EIA 93 85 64 NA NA
ICE 77 100 100 100 99
Immunochemiluminescence
assays
CLIA 98 100 100 100 100

Sena AC, White BL, Sparling PF. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the
21st century. Clin Infect Dis. 2010;51(6):700-8.
 Screening Syphilis Infections in Pregnancy
When to screen All women should be screened at their
first prenatal visit.
Repeat screening should be performed in
all pregnancies early in the third trimester.
Patients should be screened at delivery if
not screened previously or if at high risk.
How to screen* Treponemal and nontreponemal test
Diagnostic criteria Positive treponemal and nontreponemal
test

Nyholm JL. Maternal and Perinatal Infection: Chlamydia, Gonorrhea, and Syphilis in Pregnancy. In:
Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ERM, et al., editors. Obstetrics :
normal and problem pregnancies. Seventh edition. ed. Philadelphia, PA: Elsevier; 2017. p. 1089-98.
 Composite results of syphilis
testing algorithms using
treponemal tests for initial
screening and recommendations
from the Centers for Disease
Control and Prevention, 2008

Sena AC, White BL, Sparling PF. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the
21st century. Clin Infect Dis. 2010;51(6):700-8.
 DIAGNOSA IBU HAMIL DENGAN SIFILIS

1. Tes serologi : tes non-treponema & treponema

Tes non- treponema
RPR (rapid plasma reagin/rapidtest)
VDLR (venereal diseases research labotory).
Tes spesifik treponoma
tes TPHA (Treponema Pallidum HaemagglutinatioAssay)
TP Rapid (Treponema Pallidum Rapid),
TP-PA(Treponema Pallidum Particle AgglutinationAssay),
FTA-ABS (FluorescentTreponemal AntibodyAbsorption).
2. Tes Cepat Sifilis (Rapid test Syphilis)

POKJA Infeksi Saluran Reproduksi PB POGI

 Seroreactivity of Common Tests
for Untreated Syphilis
 Test Primary Secondary Latent Tertiary
Stage Stage Stage Stage
VDRL or RPR 80-85 95-98 75 <66
FTA-ABS, TP-PA 75-85 100 100 100

Kollmann TR. Syphilis. Remington and Klein's Infectious Diseases of the Fetus and Newborn
Infant. 8th Ed ed2016. p. 512-43.
 SKRINING
• Semua ibu hamil  skrining sebelum usia
kehamilan 16 minggu dan diulang pada awal
kehamilan trimester 3 (3 bulan kemudian).
• Skrining dengan VDRL / RPR atau TP rapid jika
fasilitas ini ada pada kunjungan pertama
pelayanan antenatal di semua Fasyankes.
• Jika selama kehamilan belum dikerjakan
skrining, maka dilakukan pada masa nifas.

POKJA Infeksi Saluran Reproduksi PB POGI

Alur Tes Serologis Sifilis Pada
Ibu Hamil
Bila Hanya Tersedia TP Rapid
 Alur Tes Serologis Sifilis
Bila TERSEDIA Tes Non
Treponema dan Treponema
 Interpretasi
Tes Serologi Sifilis
RPR atau TPHA atau
VDRL TP Rapid INTERPRETASI
Reaktif Non reaktif Tes skrining nontreponema
positif palsu
Reaktif Reaktif  Sifilis yang belum diobati;
 Sifilis lanjut yang pernah
diobati
 Frambusia
 Interpretasi
Tes Serologi Sifilis
RPR atau TPHA atau
VDRL TP Rapid INTERPRETASI

Non reaktif Reaktif  Sifilis sangat dini yang belum

diobati;
 Sifilis dini yang pernah diobati
 Frambusia
Non reaktif Non reaktif  Bukan sifilis;
 Sifilis masa inkubasi;
 Sifilis sangat lanjut;
 Sifilis bersamaan dengan infeksi
HIV dan imunosupresi
 Tatalaksana
SIFILIS pada ibu hamil
• Sifilis DINI (S-1 dan S-2):
– Benzathin penicillin G 2,4 juta unit dosis tunggal
injeksi intramuskular ATAU
– Procaine penicillin G 1,2 juta unit injeksi
intramuskular sekali sehari selama 10 hari
– Bila alergi penisilin dan tidak memungkinkan untuk
desensitisasi, atau tidak tersedia:
• Eritromisin 4X500 mg per oral selama 14 hari ATAU
• Seftriakson injeksi intramuscular 1 g sekali sehari, selama 14 hari, ATAU
• Azitromisin 2g per oral dosis tunggal
• Catatan: ketiga obat dapat mengobati ibu hamil, namun tidak dapat
melewati sawar plasenta, sehingga tidak dapat mengobati janinnya
WHO guidelines for the treatment of Treponema pallidum (syphilis). 2016
 Tatalaksana
SIFILIS pada ibu hamil
• Sifilis LANJUT (termasukS laten):
– Benzathin penicillin G 2,4 juta unit injeksi
intramuskular sekali seminggu selama 3 minggu
berturut-turut (interval jangan melebihi 14 hari)
ATAU
– Procaine penicillin 1,2 juta unit injeksi intramuskular
sekali sehari selama 20 hari
– Bila alergi penisilin dan tidak memungkinkan untuk
desensitisasi, atau tidak tersedia:
• Eritromisin 4X500 mg per oral selama 30 hari
• Catatan: obat dapat mengobati ibu hamil, namun tidak dapat
melewati sawar plasenta, sehingga tidak dapat mengobati janinnya
WHO guidelines for the treatment of Treponema pallidum (syphilis). 2016
 Reaksi Jarisch-Herxheimer
• Reaksi demam akut, seringkali disertai nyeri
kepala, mialgia, dan keluhan lain
• Biasanya terjadi dalam 24 jam pertama setelah
pemberian terapi awal apapun untuk sifilis dan
seringkali terjadi pada pasien sifilis dini,
kemungkinan karena bakteri masih sangat
banyak dalam stadium dini
 Reaksi Jarisch-Herxheimer
• Pasien harus diberi tahu mengenai kemungkinan
ini
• Dapat diberikan antipiretik untuk mengurangi
simtom, namun tetap tidak dapat mencegah
reaksi ini
• Reaksi Jarisch-Herxheimer dapat menginduksi
partus atau menyebabkan fetal distress pada
perempuan hamil, namun keadaan ini jangan
menjadi alasan untuk tidak mengobati atau
menunda pengobatan
 Jarisch-Herxheimer Reactions
• Up to 60% of patients with early syphilis and a significant proportion of patients with later
stages of syphilis experience a transient febrile reaction after therapy for syphilis.
• The pathogenesis is unclear, but it may be caused by the liberation of antigens from
spirochetes.
• This reaction usually occurs in the first few hours after therapy, peaks at 6 to 8 hours, and
disappears within 12 to 24 hours of therapy.
• On occasion, Jarisch-Herxheimer reactions are mistaken for allergic reactions to syphilis
therapy.
• Temperature elevation is usually low grade, and there is often associated myalgia,
headache, and malaise.
• The skin lesions of secondary syphilis are frequently exacerbated during the Jarisch-
Herxheimer reaction, and cutaneous lesions that were not visible may become visible.
• The reaction is generally of no clinical significance and in most cases can be treated with
salicylates.
• Corticosteroids have been used to prevent adverse effects of the Jarisch-Herxheimer
reaction, but there is no evidence that they are clinically beneficial (other than reducing
fever) or necessary. Institution of treatment with small doses of penicillin does not
prevent the reaction.
Hook EW. Syphilis. In: Goldman L, Schafer AI, editors. Goldman-Cecil medicine. Philadelphia, PA:
Elsevier/Saunders; 2016. p. 2013-20.e2.
 MONITOR
• Pemeriksaan serologi VDRL dan RPR pada bulan ke – 3
dan bulan ke – 6 (VDRL dan RPR menurun 4x)
• Selama kehamilan titer serologi diperiksa setiap bulan
(wanita risiko tinggi reinfeksi).
• Evaluasi USG pada usia kehamilan > 20 minggu untuk
melihat sifilis kongenital yaitu:
• hepatomegali,
• penebalan plasenta,
• hidramnion,
• ascites,
• hidrops fetalis dan
• peningkatan arteri serebri media.
SIFILIS KONGENITAL
Organ tubuh janin yang terkena sifilis:
• Plasenta
• Hepar
• Paru-paru
• Tr. Gastrointestinal
• Ginjal
• Pankreas
• Susunan syaraf pusat
• Sistem tulang

W_Indriatmi 44
TERIMA KASIH
Management Options Evidence Quality and Recommendation
Labor and Delivery
Some states in the United States require testing —/GPP
of all women at delivery.
Evaluate all cases of stillbirth > 20 wk for the IV/C
presence of syphilis.
Inform pediatricians of prenatal syphilis. IV/C
Postnatal
Alert pediatricians to the presence of syphilis IV/C
during pregnancy so that they can properly
evaluate the neonate for early (snuffles, rash,
hepatosplenomegaly, jaundice) and late
(deafness, hydrocephalus, optic nerve atrophy,
mental retardation) manifestations of congenital
syphilis.
Follow-up tests should occur up to 2 yr after III/B
treatment, with concomitant fall in titers during
that period.