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SEXUALLY TRANSMITTED INFECTIONs (STIs)

SEXUALLY TRANSMITTED INFECTIONs (STIs). Pepy Dwi Endraswari. STI’s are infections that are spread from person to person through intimate sexual contact. Why STIs are important : ● Common ● Often asymptomatic ● Major complications and sequelae ● Expensive ● Synergy with HIV.

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SEXUALLY TRANSMITTED INFECTIONs (STIs)

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  1. SEXUALLY TRANSMITTED INFECTIONs (STIs) Pepy Dwi Endraswari

  2. STI’s are infections that are spread from person to person through intimate sexual contact. Why STIs are important : ● Common ● Often asymptomatic ● Major complications and sequelae ● Expensive ● Synergy with HIV

  3. Figure 11.1 Public health poster warning against “Venereal Disease”. Charles Casa, 1940

  4. The Fact • Silent transmission • Chlamydial infection: ±70% of women and 50% of men are asymptomatic • Gonococcal infection: 50% of women are asymptomatic. • Many STDs are easily treatable some have irreversible sequelae. • Chlamydial infection in women  pelvic inflammatory disease and tubal scarring causing infertility or the risk of ectopic pregnancy. • Untreated syphilis infection can cause progressively destructive lesions of the cardiovascular and central nervous systems. • presence of a STI increases the chance ofcontracting HIV infection. • Ulcers disrupt mucosal integrity and increase the presence or activation, or both, of HIV susceptible cells (for example, CD4 lymphocytes)

  5. Main risk factors for acquiring a sexually transmitted infection (STI) multiple sexual partners young age unmarried status concurrent sexual partners unprotected sexual intercourse. asymptomatic nature of the infection.

  6. Clinical manifestation Ulkus genital: genital herpes, syphilis, chancroid Urethritis and cervicitis:gonorrhea, nongonococcalurethritis Vulvovaginitis: Candidiasis, Bacterial vaginosis, Trichomoniasis other STIs

  7. ULKUS GENITAL

  8. SYPHILIS / LUES / RAJA SINGA Penyebab : Treponema pallidum Order : Spirochaetales Family : Treponemataceae Genus : Treponema

  9. Gejala Klinis Ada 3 stadium : Fase primer Fase sekunder Fase Laten Fase tertier

  10. Primary syphilis Fase primer • Di tempatmasuk : ULCUS  LESI PRIMER : HARD CHANCRE • Pembesarankelenjarlymphe regional Fasesekunder (bbrpminggu – bulan) • SKIN RASH seluruhtubuh • Pembesarankelenjarlymphe regional • Systemic symptoms such as fever, malaise, pharyngitis, weight loss, arthralgias, and lymphadenopathy commonly accompany the rash. Fase primer dansekunder: sangatmenular (kumanbanyak) Skin-rash Condyloma lata

  11. Fase Laten: Tidak ada gejala , tes serologis (+) Fase Tertier : (beberapa tahun) • Kerusakan syaraf  neuro syphilis • Sistem kardiovaskuler

  12. Neurosyphillis

  13. Cardiovascular syphilis: endarteritis obliterans of the ascending aorta and the coronary arteries  aneurysms, aortic regurgitation, and coronary artery stenosis

  14. Gumma in late syphillis Large, granulomatous lesions (“gummata”) in the skin, mucous membranes, and skeletal system, although viscera can also beInvolved .The lesions are locally destructive leading to soft-tissue deformity, fractures,and organ failure (e.g. liver cirrhosis).

  15. Treponema pallidum dapat menembus plasenta  (Stadium II) • SYPHILIS CONGENITAL : • Lahirmati • Lahirhidup   (liver failure, pneumonia, and pulmonary haemorrhage) • LATE CONGENITAL : • Gangguan mental • Butatuli • Kerusakangigi (Hutchinson’s teeth)

  16. Congenital syphillis Saber shaped deformity Saddle nose

  17. Hutchinson’s teeth

  18. Morfologi Kuman : Dark ground microscopy of Treponema pallidum Spiral  dengan 4-14 U lekukan yang teratur Pengecatan : • Impregnasi perak • Negatif Paling baik : dengan mikroskop lapangan gelap  kuman yang hidup • Bergerak aktif : terdiri dari 3 gerakan : . Undulasi . Cork-screw (pembuka botol) . Maju mundur

  19. Spiral inisangattipis, sehinggahanyanampakbiladilihatdengan : Darkfield illumination : Immunofluorescent • DapatdilihatpadajaringandenganLevaditi Silver Impregnation • Treponemapadaumumnyamengadakanreproduksisecara transverse fission

  20. Pembiakan : • In vivo padakelinci / intratesticular • Treponemapallidum yang : a) strain patogenuntukmanusiatidakdapatdibiakkanpada media buatan, maupundalamtelur yang suburataupundalam tissue culture b) Saprofit (Reiter)  dapatdibiakkan in vitro dalam medium tertentu

  21. DIAGNOSA : 1. Spesimen : a. Eksudat lesi b. Darah 2. Darkfield Examination 3. Immunofluorescence 4. Serologic Test for Syphilis (STS)

  22. PENGOBATAN : Benzathine Penicillin G Akut : 2,4 U / single / im Kronis : 2,4 U / 3X / im Neurosyphilis : 20 U / iv / day (2-3 mgg)

  23. SOFT CHANCRE (CHANCROID)

  24. Kuman penyebab : Family : Brucellaceae Genus : Haemophilus Species : Haemophilus ducreyi

  25. Gejala Klinik : Inkubasi 4 -10 hari Pada genitalia eksterna – timbul pustula  nekrosis  ulcus (= Ulcus Molle) Tidak ada indurasi Tepi tidak rata Undermind Merah dengan dasarnya putih kekuningan Sangat nyeri Mudah berdarah Dapat terjadi Bubo

  26. Ulcul mole / chanchroid Adenopatypadachanchroid

  27. Morfologi : • Batangpendek Gram negatif • Tampaksendiri-sendiriatauberbarisparalelsepertisekelompokikan yang berenang (= school of fish) • Tumbuhintraselulermaupunekstraseluler • Tidakberspora, Tidakberkapsul, Tidakmotil, Non hemolytic • Ujikatalase : negatif

  28. Sifat Pertumbuhan : Memerlukan X factor Hanya tumbuh pada enriched media Resistensi : Tidak tahan terhadap pemanasan Tidak tahan terhadap antiseptik Peka terhadap Streptomycin, Chlortetracyclin, Sulfonamid

  29. Diagnosa : • Gejala Klinis • Pewarnaan Gram • Biakan pada enriched medium (Chocolate agar medium)

  30. Terapi : Streptomycin Chlortetracyclin Sulfonamid

  31. LYMPHOGRANULOMA VENEREUM (LGV) = Lymphogranulomainguinale = Tropical Bubo

  32. ETIOLOGI : Chlamydia trachomatisserotype L1-L2-L3 • Obligate intracellular • Hanyadapattumbuhpada tissue culture atau yolk sac embrioayam • Pewarnaan : • Giemsa : merahungu • Macchiavello : merah • Gram : Gram negatifmerah

  33. GEJALA KLINIS : • Inkubasi : 1 – 4 minggu • Lesi primer : berupa papula  vesiculapada genitalia eksterna • Vesicula tersebut pecah  ulcus • Tidak sakit • Sembuh sendiri

  34. Suppurative Bubo Bila terapi tidak sempurna  kronis Fibrosis  Obstruksi pembuluh lymphe Setelah 1minggu –2 bulan setelah lesi primer  pembesaran kelenjar lymphe regional ♂ : Kelenjar lymphe inguinal ♀ : kelenjar perirectal

  35. Pada laki-laki : Pembuluh lymphe inguinal terjadi elephantiasis pada genitalia eksterna • Pada perempuan  obstruksi rektum

  36. DIAGNOSA : I. Gejalaklinis D.D. : Granulomainguinale (Etiologi : Calymmatobacteriumgranulomatis) II. PewarnaanGiemsa / Gram / Macchiavello III. Pembiakanpada yolk sac embrioayam IV. Serologis : Complement Fixation Test V. TesFrei

  37. Urethritis and cervicitis • Gonorrhea • nongonococcal urethritis

  38. URETHRITIS

  39. GONORRHEA

  40. Penyebab: Famili : Neisseriaceae Genus : Neisseria Species : Neisseriagonorrhoeae Neisseriameningitidis

  41. Gonorrhea • Usia paling sering: 15-35 tahun • Menyebarmelaluikontakseksual • Patogenesis • Bakterimenempelpadaepitelurogenitamenggunakanphilli memicuresponperadanganakut  sekret. • Pria:uretritisprostatitis epididimitis • Wanita: vagnitis  cervicitis  radangpanggul (PID= Pelvic Inflamatory Disease)

  42. Gejalaklinis Inkubasi 2-8 hari Sekreturetrakuningkental Urethritisakut yangnyeri Infeksipadawanitaseringasimptomatikatauditandaidengansekret vagina Komplikasiterjadilambattermasukstriktururetradaninfertilitaspadawanita.

  43. SEPSIS GONITIS • Disseminated Gonococcal Infection (DGI)  * Arthritis * Dermatitis * Peritonitis • BAYI : Ophthalmianeonatorum (Blenorrhoe) Tindakan CREDE : AgNO3 1%

  44. Diagnosis Pus dariuretraharussegeradikirimkelaboratoriummenggunakan media transporkhusus

  45. Morfologi : Kokus / Diplokokus; Gram negatif  : 0,6 -1,0 µm Sepertibiji kopi / ginjal (sisi yang berhadapanpipih) Intracellular (PMN) atau Extracellular Non motil Pilli (+)

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