INTRODUCTION

of

SEXUALLY TRANSMITTED
DISEASES
BY
Dr. Maria Dwikarya SpKK
MEDICAL FACULTY of UNTAR UNIVERSITY

TERMINOLOGY
VENEREAL DISEASES ( sifilis, gonore, ulkusmolle,
limfogranuloma inguinale, granuloma inguinale )
SEXUALLY TRANSMITTED DISEASES ( VD + peny.lain)
SEXUALLY TRANSMITTED INFECTIONS ( th.1997)

**************
PENYAKIT KELAMIN ( 5 penyakit spt di atas )
PENYAKIT akibat HUBUNGAN SEKSUAL ( PHS )
PENYAKIT MENULAR SEKSUAL
( PMS )
INFEKSI MENULAR SEKSUAL th.1998 ( I MS )
Perbaikan sarana teknik Laboratorium
Eidemiologi + Dampak penyakit pd janin

REPRODUCTION

S E X UAL
INTERCOURSE
RECREATION

RELATIONSHIP

WHAT FOR ?
HOW ?

GENITOGENITAL
MANO-GENITAL / OROGENITAL / ANO-GENITAL
HETERO & HOMO SEXUAL

Alat Reproduksi Wanita

a. Klitoris
b. Vestibulum vagine
c. Ostium uretre eksternum
d. Ostium vagine
e. Himen
f. Anus
g. Frenulum labia pudendi
h. Labium minus
i. Labium mayus
j. Kelenjar Bartholin
k. Kelenjar Skene

ALAT REPRODUKSI WANITA

Korpus Uteri
Tuba uterina
Fimbria
ovarika
Infundibulum
Lig. Ovarii propium
Ligamen latum uteri

Fimbria tuba uterina

Ovarium
Ostium uteri internum
Kanalis servisis
Ostium uteri eksternum
Vagina

ALAT REPRODUKSI PRIA

Penyakit Hubungan
Seksual
KELUHAN UTAMA
DUH
DUH URETRA
Gonore
NSU
Viral infeksi
FLUOR ALBUS
Candida
Gardnerella vag
Trichomonas vag

ULSERASI
MULTI EROSI
Herpes Genital
LGV st I
ULKUS DURUM
Sifilis st I
ULKUS MOLLE
ULKUS MIKSTUM

VEGETASI
KONDiLOMA
Akuminatum
Kondilom Latum
PAPUL + Delle
Moluskum kontg
GRANULATION
Granuloma Inguin

DUH

ULKUS GENITAL

VEGETASI

GONORRHOEA
KENCING NANAH

Neisseria Go

Herpes Simplex

Chalmydia Trch

Human Papiloma

Mycoplasma

MoluscumCon Vi

Ureaplasma

VIRUS

BAKTERI

Hepatitis B/C Vi

Treponem Pall

Cytomegalo Vi

Gardnerella Vg

EipsteinBarr Vi

Hemofilus ducry

Hum Imundeff Vi

FUNGUS
PROTOZOA
PARASIT
CANDIDA + TRICHOMONAS vaginalis
Pediculosis + Sarcoptes scabiei

Bakteri

Neisseria gonorrhoeae
Treponema pallidum
Gardnerella vaginalis
Donov. Granulomatis

Uretritis-orchitis,Bartholin-cervisitis
Sifilis, Ulkus durum
Vaginitis, becek , bau amis
Granuloma inguinale

Chlamydia trachomatis
Mycoplasma hominis
Ureaplasm urealyticum

Uretritis-orchitis,Cervisitis,Rdg
Wanita: cervisitis,salfingitis
Pria: uretritis, prostatitis

Virus

Herpes simplex virus

Human papilloma virus
MolluscumCont Virus
HIV virus

Herpes genitalis
Condyloma acc,Papilom laring By
Molluscum contagiosum
AIDS (Acquried Imun Deff Synd)

Jamur

Candida albicans

Wanita: Vulvo vaginitis

Pria : BalanoPhostitis

Trichomons
vaginalis
Sarcoptes scabiei
Phthirrus pubis

Uretritis, Vulvo vaginitis

Scabies
Pedikulosis pubis

5 Protozoa
6 Parasit

HUMAN HERPES VIRUS

8 groups of HHV :
HHV 1 & 2 = HSV ( Herpes Simplex Virus 1 + 2)
HHV 3
= VZV ( Varicella Zoster Virus )
HHV 4
= EBV ( Eipstein Barr Virus )
HHV 5
= CMV ( Cyto Megalo Virus )
HHV 6-7-8 = Kaposi sarcoma ascociated Virus

3 groups HHV
HumanHerpesVirus
ALPHA

HSV 1 + 2
VZV
Variable host
Rapid destruction
Latent infection
Sensory ganglia

BETA

GAMMA

CMV

EBV
HHV 6+7+8

Restricted host
Spread slowly
Retina
Pulmo & Colon

Lymphotropic
Specific
Either T or B
lymphocyte

HERPES SIMPLEX VIRUS

Age of onset : Infancy Young adult Senescence
Etiology : HSV-1 and HSV-2

LABIALIS
HSV-1 80%
HSV-2 20%

UROGENITALIS

HERPETIC WHITLOW
HSV-1 20 %
HSV-2 80 %

< 20 yr HSV-1
> 20 yr HSV-2

NEONATAL
HSV-2 =70 % HSV-1 =30%:

HERPES SIMPLEX VIRUS

Acute muco-cutaneus infection

Herpetiform group : Erythemal based vesicles
Constitutional state : fever, malaise, anorexia
Bacterial secondary Infection : Lesions soon
become purulent & crusted & ulcerated

Latent episode Recurrent periodically with

Precipitating factors.

HERPES SIMPLEX VIRUS INFECTION

Transmission: Skin- skin & Skin-mucosa
Incubation: average 6 days
Crowded living & Low SocioEconomy
Wrestler Herpetic whitlow also Medical Staff

Precipitating factor of Recurrence:

UV radiation
Hormonal : Menstruation
Fever & Influenza
Altered Immunity : HIV infection, ChemoTherapy, Radiotherapy,
Steroid therapy, Malignancy: Leucemia

JENIS VIRUS

HSV-Tipe I (Herpes Simplex Virus Type I)

HSV-Tipe II (Herpes Simplex Virus Type II).

Herpes labialis

Ulkus Durum
Ulkus pada infeksi
Herpes simplex
genital pria

Herpes Simplex Genital

+ Infeksi sekunder & Phymosis

HERPES SIMPLEKS GENITALIS

+ INFEKSI SEKUNDER

Ulkus Durum di Penis & Vulva

SIFILIS

Sifilis stad 2 : Roseolae

palmoplantar

Sifilis congenital

Kissing Effect of Ulcus Molle

Viral infection wide spectrum clinical

manifestations
HPV & MCV
Healthy

Children

Immundeff

Colonize
Without
Lesions

Benign
Proliferation
Transient

Extensive
Persistent
Refractory

HPV = Human Papiloma Virus , MCV = Moluscum Contagiosum Virus

MOLUSCUM CONTAGIOSUM
widespreading
Lesi agak banyak

ATOPIK

HIV
infection
Lesi
sangat banyak

Terapi

Imuno
supressif

Lesi banyak

Multiple facial MC and Trunk widespreading

suggest HIV infection

Spektrum Klinis Moluscum Contagiosum

sesuai tingginya imunitas tubuh Hospes

MC

MC + ATOPY

MC+H I V

CONDYLOMA intra URETHRA

CONDYLOMA peri ANAL

Moluscum Contagiosum
+ CONDYLOMA accum

FLUOR ALBUS
CANDIDOSIS

GARDNERELLA
VAGINALIS

DUH PUTIH
LENGKET
BERGUMPAL
GATAL
DYSPAREUNIA

DUH ABU2
ENCER
TIDAK GATAL
BAU
HUB SEX NORMAL

TH/
ITRACONAZOL
2dd200 MG

TH/
METRONIDAZOL
1 dd 2 GR
Hari 1 dan 3
( 2dd 500 mg= 7hr)

FLUCONAZOL
1 dd 150 mg

TRICHOMONAS
VAGINALIS

DUH KUNING HIJAU

BERBUSA
GATAL NYERI
BAU
DYSPAREUNIA
TH/
METRONIDAZOL
1 dd 2 GR
Single dose
( 2dd 500 mg= 7 hr)

CANDIDOSIS VULVOVAGINALIS
PREDISPOSISI

Diabetes
OBESITAS
KEHAMILAN
TERAPI ANTIBIOTIKA
TERAPI STEROID
INFEKSI HIV

Etio : Candida albicans (85%)

C glabrata & parapsilosis(10%)
Lab: Pseudohifa(+) Yeast cell(+)

ABSES BARTHOLIN& SKENE

FAKTOR
KENAIKAN INSIDENS IMS

PERUBAHAN
DEMOGRAFIK
MODERNISASI tetapi

PERUBAHAN
SIKAP& NORMA
KURANG PENDIDIKAN SEKS

INDUSTRI MAJU tetapi KURANG FASILITAS KESEHATAN

BANYAK KASUS ASIMPTOMATIK CARRIER ; PSK
BANYAK TERSEDIA OBAT CARA PAKAI TDK BENAR

GOLONGAN

RISIKO TINGGI IMS

Umur muda : Pria 20 30 th
Wanita 16 24 th
Kelompok sering berpergian/ Turis
Suami isteri hidup terpisah tempat
Pekerja Seks Komersial
Kelompok Homoseksual /Napi
Kelompok tinggi Pesona & Permisif
& Promiskuitas

PERLU KERJASAMA TERPADU

SEGI MEDIS
SEGI EPIDEMIOLOGIK
SEGI SOSIAL

DIAGNOSTIK DINI & LABORATORIS

TERAPI EFEKTIF KONTROL LAB.
KONSELING & PROMOSI KONDOM
PEMERIKSAAN SEROLOGI
PEMBERITAHUAN PADA KELUARGA

 Setiap penyakit mempunyai stadium awal dan

stadium lanjut Usahakan kenal lebih awal
Ciri diagnostik membantu diagnosis dini
Diagnosis banding sangat penting
Distribusi, konfigurasi , morfologi penting !!
Terapi > efektif : diagnosis tepat & cepat
FOTODOKUMENTASI KASUS YG DIDAPAT
BERMANFAAT DI LAIN SAAT

Laboratory Screening

Pemeriksaan pra nikah sangat penting

karena dapat mengungkap kelainan Serologi
yg tidak terlihat pada kondisi fisik seseorang.
Pemeriksaan yg dianjurkan
1. Kultur sekret uretra pria : Gonorrhoea
2. Pemeriksaan Trio sekret wanita
3. Serologi VDRL, TPHA, Anti HSV-1 & 2,
HbsAg, Anti HIV
4. Wanita di + Toksoplasma, antiCMV, Rubella
5. General Medical check up
6. Cek Thalasemia

Prurigo Nodularis berat HIV infc

Lab Hiper Eosinofilia !!

Oral Hairy Plakia HIV and EBV

infct

Lipodystrophy Syndrome
Terjadi setelah 1 2 th terapi ARV
Terutama Obat golongan protease inhibitor
Gambaran klinis :
Lipo-hipertrofi : tengkuk, leher, dada,
abdomen
Lipo-atrofi pipi, ekstremitas atas bwh
proksimal

Serum trigliserid + glukosa

Dis Figure Stigma AIDS orang kurus
cekung

HIGH cure rate

LOW price
AVAILABLE
HIGH tolerance
LOW toxicity
LOW resistency

PATIENT COMPLIANCE
CHOOSE ORALLY GIVEN
TIME OF WELL ABSORBED
SAFE FOR PREGNANCY &
LACTATION
TIME TO FOLLOW UP

Usaha Penangulangan

Segi Medis

: Diagnosa tepat & Terapi efektif

Blind treatment Partner
Konseling(KIE = komunikasi, inform, edukasi)
Imunisasi Hepatitis & HPV pd remaja

Epidemiologis :

Sosial, Ekonomi, dan Budaya :

lintas sektoral pendidikan dan bidang sosial

Bekerjasama dengan yayasan sosial yang menangani

masalah AIDS, Narkoba, WHO, dsb
Pendataan serologis penghuni di LP & para PSK,
Pembinaan Medis Pra Nikah bagi calon mempelai

Care management
Counseling
Contact therapy
Condom promotion
Vaksinasi HPV

FOUR Cs

KEPUSTAKAAN
Wolff K, Johnson RA,Surmond D : Fitzpatricks color atlas
& synopsis of Clinical Dermatology, McGrawHill USA, 5 th
ed.2005
Daili SF, Djuanda A : Ilmu Penyakit Kulit & Kelamin,
Penerbit FKUI Jakarta, 5th ed. Th. 2007
Indriatmi W BMakes :
Materi AjarIlmuKesehatanKulit&Kelamin
Mahasiswa FKUI tahap Akademik th 2007
Dwikarya M : Koleksi FotoDigital Dokumentasi pribadi