DISCAR URETRA dan

FLUOR ALBUS
Nurrachmat Mulianto,
SpKK

Pemeriksaan IMS
ANAMNESIS
Keluhan saat datang
Riwayat seksual ( coitus suspectus ) :
a. kontak seksual, di dlm/luar nikah, gonta- ganti
pasangan (kontak seksual multipel)
b. kontak dg pasangan setelah gejala
c. frekuensi hub sex dan jenis
(homo/hetero)
d. cara hub (genital, anal, oral)
e. apakah psngan jg menderita
keluhan sama.

 Riwayat peny dahulu yg berhub dg kon

tak seksual
Riwayat keluarga ( IMS lwt penularan i
bu kpd bayi)
Keluhan yg berkaitan dg komplikasi kr
n IMS misal : PID krn cervicitis GO
Riwayat alergi obat

Pemeriksaan Fisik
INSPEKSI dan PALPASI
Pada pria :
Lbih mudah krn terdpt 1 kesatuan salu
ran genital & organ mudah diraba
Pada wanita :
Harus dg spekulum krn organ
Genital tdp di rongga pelvis

Gonnorhea
Pada laki-laki Uretritis GO, pd wanita Cervicitis GO
Penyebab
kumanNeisseria Gonorrhoea, disebut juga gonokokus, berb
entuk diplokokus.
Kuman ini menyerang selaput lendir dari :
Vagina, saluran kencing dan daerah rahim/ leher rahim.
Saluran tuba fallopi.
Anus dan rektum.
Kelopak mata.
Tenggorokan.

Neisseria gonorrhoeae

Gram negative diplococcus

Non motile
Non spore forming
Some types have independent chromosomal mutat
ion, resulted resistance to penicillin, tetracyclin an
d spectinomycin
No resistance has yet been reported to ceftriaxone

Clinical Manifestations
Urethral infection in men
Urogenital infection in women
Rectal infection
Pharyngeal infection

Tanda Dan Gejala

Penularan melalui oral, anal dan vaginal seks. Hampir
90% penderita GO pd wanita tidak memperlihatkan
keluhan dan gejala.
Lelaki
Keluar cairan putih kekuning-kuningan melalui penis
.
Terasa panas dan nyeri pada waktu kencing.
Sering buang air kecil.
Terjadi pembengkakan pada
testis

Tanda dan gejala

Perempuan
Pengeluaran cairan vagina tidak seperti biasa.
Panas dan nyeri saat kencing.
Keluhan dan gejala terkadang belum tampak meskipun su
dah menular ke saluran tuba fallopi.
Bila gx sdh meluas ke PID ( Pelvic Inflamatory Disease ) serin
g timbul :
Nyeri perut & pinggang bagian bawah.
Nyeri sewaktu hubungan seksual.
Perdarahan mell vagina diantara siklus haid.
Mual-mual.
Terdapat infeksi rektum atau anus.

KOMPLIKASI GO
Bila GO tidak diobati maka 1% dari lel
aki dan wanita, akan terjadi DGI atau
Dessiminated Gonorrhoe Infection . Ta
nda dan gejalanya berupa demam, be
rcak di kulit, persendian bengkak dan
nyeri (FRANK ATHRITIS), peradangan p
ada dinding rongga jantung, peradang
an selaput pembungkus otak serta me
ningitis.

Komplikasi pada pria

Epididymitis
Penile lymphangitis
Generalized penile edema
Urethral stricture
Periurethral abscesses

Komplikasi pada wanita

Acute salphingitis
Pelvic inflammatory disease
Infertility
Ectopic pregnancy
Bartholins gland abscess

Treatment : Uncomplicated GO

Ceftriaxone 250 mg i.m once

Cefixime 400 mg orally once
Cyprofloxacin 500 mg once
Ofloxacin 400 mg once

Plus
Coinfection with C. Trachomatis
Doxycycline 100 mg orally 2 times a day for 7
days
Alternative regimen :
azythromicyn 1 gr SD

Treatment
Disseminated Gonococcal Infectio
n:
Hospitalization
Ceftriaxone 1 gr/24 hours for 7 days

Or
Cefotaxime 1 gr/8 hours i.v
Ceftizoxime 1gr/8 hours i.v
Spectinomycin 2 gr/12 hours

for a week

Treatment
Gonococcal Meningitis :
Ceftriaxone 1 2 gr/12 h
ours for 14 days
Gonococcal Endocarditis :
At least 4 weeks

Chlamydia Trachomatis Infectio

n in The Adults

Etiologic agent :
Chlamydia trachomatis strain D K
Obligate intracelluler
An unique growth cycle :

Elementary body
Reticulate body

Clinical Manifestations
Men :
1. Disuria ringan
2. Polakisuria
3. Discar seropurulen

a)
b)
c)
d)

Reiters syndrome :
Uretritis
Conjunctivitis
Arthritis
Mucocutaneous lesion

Clinical Manifestations
Women :
1. Asimptomatik
2. Disuria ringan
3. Sering kencing
4. Nyeri di daerah pelvis
5. Disparenia

Treatment
Recomended regimen :
Doxycycline 100 mg twice for 7 da

ys
Azithromycin 1 gr orally once

Alternative regimen :
Ofloxacin 200 mg twice for 7 days
Erythromycin base 500 mg q.i.d fo

r 7 days
Erythromycin ethyl succinate 500
mg q.i.d for 7 days

FLUOR ALBUS
KANDIDIASIS VULVOVAGINA
TRICHOMONAS VAGINALIS
BACTERIAL VAGINOSIS

Vulvovaginal Candidiasis
Etiologic agent :
Yeast family : Candida spp.,
C. Albicans
Predisposing factors :
Pregnancy
Oral contraceptives
Diabetes mellitus
Antibiotics

Clinical Manifestations
Acute pruritus and vaginal di

scharge, ph < 4,5

As typically cottage cheese li
ke

Treatment
Recomended treatment :
Miconazole nitrat (vaginal supp) 200
mg at bed time for 3 days
Clotrimazole (vaginal tab) 200 mg at
bed time for 3 days
Bufoconazole (2% cream 5 gr) intrav
aginally at bed time for 3 days
Terconazole (80 mg supp) at bed tim
e for 3 days

Treatment
ORAL :
Fluconazole 150 mg orally single d
ose
Itraconazole 400 mg orally single
dose
Itraconazole 100 mg b.i.d for 3 da
ys

Trichomoniasis
Penyebab : T. vaginalis
Keluhan
1. Tdk ada
2. Discar berbau,
iritasi/gatal.
3. Dispareunia
4. Disuria
5. Rasa tdk enak
perut bawah

Gejala
1. Tdk ada
2. Eritema vulva
difus
3. Discar >>
kuning, hijau,
berbusa
4. Inflamsi dind
vag
5. Strawberry
Cervix

Foamy discharge

Strawberry cervix

Jenis pemeriksaan
pH 4,5 - 7
Sniff test positif
Dg sediaan basah (NaCl) pergerakan t
richomonas khas
Fluorescent antibodi
Pap smear

Terapi
Metronidazol 2 gram dosis tunggal
Metronidazol 2 x 0,5 gr selama 7 hari
Klindamisin 2 x 300mg slm 7 hari

Bakterial Vaginosis
Penyebab : Gardnerella vaginalis, Bactero
ides Spp, Mycoplasma hominis
Dpt tanpa gejala
Tes amin dg KOH 10% Bau spt ikan (ami
n yg menguap)
pH > 7,2
Sekret menggumpal wrn putih atau keab
u-abuan melekat pd dinding vag.
Clue cells pd mikroskop

Clue cells: squamous epithelial

cells covered primarily with
gardnerella which then take on
this fuzzy appearance called
"clue cell" as seen on wet mount
of vaginal fluid.
antibiotic therapy:
metronidazole or clindamycin for 7 days

Differential Diagnosis of Vaginal Infections

Diagnostic
Criteria

Normal

Bacterial
Vaginosi
s

Vaginitis
Cand.
Trichomo
Vulvov
nas
ag
< 4.5
(usually
)

Vaginal pH

3.8 - 4.2

> 4.5

4.5

Discharge

White,thin,
flocculent

Thick, white
(milky),
gray

Yellow,
green,
foamy

Amine
odor
"whiff"
test

Absent

fishy

fishy

White,
curdy
, "cotta
ge chees
e"
Absent

Lactobacilli,
epithelial
cells

Clue cells,
adherent
cocci, no
WBC's

Trichomonad
s
, WBC's

Budding yea
st, hyphae,

Miroscopic