Manifestasi oral pada infeksi menular seksual

Hanny Nilasari Departemen Ilmu Kesehatan kulit dan Kelamin FKUI/RSCM Jakarta

Infeksi Menular Seksual

Infeksi yang ditularkan melalui hubungan seksual Manifestasi lesi : Genital, dan non genital Cara hubungan seksual: genitogenital, orogenital, anogenital Infeksi : gejala klinis : duh tubuh, vegetasi, ulkus/luka

Chlamydia
Chlamydia is the most common and fastest-spreading sexually transmitted disease in the UK. It's caused by a bacterium, Chlamydia trachomatis. Unfortunately, many people (particularly females) have no symptoms at all. Where symptoms do occur, they may include pain in passing urine and a discharge. They usually appear approximately 7 to 21 days after infection. Chlamydia can also cause a form of conjunctivitis in adults. Also, this eye infection may occur in the newborn babies of mothers who have chlamydia.

 Chlamydia can be detected on material collected by swabbing the cervix during a traditional examination using a speculum, but noninvasive screening tests done on urine or on self-collected vaginal swabs are less expensive and sometimes more acceptable to patients. While culturing of the organism can confirm the diagnosis, this method is limited to research laboratories and forensic investigations. No data if the infection in the pharynx

Gonorrhoea
Gonorrhoea is caused by Neisseria gonorrhoeae, a bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum. The cervix is the most common site of infection in women. Gonorrhoea is most commonly spread during genital contact, but it can also be passed from the genitals of one partner to the throat of the other during oral sex. Gonorrhoea of the rectum can occur in people who practice anal sex. In pregnant women, gonorrhoea can be passed from an infected woman to her newborn infant during delivery.

 Testing for gonorrhea is done by swabbing the infected site (rectum, throat, cervix) and identifying the bacteria in the laboratory either through culturing of the material from the swab (growing the bacteria) or identification of the genetic material from the bacteria. Sometimes the tests do not show bacteria because of sampling errors (the sampled area does not contain bacteria) or other technical difficulties, even when the woman has an infection. Newer tests to diagnose gonorrhea involve the use of DNA probes or amplification techniques (for example, polymerase chain reaction, or PCR) to identify the genetic material of the bacteria. These tests are more expensive than cultures but typically yield more rapid results.

 For uncomplicated gonococcal infections of the pharynx, the recommended treatment is 125 mg of ceftriaxone in a single IM dose.

Treatment should always include medication that will treat chlamydia [for example, azithromycin (Zithromax) or doxycycline

herpes simplex II infection

It is believed that some thousands of other people developed herpes but were not seen at a clinic.

 Genital herpes is a highly contagious viral condition caused by the herpes simplex virus (HSV). It infects the skin and mucous membranes of the genitals or rectum, but it can also appear in areas such as the mouth, particularly the lips. Its chief symptom is an outbreak of small blisters, and these can be very painful. It's transmitted primarily through physical and sexual contact. During birth, the presence of herpes simplex virus in the birth canal is a threat to the infant's life

 Genital herpes is suspected when multiple painful blisters occur in a sexually exposed area.
During the initial outbreak, fluid from the blisters may be sent to the laboratory to try and culture the virus, but cultures only return a positive result in about 50% of those infected In other words, a negative test result from a blister is not as helpful as a positive test result, because the test may be a false-negative test. There are also blood tests that can detect antibodies to the herpes viruses that can be useful in some situations. Other diagnostic tests such as polymerase chain reaction (PCR) to identify the genetic material of the virus and rapid fluorescent antibody screening tests are used to identify HSV in some laboratories.

 Although there is no known cure for herpes, there are treatments for the outbreaks. There are oral medications, such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex) that prevent the virus from multiplying and even shorten the length of the eruption. Although topical (applied directly on the lesions) agents exist, they are generally less effective than other medications and are not routinely used. Medication that is taken by mouth, or in severe cases intravenously, is more effective. It is important to remember that there is still no cure for genital herpes and that these treatments only reduce the severity and duration of outbreaks.

HIV and AIDS

Some of those who are HIV-positive will go on to develop AIDS. AIDS is a potentially lethal disease, which is caused by the HIV virus. HIV means 'human immunodeficiency virus'. HIV invades and destroys the immune system, which protects the body from infection. This means that a person who carries the HIV virus is prone to many different illnesses and may die from diseases that are harmless to healthy people. In some countries, particularly those located in SubSaharan Africa, the HIV rates are very high. For instance, in the Republic of South Africa it's estimated that about 11 per cent of the population is HIV-positive.

Genital warts
At the present time, British GUM clinics see about 91,000 new cases of genital warts a year. Many other people develop warts, but they are not seen at clinics. Warts, or condylomata acuminata, are caused by the human papilloma virus (HPV). Many months can pass from the time of infection to the actual development of warts, so it may be very difficult to determine who you got them from. In women, HPV can lead to microscopic changes in the cervix and to the development of cervical cancer. HPV is now thought to be associated with various other cancers, including carcinoma of the anus and possibly of the throat and adjoining regions.

 A typical appearance of a genital lesion may prompt the physician to treat without further testing, especially in someone who has had prior outbreaks of genital warts.

Genital warts usually appear as small, fleshy, raised bumps, but they can sometimes be extensive and have a cauliflower-like appearance.

 Remove the lesion best choice With electrocauterization or caustic topical agent

Syphilis
If left untreated, syphilis is a dangerous and life-threatening disease. It's caused by a corkscrew-shaped germ called Treponema pallidum. It's passed on by intercourse or by almost any other form of sexual interaction. The first symptom appears between 9 and 90 days after exposure to the germ that causes it. A small lump develops at the infection site, and this soon breaks down to form a painless ulcer. Later, there is a secondary stage (characterised by fever, rashes and throat ulcers), and eventually a tertiary stage (in which the germ may attack the brain, spinal cord and other organs).

 Formation of an ulcer (chancre) is the first stage. The chancre develops any time from 10 to 90 days after infection, with an average time of 21 days following infection until the first symptoms develop. Syphilis is highly contagious when the ulcer is present.

ulkus

Aphtae in 2nd syphilis

 Syphilis can be diagnosed by scraping the base of the ulcer and looking under a special type of microscope (dark field microscope)
Special blood tests can also be used to diagnose syphilis. The standard screening blood tests for syphilis are called the Venereal Disease Research Laboratory (VDRL) and Rapid Plasminogen Reagent (RPR) tests. Any positive non-treponemal test must be confirmed by a treponemal test specific for the organism causing syphilis, such as the microhemagglutination assay for T. pallidum (MHA-TP) and the fluorescent treponemal antibody absorbed test (FTA-ABS). These treponemal tests directly detect the body's response to Treponema pallidum.

Treatment of syphilis
Depending on the stage of disease and the clinical manifestations, the treatment options for syphilis vary. Long-acting penicillin injections have been very effective in treating both early and late stage syphilis. The treatment of neurosyphilis requires the intravenous administration of penicillin. Alternative treatments include oral doxycycline or tetracycline. Women who are infected during pregnancy can pass on the infection to the fetus through the placenta. Penicillin must be used in pregnant patients with syphilis since other antibiotics do not effectively cross the placenta to treat the infected fetus. Left untreated, syphilis can lead to blindness or even death of the infant.