Bakteri penyebab STD / PHS

Riyani Wikaningrum
Bagian Mikrobiologi
FKUY
 Top Ten STD
Organism Disease Comment Treatment
Papillomaviruses Genital warts, The commonest of Podophyllin,
(types 6 and 11 dysplasias all STDs, associated cryotherapy
associated with with cancer of
visible genital cervix, penis, etc.
warts)
Chlamydia Non-specific Increasing Doxycycline,
trachomatis (D-K urethritis incidence azithromycin
serotypes)
C. trachomatis (L1, Lymphogranuloma Mainly tropical Doxycycline,
L2, L3 serotypes) venereum countries tetracycline,
erythromycin
Candida albicans Vaginal thrush, Very common; Nystatin,
balanitis predisposing factors fluconazole
 Top Ten STD
Organism Disease Comment Treatment
Trichomonas Vaginitis, urethritis Very common; can Metronidazole
vaginalis be asymptomatic
Herpes simplex Genital herpes Increasing; problem Aciclovir,
virus types 1 and 2 of latency and valaciclovir,
reactivation famciclovir
Neisseria Gonorrhea Decreasing Ceftriaxone,
gonorrhoeae incidence in ciprofloxacin
resource-rich
countries
HIV AIDS Incidence Nucleoside,
increasing nucleotide and
worldwide non-nucleoside
reverse
transcriptase
inhibitors; fusion
inhibitors; protease
inhibitors
 Top Ten STD
Organism Disease Comment Treatment
Treponema Syphilis Decreasing Penicillin
pallidum incidence in
resource-rich
countries
Hepatitis B virus Hepatitis 350 million carriers Lamivudine,
worldwide adefovir, interferon
alpha
Haemophilus Chancroid Mainly tropical Erythromycin,
ducreyi ceftriaxone
 Other STD
Organism Disease Comment Treatment
Calymmatobacterium Granuloma inguinale Tropical Doxycycline,
granulomatis azithromycin
Sarcoptes scabiei Genital scabies Common Permethrin cream
Phthirus pubis Pediculoses pubis Common Permethrin
cream/shampoo
Mycoplasma Non-specific Less important than Doxycycline,
Ureaplasma (T urethritis chlamydia azithromycin
strains) Erythromycin
Gardnerella vaginalis Vaginitis Acts together with Metronidazole
anaerobes
 Microbes to combat host defenses
Host defenses
Complement
Inflammation
Antibodies (especially IgA)
Cell-mediated immune
response (T cells,
lymphokines, natural killer
cells, etc.)
Microbial strategies Examples
C3d receptor on microbe Candida albicans
binds C3b/d and reduces
C3b/d-mediated
polymorph phagocytosis
Induce strong Gonococcus, C. albicans,
inflammatory response, yet HSV, chlamydia
evade consequences
Produce IgA protease Gonococcus
Antigenic variation; allows Gonococcus, Chlamydia,
re-infection of a given Papillomaviruses (not HSV
individual with an antigenic or T. pallidum)
variant T. pallidum, HIV
Poorly understood factors
cause ineffective cell-
mediated immune
response
Host defenses Microbial strategies
Integrity of mucosal Specific attachment
surface mechanism
Urine flow (for urethral Specific attachment;
infection) induce own uptake and
transport across urethral
epithelial surface in
phagocytic vacuole
Infection of urethral
epithelial or subepithelial
cells
Phagocytes (especially Induce negligible
polymorphs) inflammation
Resist phagocytosis
Examples
Gonococcus or Chlamydia
to urethral epithelium
Gonococcus
Herpes simplex virus (HSV),
Chlamydia
Treponema pallidum,
mechanism unclear,
perhaps poorly activates
alternative complement
pathway due to sialic acid
coating
Gonococcus (capsule) T.
pallidum (absorbed
fibronectin)
SIFILIS
 Spiral Organisms
Family Genus Species Subspecies Disease
Spirochaetaceae Treponema pallidum Pallidum Syphilis
pallidum Pertenue Yaws
carateum - Pinta
Borrelia recurrentis - Relapsing fever
burgdorferi - Lyme disease
Leptospiraceae Leptospira Interrogans (Serovar) Leptospirosis
Icterohaemorrha (Weil's disease)
giae
 Introduction

• Pathogenic members of this genus

include:
- T pallidum
- T pertenue
- T carateum
 Introduction
Pathogenic treponemes are associated with 4
diseases :

1. Venereal syphilis -T pallidum pallidum

2. Yaws -T pallidum pertenue
3. Endemic syphilis (bejel) - T pallidum
endemicum
4. Pinta - T carateum

The treponemes responsible for these diseases cannot be distinguished

serologically, morphologically, or by genome analysis, and they have not
been successfully cultivated on artificial media.
 Treponema Pallidum
• Thin
• Motile
• Extremely fastidious
• Survive only briefly outside host
• Not cultivated successfully on artificial
media
 Transmission
• Direct sexual contact with ulcerative lesions of
skin or mucous membranes
• Trans placental:
- Typically during second half of pregnancy
- As early as 6 weeks of gestation
- Pregnant with primary or secondary syphilis are more
likely to transmit the disease than those with latent
(not clinically apparent) disease

Cannot be spread through contact with toilet seats, doorknobs, swimming pools,
hot tubs, bathtubs, shared clothing, or eating utensils
 Spirochetes
• Gram negative
• long, thin, helical, motile

• axial filaments
– locomotion
– between peptidoglycan layer/outer membrane
* runs parallel

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T. pallidum
Natural History of Untreated Syphilis
Clinical Presentation of Syphilis
 Treponema pallidum

• transmission
– genital/genital
– in utero or during birth

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 Syphilis
• chronic
• slowly progressive

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Syphilis Primer
• primary lesion - chancre
– 10 to 60 days
– area of ulceration/inflammation
– many organisms

21
Syphilis Secunder
• Secondary (2-10 weeks later)
– systemic spread
– flu-like symptoms
– skin, particularly
– many organisms

mouth muosa 23
 Latent syphilis
• Patients are asymptomatic
• Serologic testing positive
• Early latent disease
– Patients are potentially infectious
– <1 year
• Late latent disease
– Patients no longer infectious
– >1 year
– Longer duration of therapy recommended
Syphilis Tertier
 Diagnosis Laboratorium
• Mikroskopis:
– Sample: kerokan lesi, biopsi, LCS
– Langsung  Mikroskop lapangan gelap
– Pewarnaan:
• impregnansi perak
• Imunofluoresens
• Serologi:
– Non - Treponemal test (VDRL; RPR; WR)
– Treponemal test (FTA-ABS; TP-PA; TPHA)
 Microbiological diagnosis
• not culturable
• dark field microscopy
– actively motile organisms
– brightly lit against dark backdrop
– light shines at an angle
– reflected from thin organisms
– enters objective
• conventional light microsrcopy
– light shines through
– NOT visualized
• fluorescence microscopy
–antibody staining 27
 Tes Serologi untuk Sifilis
Conditions associated with false-positive
Test results
Non-specific (non-treponemal)
VDRL Viral infection, collagen vascular disease,
RPR acute febrile disease, post-immunization,
pregnancy. leprosy, malaria, drug misuse
Specific (treponemal)
FTA-ABS Diseases associated with increased or
TP-PA abnormal globulins, lupus erythematosus,
TPHA Lyme disease, autoimmune disease,
diabetes mellitus, alcoholic cirrhosis, viral
infections, drug misuse, and pregnancy
RPR :

• A definite clumping of the charcoal particles is reported as

reactive (R).

• No clumping is reported as non-reactive (N).

Secondary and Tertiary Syphilis
- serology

• screening method
• antibodies to cardiolipin

• specific diagnosis
• antibodies to treponemal antigen

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 Autoimminty

• cardiolipin
– self antigen

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Treatment & Prevention:

• no vaccine

• antibiotics (e.g. penicillin)

– effective

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 NEISSERIA

Neisseria gonorrhoeae
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34
 Neisseria
• Gram negative
• diplococci (pairs of cocci)
• oxidase positive

• culture
• Thayer Martin.
– selective
– chocolate agar
* heated blood (brown)

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 N. gonorrhoeae
the “Gonococcus"

• found only in man

• gonorrhea
• second most common venereal disease

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Infeksi GO
Manifestasi klinis infeksi Gonokokus
Opthalmia neonatorum
 Smear
• polymorphonuclear cell
• Gram negative cocci
– many in cells

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Sediaan langsung sekret
Dissemination -gonococci

• gonoccocal arthritis
– “septic” arthritis

• dermatitis

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 Antibiotic therapy
• β lactamase-resistant cephalosporin
– e.g. ceftriaxone

• resistant strains
– common
– produce β lactamases
– destroy penicillin

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Virulence Factor of Gonococcus
 Pathogensis
• adhesion to genital epithelium
– outer membrane
– pili
*Antigenicity
highly variable among strains
• no vaccine

• IgA protease
– also N. meningitidis
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 N. gonorrhoeae
• Tissue injury
– lipopolysaccharide
– peptidoglycan

•Infeksi pada feminina:

•Cervisitis  Asimtomatik
•Berlanjut menjadi PID
•Infeksi pada maskulina:
•Urethritis
•Berlanjut menjadi epididimitis
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CHLAMYDIA TRACHOMATIS
 Pendahuluan
• Bakteri Gram (-), tdk mampu memproduksi
enersi untuk metabolisme, tdk dapat mensintesa
ATP  parasit intrasel obligat atau parasit enersi
• Spesies:
– Chlamydia trachomatis
– Chlamydia pneumoniae
– Chlamydia psittaci
• C. pneumoniae dan C. psittaci
digolongkan pada Genus Chlamydophila
• Mempunyai dua bentuk:
– Elementary body (300 – 3250nm)
• bentuk ekstraseluler dari chlamydia
• Infeksius
• Metabolisme tidak aktif
– Reticulate body (800 – 1000nm)
• Bentuk intrasel Chlamydia
• Non-infeksius
• Metabolisme sangat aktif
Siklus Chlamydia
• Bakteri berukuran kecil, dapat diwarnai
dengan pewarnaan GIEMSA
• Hasil pewarnaan GIEMSA
– C. trachomatis – badan inklusi yang matur
berwarna ungu, masa padat dekat nukleus.
Pewarnaan untuk glikogen (+)  Glycogen
inclusion (+)
– C. psittaci – badan inklusi merupakan
agregat intrasel yang merata
Intracellular Inclusions of C. trachomatis
 Serovarian
• C. trachomatis – 15 serovar
– A, B, Ba, C – K, L1 – L3
• C. psittaci – beberapa serovar
• C. pneumoniae – satu serovar
 Infeksi Chlamydia pada Manusia
• TRAKTUS GENITAL:
– Laki-laki:
• Urethritis, epididymitis, proctitis – C. trachomatis (D –K)
– Perempuan
• Urethritis, cervicitis, proctitis, PID – C. trachomatis (D – K)
• Aborsi, lahir mati – C. psittaci
– Laki-laki & Perempuan
• Limfogranuloma venereum – C. trachomatis (L1 –L3)
 Infeksi genital
• Penyebab STD / PHS yang penting
• Disebabkan oleh C. trachomatis serovar D
–K
• Mengakibatkan sterilitas dan kehamilan
ektopik
• Sekret genital orang dewasa yang
terinfeksi  self-inoculation  inclusion
conjunctivitis
 Limfogranuloma Venereum
• Disebabkan oleh C. trachomatis L1 – L3
• Merpakan STD, inkubasi beberapa hari
s/d beberapa minggu
• Klinis: Papul/vesikel pad genital externa 
sembuh spontan  limfadenopati regional
 lnn. Pecah  discharge mukopurulen,
bersifat kronis  fibrosis
Lymphogranuloma Venereum
 Cara penularan Chlamydia

C. trachomatis A, B, Ba, C

Lalat
Manusia Manusia
Tangan

C. trachomatis D - K

Laki-laki Perempuan Neonatus

 Cara penularan Chlamydia (lanj)

C. pneumoniae

Manusia Manusia Manusia

C. psittaci
Manusia
Burung Burung

Manusia
 Diagnosis Laboratorium
• Sediaan langsung  pewarnaan GIEMSA
• Kultur  biakan sel dan telur berembrio
• Deteksi Antigen  immunofluoresensi
• Serologi
 Terapi dan Kontrol
• Drug of choice:
– Tetrasiklin
– Eritromisin
– Penisilin dan chloramphenicol 
chlamydiostatic
• Pembuatan vaksin belum berhasil
HAEMOPHILUS DUCREYI
Chancroid
• Bakteri berbentuk batang kecil, pleomorfik, Gram
(-), membutuhkan faktor pertumbuhan khusus
untuk isolasinya
• Faktor pertumbuhan  darah atau derivatnya
• Spesies penting:
– H. influenzae
– H. aegyptius
– H. ducreyi
– H. parainfluenzae; H. aphrophilus; H. paraaphrophilus
 Berdasarkan kebutuhan faktor X dan V

Spesies Faktor X Faktor V Hemolisa

H. influenzae + + -
H. aegyptius
H. parainfluenzae - + -
H. ducreyi + - -
H. haemolyticus + + +
H. parahaemolyticus - + +
H. aphrophilus - - -
 H. ducreyi
• Penyebab penyakit menular seksual (PMS) 
cahncroid (soft chancre)
– Ulkus yang sakit pada penis disertai limfedenitis (bubo)
– DD: sifilis, herpes simpleks, limfogranuloma venereum
• Bakteri bentuk batang, Gram (-), membutuhkan
faktor X
• Terapi:
– Ceftriaxon  im
– Trimetoprim, eritromisin  oral 2 minggu