I.

Viral Infection
Viral infections are illnesses caused by tiny organisms called viruses that
hijack our cells to replicate themselves. Viruses are incredibly small and consist of
genetic material (DNA or RNA) enclosed in a protective coating. While our cells are
like fully equipped factories, viruses lack the necessary machinery to reproduce. To
replicate, they invade our cells and use our cellular machinery, ultimately making us
ill when they multiply.

II. Types of Viral Infections

A. Covid-19
a) Definition
COVID-19, or Coronavirus Disease 2019, is an illness caused by a novel
coronavirus known as severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), previously referred to as 2019-nCoV. It was first identified
during an outbreak of respiratory illnesses in Wuhan City, Hubei Province,
China, and reported to the World Health Organization (WHO) on December
31, 2019. The WHO declared COVID-19 a global health emergency on
January 30, 2020, and on March 11, 2020, it was declared a global pandemic,
marking the first such designation since the H1N1 influenza pandemic in
2009.
b) Symptoms
Symptoms of COVID-19 can appear 2 to 14 days after exposure and include:
- Common Symptoms:
- Fever
- Cough
- Tiredness
- Loss of taste or smell
- Other Symptoms:
- Shortness of breath
- Muscle aches
- Chills
- Sore throat
- Runny nose
- Headache
- Chest pain
- Pink eye (conjunctivitis)
- Nausea
- Vomiting
- Diarrhea
- Rash
 Symptoms can range from mild to severe, and some individuals may be
asymptomatic (showing no symptoms) but can still spread the virus. In some
cases, symptoms can worsen after about a week, leading to severe respiratory
issues. Certain individuals may experience COVID-19 symptoms for an
extended period, and some may develop post-COVID-19 conditions. Children
may experience multisystem inflammatory syndrome weeks after having
COVID-19, and this condition can affect organs and tissues. In rare instances,
adults may also experience this syndrome.
c) Transmission
1. Droplet Transmission. This occurs when individuals infected with the
virus talk, cough, breathe, sing, or sneeze, releasing bioaerosol
particles. These particles can reach the nose, mouth, and eyes of other
individuals, potentially causing infection.
2. Contact Transmission. SARS-CoV-2 can be transmitted through
contact with surfaces and objects contaminated with the virus. The
virus can remain viable on these surfaces for several hours or even
days, potentially leading to infection.
3. Airborne Transmission. Airborne transmission involves small droplet
nuclei or particulates, including the virus, suspended in the air for an
extended period, exceeding 2 hours. These particles can travel
significant distances from carriers of SARS-CoV-2, with concentrated
airborne droplets released during respiration or sneezing potentially
moving several meters, remaining suspended for about 30 minutes, and
staying viable on surfaces for a few days.
d) Risk Factor
Individuals at a higher risk of severe illness from COVID-19 include:
1. Age. The risk of severe illness increases with age, with those 85 and
older at the highest risk. This is due to factors such as the presence of
underlying health conditions, a weakening immune system, and age-
related changes in lung tissue.
2. Heart Problems. Conditions like heart failure, coronary artery disease,
and heart disease elevate the risk of severe illness.
3. Long-term Kidney Disease. Underlying kidney disease weakens the
immune system, reducing its ability to combat infections effectively.
4. Cancer. Individuals currently battling cancer face higher risks, but it's
uncertain whether the same applies to those with a history of cancer.
5. Chronic Obstructive Pulmonary Disease (COPD). People with this
long-term lung condition may already have lung damage, which can
exacerbate the effects of COVID-19.
 6. Diabetes. Those with type 2 diabetes are more likely to require
intensive care and longer hospital stays. Limited research is available
on COVID-19's impact on individuals with type 1 diabetes.
7. Asthma. Moderate to severe asthma, given its involvement with the
respiratory system, is considered a risk factor for severe illness in
COVID-19 cases.
e) Treatment
Several antiviral medications have been authorized or approved by the FDA to
treat mild to moderate cases of COVID-19, particularly in individuals at
higher risk of developing severe illness.
1. Nirmatrelvir with Ritonavir (Paxlovid):
a) This antiviral is suitable for adults and children aged 12 and
older.
b) It is recommended to start this treatment as soon as possible,
preferably within 5 days of symptom onset.
c) The medication is taken orally and can be administered at
home.
2. Remdesivir (Veklury):
a) Remdesivir is an antiviral option for both adults and children.
b) It is most effective when initiated as early as possible, ideally
within 7 days of symptom onset.
c) This treatment involves intravenous (IV) infusions at a
healthcare facility and spans 3 consecutive days.
3. Molnupiravir (Lagevrio):
a) Molnupiravir is intended for adults.
b) Treatment should commence as soon as possible, within 5 days
of experiencing COVID-19 symptoms.
c) This antiviral medication is taken orally and can
be administered at home.

f) Prevention
To protect yourself and others from illnesses, it's important to follow these
guidelines:
1. Frequent Handwashing: Make it a habit to wash your hands with soap
and water for at least 20 seconds, ensuring they are thoroughly clean.
2. Avoiding Face Touching: Refrain from touching your face, nose, or
mouth with unwashed hands, as this can introduce germs to your body.
3. Maintain Safe Distance: Stay away from close contact with individuals
who are unwell and practice social distancing to reduce the risk of
infection.
4. Wild Animals: Don't touch wild animals or birds, as they can carry
diseases that may transmit to humans.
5. Surface Sanitization: Regularly clean and sanitize frequently used
surfaces to minimize the presence of germs.
 6. Coughing and Sneezing Etiquette: Cover your nose and mouth with a
tissue when sneezing or coughing, and promptly dispose of the tissue.
Remember to wash your hands thoroughly.
7. Stay Home When Sick: If you're not feeling well, avoid going out to
prevent the potential spread of illness to others.
8. Mask Usage: Wear a mask, especially when you have respiratory
illness symptoms. Seek immediate medical attention if needed.
9. Boosting Immunity: Consider incorporating vitamins into your diet to
strengthen your immune system.

g) Control Effort

The control efforts for COVID-19 have relied on a multifaceted approach to

mitigate the spread of the virus. Public health measures such as social
distancing, the promotion of awareness, maintaining personal hygiene, and
isolation of infected individuals have played a crucial role in slowing down
the transmission of the virus. These measures reduce the opportunities for the
virus to spread from person to person. Additionally, movement restrictions
and lockdowns have been implemented in various regions to limit large
gatherings and non-essential travel, further curbing the virus's reach.
Combined with vaccination campaigns, contact tracing, and testing, these
control efforts have been instrumental in managing the pandemic and
protecting public health by reducing infection rates, hospitalizations, and
fatalities. Ongoing vigilance and adherence to these measures, alongside
widespread vaccination, continue to be essential in the global fight against
COVID-19.

B. Hepatitis
Hepatitis is a liver inflammation resulting from various infectious viruses and
noninfectious factors, potentially leading to a spectrum of health issues,
including life-threatening conditions. The hepatitis virus is classified into five
primary strains, designated as types A, B, C, D, and E.
1. Hepatitis A
a) Definition

Hepatitis A is an inflammation of the liver caused by the hepatitis

A virus (HAV). The virus is primarily spread when an uninfected
(and unvaccinated) person ingests food or water that is
contaminated with the faeces of an infected person. The disease is
closely associated with unsafe water or food, inadequate
sanitation, poor personal hygiene and oral-anal sex.

b) Symptoms
Hepatitis A is a viral infection that primarily affects the liver. The
symptoms of hepatitis A can vary in severity, and not everyone
 who is infected will experience all of these symptoms. The typical
symptoms of hepatitis A include:
1. Fever: Many individuals with hepatitis A develop a fever,
which is often one of the first signs of the infection.
2. Malaise: A general feeling of discomfort, tiredness, and unease
is common in hepatitis A patients.
3. Loss of Appetite: People infected with hepatitis A often
experience a reduced or complete loss of appetite, leading to
weight loss.
4. Diarrhea: Diarrhea can be one of the early symptoms of
hepatitis A and may persist throughout the illness.
5. Nausea: Nausea, sometimes accompanied by vomiting, is a
common symptom of the infection.
6. Abdominal Discomfort: Many individuals with hepatitis A
experience abdominal pain, discomfort, or cramping.
7. Dark-Colored Urine: The urine may become darker in color,
which can be a result of liver dysfunction.
8. Jaundice: Jaundice is a characteristic symptom of hepatitis A. It
causes a yellowing of the skin and the whites of the eyes due to
the buildup of bilirubin in the body.

It's important to note that the severity of these symptoms can vary
widely, and some individuals may have a milder form of the
illness with only a few of these symptoms. Additionally, children,
especially those under 6 years of age, are less likely to exhibit
noticeable symptoms, and only a small percentage may develop
jaundice. In adults, the signs and symptoms of illness are more
common than in children. The severity of the disease and the risk
of fatal outcomes tend to be higher in older age groups.

Furthermore, hepatitis A can sometimes relapse, meaning that a

person who has just recovered from an acute episode of the
infection may fall ill again with similar symptoms. However, these
relapses are typically followed by recovery. Hepatitis A is usually
a self-limiting illness, and most people recover from it without
long-term complications.
c) Transmission
Hepatitis A is mainly spread through the fecal-oral route, where an
uninfected person ingests food or water that has been tainted with
the feces of someone who is infected. Within households, this
transmission can occur when an infected individual handles food
for family members with unclean hands. Although waterborne
outbreaks are rare, they are typically linked to water sources
contaminated by sewage or inadequately treated water.
 Additionally, the virus can be transmitted through intimate
physical contact, like oral-anal sex, with an infected person, but it
doesn't typically spread through casual contact between people.
d) Risk Factor
1. Those who haven't received the hepatitis A vaccine or haven't
been previously infected are susceptible to the virus.
2. In areas with inadequate sanitation, the risk of hepatitis A
transmission is elevated because the virus can be found in
contaminated environments.
3. Access to clean and safe drinking water is essential to prevent
hepatitis A, as the virus can be spread through water that is
contaminated.
4. Close contact with an individual infected with hepatitis A,
particularly within the same household, increases the risk of
transmission.
5. Engaging in sexual activity with someone currently infected
with hepatitis A can lead to transmission.
6. Participating in recreational drug use, sharing drug-related
equipment, or partaking in drug-related activities can elevate
the risk of contracting the virus.
7. Men who have sex with men are at a higher risk due to the
potential for oral-anal contact, which can facilitate the virus's
spread.
8. Traveling to regions with a high prevalence of hepatitis A
without vaccination or appropriate precautions can result in
exposure to the virus. It's crucial to be aware of these risk
factors and take preventive measures, such as vaccination and
good hygiene, to reduce the risk of hepatitis A infection.
e) Treatment
Hepatitis A doesn't have a specific treatment, and the recovery
process can be slow, spanning several weeks or even months. It's
crucial to avoid using medications that aren't necessary and could
potentially harm the liver, such as acetaminophen or paracetamol.
Hospitalization is typically only needed in cases of acute liver
failure. Treatment primarily centers on ensuring the patient's well-
being and maintaining a proper nutritional balance, which includes
replacing lost fluids from vomiting and diarrhea.
f) Prevention
Reducing the transmission of hepatitis A involves:
● Providing an adequate and safe drinking water source.
● Implementing proper sewage disposal methods within
communities.
● Fostering personal hygiene practices, such as regular
handwashing prior to meals and after restroom use.
2. Hepatitis B
a) Definition
Hepatitis B is a liver infection caused by the hepatitis B
virus, with the potential to present as either a severe, short-term
acute infection or a persistent, long-lasting chronic condition.
b) Symptoms

Some people have acute illness with symptoms that last

several weeks:

● yellowing of the skin and eyes (jaundice)

● dark urine
● feeling very tired
● nausea
● vomiting
● pain in the abdomen.

When severe, acute hepatitis can lead to liver failure, which can
lead to death.

c) Transmission

The hepatitis B virus is transmitted through blood and sexual

fluids. This can most commonly occur in the following ways:

● Direct contact with infected blood

● From an infected pregnant person to their
newborn during pregnancy and childbirth
● Needles and other medical/dental equipments or
procedures that are contaminated or not sterile
● Unprotected sex
● Use of illegal or “street” drugs
● Body piercing, tattooing, acupuncture and even
nail salons are other potential routes of infection
unless sterile needles and equipment are used. In
addition, sharing sharp instruments such as
razors, toothbrushes, nail clippers, earrings and
body jewelry can be a source of infection.
d) Higher
risk
Certain groups are at a higher risk of contracting hepatitis B,
and they should consider taking preventive measures and
getting vaccinated:
1. Healthcare providers and emergency responders due to
potential exposure to infected body fluids.
 2. Sexually active individuals with multiple partners, as
this increases the risk of sexual transmission.
3. Men who have sex with men, who face a higher risk of
sexual transmission.
4. Individuals diagnosed with a sexually transmitted
disease, as they are already at risk of infections,
including hepatitis B.
5. Illicit drug users, especially those who inject, inhale,
snort, or use pills, as shared needles or drug
paraphernalia can lead to transmission.
6. Sexual partners or close household contacts of infected
persons due to close contact with infected individuals.
7. Individuals born in or to certain regions, such as Asia,
Africa, South America, Pacific Islands, Eastern Europe,
and the Middle East, where hepatitis B is common.
8. Children adopted from high-risk regions, particularly if
adopted from countries with a high prevalence of
hepatitis B.
9. Adoptive families of such children who may also be at
risk.
10. Anyone diagnosed with cancer before starting
anticancer treatment, as their immune systems may be
compromised.
11. Kidney dialysis patients and those in early kidney
(renal) failure due to the risk during medical
procedures.
12. Inmates and staff of correctional facilities where close
quarters can facilitate transmission.
13. Residents and staff of facilities for developmentally
disabled persons because of potential close contact and
shared facilities.
14. All pregnant women should be screened and vaccinated
if necessary to prevent mother-to-child transmission
during childbirth.
e) Treatment

There is no specific treatment for acute hepatitis B.

Chronic hepatitis B can be treated with medicines. Care for
acute hepatitis B should focus on making the person
comfortable. They should eat a healthy diet and drink plenty of
liquids to prevent dehydration from vomiting and diarrhea.
Chronic hepatitis B infection can be treated with oral
medicines, including tenofovir or entecavir. Treatment can
slow
 the advance of cirrhosis, reduce cases of liver cancer, and
improve long term survival.

f) Prevention
Hepatitis B can be effectively prevented through
vaccination. The hepatitis B vaccine is a safe and reliable
immunization recommended for all infants at birth and children
up to 18 years of age. Additionally, it's advised for adults living
with diabetes and those at an elevated risk of infection due to
their occupation, lifestyle, living conditions, or country of birth.
Given that everyone carries some level of risk, all adults are
encouraged to seriously consider getting the hepatitis B vaccine
for lifelong protection against a preventable chronic liver
disease. This vaccine is also renowned as the first "anti-cancer"
vaccine because it effectively prevents hepatitis B, which is the
leading cause of liver cancer on a global scale.
3. Hepatitis C
a) Definition
Hepatitis C is a disease caused by the Hepatitis C virus (HCV) which
belongs to the Flaviviridea family of enveloped viruses which belongs to
the Hepacivirus genus and is a single-stranded RNA virus (RNA single
strain), linear in shape and 50 nm in diameter. At least 6 major HCV
genotypes and more than 50 different HCV subtypes have been
discovered. This diversity has different consequences, variations in these
genotypes influence the response of HCV to combination
interferon/ribavirin therapy.
b) Symptoms
The following are the symptoms of hepatitis C:
1. Fatigue
2. Muscle and joint pain.
3. Fever
4. No appetite.
5. Nausea and vomiting.
6. Stomach ache.
7. Gray stools.
8. Jaundice
The majority (> 90%) of acute Hepatitis C cases are asymptomatic.
The incidence of fulminant hepatitis is also very small compared to VHC
infection. A small number of sufferers may experience prodromal
symptoms like viral infections in general. Most of the conditions of acute
Hepatitis C sufferers will develop into chronic Hepatitis C which is
generally also asymptomatic. Between 20 - 30% of these sufferers will
progress to Liver Cirrhosis within the next 20 - 30 years. In this condition,
liver damage is slowly progressive, often sufferers who are infected with
 VHC in old age do not experience liver problems or complaints at all
throughout their life.
c) Transmission
The following is how Hepatitis C is transmitted
1. Blood Transmission Hepatitis C is a Blood Borne Virus. Through
blood transfusions and blood products such as organ transplants that
have not gone through the screening process are potential sources of
HCV transmission. Transmission of HCV through blood is closely
related to Injection Drug Use, this is caused by the use of non-sterile
syringes. For example, for drug users, sharing needles is normal for
them. Therefore, there is a high possibility of HCV transmission
among injecting drug users. Then through blood transfusions, this
happens if the blood does not pass screening, then body piercing and
tattooing activities, if you do not use safe tools and procedures, the risk
of contracting HCV is greater. Sharing personal tools that tend to cause
injuries, such as shavers, scissors, toothbrushes, etc., can also increase
the risk of contracting HCV.
2. Sexual Contact Through sexual intercourse without using protective
equipment such as condoms with carrier hepatitis sufferers can
transmit the Hepatitis C virus, this can happen if someone engages in
risky sexual behavior, although the percentage of transmission through
sexual contact is not too large, namely around 15%. These risky sexual
behaviors are as follows:
● Users of prostitute services
● Sexually transmitted wounds (lack of pelicans in the vagina can
increase transmission through blood)
● Having more than one partner
● Men like men (homosexuals)
● Having sex with someone infected with HCV.
3. Vertical Transmission Transmission from someone who is positive for
HCV to their baby during pregnancy. However, vertical transmission
is very rare, approximately 6 out of 100 births occur.
4. Nosomical Infections Nosomical transmission usually occurs in
hemodialysis patients. This transmission occurs due to inadequate
disinfection and sterilization techniques for hemodialysis equipment,
resulting in the equipment being contaminated by HCV.
5. Simultaneous use of syringes (IDUs) or other equipment such as tools
used by Hepatitis C sufferers.
d) Risk Factor
1. Drug abuse using injection equipment.
2. Blood Transfusion
3. Organ Transplantation
4. Hemodialysis
5. Sexual Intercourse
 e) Treatment
● Hepatitis C treatment is given for chronic Hepatitis C because
patients often come to health care centers in the chronic phase.
● Giving antivirals to patients with chronic hepatitis C must also
be at the discretion of the doctor after carrying out a series of
examinations.
● The newest therapeutic option and the backbone of chronic
Hepatitis C therapy is direct acting antiviral agents (DAA).
● The DAAs currently available in Indonesia are sofosbuvir,
ledipasvir/sofosbuvir, simeprevir,
daclatasvir,
elbasvir/grazoprevir, and velpatasvir/sofosbuvir.
● If DAA is not available, a combination of peg-interferon and
ribavirin injection drugs can be given.
f) Prevention
● Wash your hands regularly with soap and water, especially after
outdoor activities and before eating.
● Avoid sharing personal items such as toothbrushes, nail clippers, and
razors.
● Do not share or reuse needles or other drug paraphernalia.
● Practice safe sex by using condoms and limiting the number of sexual
partners.
● Be cautious when getting pierced or tattooed, and ensure that the
equipment used is sterile.
● Maintain a balanced and nutritious diet to boost your immune system.
● Cover open wounds with a plaster, especially for individuals with
hepatitis C, to prevent transmission to others.

4. Hepatitis D
a) Definition
Hepatitis D is a disease caused by the Hepatitis delta (VHD) virus which
was first discovered in 1977, measuring 35-37 nm and has a unique
internal antigen, namely the delta antigen. This virus is an RNA virus
with a defect, meaning that this virus is unable to replicate completely
without another virus, namely the Hepatitis B virus. This is because VHD
is unable to synthesize its own envelope protein and depends on proteins
synthesized by VHB, including HBsAg. Therefore, VHD infection can
only occur in sufferers who are also infected with HBV at the same time
or have been chronically infected with HBV. The VHD genome consists
of 1,700 base pairs, which is the smallest number of base pairs for a virus
in animals.
b) Symptoms
 The symptoms of Hepatitis D infection are exactly the same as Hepatitis
B, namely:
● Loss of appetite
● Nausea and vomiting.
● Weight loss.
● Flu-like symptoms such as fatigue, body aches, headaches and high
fever (around 38ºC or more).
● Abdominal pain.
● Weak and tired. Jaundice (yellowing of the skin and whites of the
eyes).
However, the presence of this virus has been proven to accelerate the
fibrosis process in the liver, increase the risk of liver cancer, and
accelerate decompensation in liver cirrhosis. If the Hepatitis B suffered by
the sufferer is acute and then cured, VHD will also disappear completely.
However, if VHD infects a patient who already suffers from chronic
Hepatitis B, then the patient will also suffer from chronic Hepatitis D.
c) Transmission
The Hepatitis D virus can be transmitted or spread through contact with
blood contaminated with VHD or other body fluids.
d) Risk Factor
● Suffering from hepatitis B (including carriers).
● Having same-sex sexual relations, especially with men.
● Living with someone suffering from or in a hepatitis D outbreak area.
● Frequently receive blood transfusions, especially if the blood donated
has not undergone strict examination or the equipment used is not
clean.
● Using used syringes from hepatitis D sufferers, which usually occurs
in injecting drug users.
e) Treatment

Pegylated interferon alpha is the generally recommended treatment for

hepatitis D virus infection. Treatment should last for at least 48 weeks
irrespective of the patient’s response. The virus tends to give a low rate
of response to the treatment; however, the treatment is associated with
a lower likelihood of disease progression.

This treatment is associated with significant side effects and should not
be given to patients with decompensated cirrhosis, active psychiatric
conditions and autoimmune diseases. Bulevirtide is one of the new
promising treatments for hepatitis D.

More efforts are needed to reduce the global burden of chronic

hepatitis B and develop medicines that are safe and effective against
 hepatitis D and are affordable enough to be deployed on a large scale
to those who are most in need.
f) Prevention

While WHO does not have specific recommendations on

hepatitis D, prevention of HBV transmission through hepatitis B
immunization, including a timely birth dose, additional antiviral
prophylaxis for eligible pregnant women, blood safety, safe injection
practices in health care settings and harm reduction services with clean
needles and syringes are effective in preventing HDV transmission.
Hepatitis B immunization does not provide protection against HDV for
those already infected with HBV.

5. Hepatitis E
a) Definition
Hepatitis E is a disease caused by the Hepatitis E virus (VHE), a spherical
RNA virus. VHE belongs to the Hepeviridiea family, Hepevirus genus.
This virus was initially referred to as the cause of enterically transmitted
non-A non-B Hepatitis (ET-NANB). It was only in 1983 that this virus
was identified and named the Hepatitis E virus.
b) Symptoms
Hepatitis E infection is always acute, the signs and symptoms of this
infection vary from subclinical to fulminant. The possibility of fulminant
hepatitis due to VHE infection is currently not high, only 0.5 - 3%. This
possibility increases in pregnant women where the death rate can reach
20%. Symptoms that may appear in acute Hepatitis E are no different
from other acute Hepatitis, namely weakness, decreased appetite, fever,
abdominal pain, nausea, vomiting, and jaundice. When compared with
Hepatitis A, acute Hepatitis E tends to be more severe clinically, with the
risk of coagulopathy and cholestasis occurring in approximately 50% of
sufferers.
c) Transmission
VHE is transmitted via the fecal-oral route. Drinking water contaminated
with feces is the most common medium of transmission. Postnatal and
perinatal transmission has been documented. Based on various recent
studies, it shows the possibility of transmission through zoonotic
transmission from pigs, deer and rodents.
d) Risk Factor
- Poor personal hygiene
- The hepatitis E virus enters the feces when defecating
- Having sex without using protection
- Consuming food or drinks contaminated with the hepatitis E virus
- Not washing hands after using the toilet, before preparing food or
before eating
 - Sharing personal items, such as razors or nail clippers
- Having sexual relations with someone with hepatitis, having more than
one sexual partner, or having sex with men
e) Treatment
There is no specific treatment capable of altering the course of acute
hepatitis E. As the disease is usually self-limiting, hospitalization is
generally not required. It is important to avoid unnecessary medications
that can adversely affect liver function, e.g. acetaminophen, paracetamol.

Hospitalization is required for people with fulminant hepatitis and should

also be considered for symptomatic pregnant women.

Immunosuppressed people with chronic hepatitis E benefit from specific

treatment using ribavirin, an antiviral drug. In some specific situations,
interferon has also been used successfully.
f) Prevention

Prevention is the most effective approach against the infection. At the

population level, transmission of HEV and hepatitis E infection can be
reduced by:

1. Maintaining quality standards for public water supplies; and

establishing proper disposal systems for human faeces. On an
individual level, infection risk can be reduced by: maintaining
hygienic practices
2. avoiding consumption of water and ice of unknown purity.

C. HIV/Aids
1. Definition
HIV (human immunodeficiency virus) is a virus that attacks the human
immune system. AIDS is short for Acquired Immune Deficiency Syndrome
Acquired means acquired, not hereditary. Immune relates to our immune
system. Deficiency means lack. Syndrome means a disease with a
collection of symptoms, not a specific symptom. So AIDS means a collection
of symptoms due to a deficiency or weakness of the immune system that is
formed after we are born.
2. Symptoms
After infection with the HIV virus, there are no symptoms at first. symptoms.
It is only a few weeks later that the infected person often suffers from
everyday minor illnesses such as flu or diarrhea. Patients often feel healthy
and outwardly healthy. It is often 3-4 years before the patient shows any
symptoms. Afterwards, in year 5 or 6, recurrent diarrhea, sudden weight loss,
frequent mouth ulcers, and swelling of the glands. sudden weight loss,
frequent mouth ulcers, and swelling of the lymph nodes. lymph nodes.
3. Transmission
HIV can be transmitted through the exchange of various bodily fluids from
infected individuals, such as blood, breast milk, semen and vaginal fluids.
Individuals cannot be infected through ordinary daily contact such as kissing,
hugging, shaking hands or sharing personal objects, food or water. Ways of
transmission of HIV/AIDS
● Sexual intercourse: unsafe sexual intercourse with a person who has
been exposed to HIV.
● Blood transfusion: through transfusing blood that is embedded with
HIV.
● Syringe use: the use of needles, piercing, tattooing and razors that can
cause wounds that are not sterilized together are used and have
previously been used by HIV-infected people. This method can
transmit HIV because of the blood box.
● Pregnant women to their children
➢ Antenatal: when the baby is still in the womb, through the
placenta.
➢ Intranatal: during labor, the baby is exposed to the mother's
blood or vaginal fluids.
➢ Postnatal: after delivery, through breast milk. The reality is that
25-35% of all babies born to infected mothers in developing
countries contract HIV and 90% of infants and children who
contract HIV get it from their mothers.
4. Risk Factor
● Changing sexual partners without using contraceptives
● Simultaneous use of needles and syringes
● Transmission from pregnant mother to fetus through the placenta
● Receiving injections, blood transfusions, or using contaminated blood
products
● Sexual intercourse with an HIV patient
● Hereditary factors, HIV can also be transmitted from a mother to her
child during pregnancy and childbirth
5. Treatment
Following a positive diagnosis, people should be retested before they are
enrolled in treatment and care to rule out any potential testing or reporting
errors. While testing for adolescents and adults has been made simple and
efficient, this is not the case for babies born to HIV-positive mothers. For
children less than 18 months of age, rapid antibody testing is not sufficient to
identify HIV infection – virological testing must be provided as early as birth
or at 6 weeks of age. New technologies are now available to perform this test
at the point of care and enable same-day results, which will accelerate
appropriate linkage with treatment and care.
 To slow down the progression of the virus, several medications are available
for HIV/AIDS treatment. Antiretroviral drugs (ARVs) are used to inhibit the
replication of the HIV virus. Some examples of ARV drugs include AZT,
Didanosine, Zalcitabine, and Stavudine. Opportunistic infectious medications
are used to treat diseases that may arise as a consequence of a weakened
immune system. The key to treating opportunistic infections is to use
appropriate drugs specific to the type of disease, for example, anti-TB
medications. These treatments can help manage the virus and improve the
quality of life for individuals living with HIV/AIDS.
6. Prevention
Several things that can be done so that fewer people are affected are:
1. Avoid free sex as much as possible
2. Try to only have sexual relations with one partner
3. Provide vaccination if the pregnant woman is HIV positive so that the
baby is less likely to become infected with HIV
4. Do not donate blood if you have HIV
5. Providing education/information to the entire community about
HIV/AIDS, through distributing brochures, posters related to
HIV/AIDS, and through advertising in mass media, both print and
electronic media.
D. Sexually Transmitted Disease
Sexually Transmitted Diseases (STDs) or Sexually Transmitted Infections (STIs) are
various infections that can be transmitted from one person to another, through sexual
contact. All sexual intercourse techniques, whether through the vagina, anus or
mouth, whether of the opposite sex or with members of the same sex, can be a means
of venereal disease. So that the abnormalities caused are not only limited to the
genital area, but can also occur in extra-genital areas. The age group that has the
highest risk of contracting STIs is the group of teenagers to young adults aged around
15-24 years. Sexually transmitted disease that caused by virus:
1. HPV
a. Definition
Human papillomavirus (HPV) is a member of the Papoviridae family,
the papillomavirus genus. HPV is small in size with a diameter of 55
nm and is a circular DNA virus with non-enveloped double strands.
HPV has an icosahedral capsid (L1 and L2) composed of 72
capsomeres. Each capsomere is a major capsid pentamer (L1). Each
virion capsid consists of several minor capsids (L2). The HPV genome
is functionally divided into 3 parts. The first part is the noncoding
upstream regulatory region (URR). This part has p97 which is a core
promoter that regulates DNA replication by regulating transcription
from the early region and late region. The second part is the early
region in the form of E1, E2, E3, E4, E5, E6, E7, and E8. This
region is involved in viral replication and oncogenesis. The third
part is the
 late region which codes for the L1 and L2 protein structures for the
capsid.
b. Symptoms
1. Genital Warts
In the case of genital warts, most of the symptoms of HPV
virus infection are the presence of small lumps which over time
become more numerous and form protrusions like a cock's
comb. These lumps are called warts. These warts can grow on
the sexual organs, cervix (in women), or anus. Warts caused by
the HPV virus can cause itching, pain and discomfort
throughout the day.
2. Skin Warts
Not much different from genital warts, this condition causes
symptoms of small bumps appearing on the skin. These warts
often grow on the skin of the hands, elbows and fingers. If you
are frequently exposed to pressure or trauma, it can cause pain
and even bleed.
3. Cervical cancer
In most cases of cervical cancer, symptoms due to HPV virus
infection are smelly vaginal discharge, bleeding after
menopause, and bleeding after sexual intercourse. In more
severe conditions, or advanced stages, people with cervical
cancer will experience weakness, weight loss, bone pain,
problems urinating and the spread of cancer cells.
c. Transmission
● HPV can be transmitted through vaginal, anal, or oral sex with
an infected person
● The virus can be spread even when the infected person does not
have any symptoms or signs of infection
● HPV can also be transmitted through non-sexual activities that
involve genital contact with an infected person
● The virus can live in the skin cells and enter the body through
a cut or an open wound
● Sharing personal items such as towels, handkerchiefs, or socks
does not appear to be a common way of transmitting the virus
d. Risk Factor
● Sexual activity: The most common way of transmission is
through skin-to-skin contact during sexual intercourse. This
includes vaginal, anal, and oral sex
● Having multiple sexual partners and engaging in high-risk
sexual behaviors can increase the risk of HPV infection
● Weakened immune system: Individuals with a weakened
immune system, such as those with HIV/AIDS or who have
 undergone organ transplantation, are more susceptible to HPV
infection.
● Open wounds or cuts: HPV can enter the body through open
wounds, cuts, or small tears in the skin
● Genital contact: HPV can be transmitted through other
activities that involve genital contact with an infected person,
even without penetration
● Personal hygiene: Poor personal hygiene, especially in the
genital area, can contribute to the spread of HPV
● Age: Younger individuals, especially those in their late teens
and early 20s, are more likely to contract HPV
● Type of HPV: There are more than 100 types of HPV, and
some are more likely to cause genital warts or cancer than
others. Types 16 and 18, for example, are considered high-risk
and are responsible for most cases of cervical cancer
● Smoking: Smoking has been associated with an increased risk
of HPV infection and the development of cervical cancer
● Pregnancy: Hormonal changes during pregnancy can make
women more susceptible to HPV infection and the
development of genital warts
● Low socioeconomic status: Some studies have suggested a link
between low socioeconomic status and an increased risk of
HPV infection, although the relationship is not consistent
among researchers
e. Treatment
HPV is a type of virus that can disappear on its own, but to speed up
recovery, you can use topical medication to remove warts. Meanwhile,
if the virus has mutated and caused cervical cancer, cancer treatment
such as chemotherapy, cryotherapy, radiotherapy and surgery is
needed.
f. Prevention
● Carrying out HPV vaccination, this vaccine is recommended
to be given to adolescent girls from the age of 10-26 years.
● Minimize sharing of personal items
● Consider using protection during sexual intercourse
● Immediately wash your hands with soap if you accidentally
touch the wart
● Maintain cleanliness
2. Herpes Simplex
a. Definition
Herpes simplex infection is characterized by repeated episodes of
small blisters on the skin or mucous membranes, which are fluid-filled
and painful. Herpes Simplex causes an eruption on the skin or mucous
membranes. This eruption will disappear even though the virus
 remains in an inactive state in the ganglia (nerve cell bodies), which
innervate the infected area. Periodically, this virus will reactivate and
begin to multiply, often causing skin eruptions in the form of blisters
in the same location as the previous infection. The virus can also be
found in the skin without causing real blisters, in which case the virus
is a source of infection for other people.
b. Symptoms
Common symptoms of Herpes simplex are fluid-filled bumps that feel
sore and hot. This bump will last several days. These small nodules
can spread not only on the face but also throughout the body. It can
also look like acne, and in women there is vaginal discharge. This
uncomfortable feeling of pain and heat throughout the body can last
for several days, accompanied by pain when swallowing food, because
the lymph nodes have been disturbed. These symptoms come and go
for some time. It is possible that after recovery, these symptoms
"sleep" for a while for up to a year. But it will suddenly recur within a
few weeks. Often there is itching that is not clear where, the skin feels
like it is burning in certain parts of the body accompanied by pain in
the groin area or even spreading to the lower legs. Symptoms of
herpes can injure the penis, testicles, anus, thighs, buttocks, vagina and
bladder.
c. Transmission
1. Horizontal
Horizontal transmission occurs when a seronegative
individual is infected with a seropositive individual via
vesicles containing active virus (81-88%), dried HSV
ulcers or lesions (36%) and from other body fluid
secretions such as saliva, semen, and genital fluids (3.6-
25%). If these materials come into contact with injured
skin or mucosa, or in some cases the skin or mucosa, the
virus can enter the body of the new host and multiply in
the nucleus of the cell it has just entered and then remain
for life and at any time can causes typical symptoms,
namely the appearance of small vesicles in groups with
an erythematous base.
2. Vertical
Vertical transmission of HSV occurs in neonates in the
antenatal, intrapartum and postnatal periods. The
antenatal period is responsible for 5% of neonatal HSV
cases. This transmission mainly occurs when the mother
experiences a primary infection and the virus is in the
viremia phase (the virus is in the blood) so that the virus
enters the placenta hematogenously following the
uteroplacental circulation and finally infects the fetus.
 The period of primary maternal infection also influences
the baby's prognosis, if infection occurs in the first
trimester, abortion will usually occur and in the second
trimester, premature birth will occur. Babies with
antenatal HSV infection have a mortality rate of
approximately 60% and half of those who survive will
experience central nervous and eye disorders. Primary
infection which occurs in the later stages of pregnancy
will give a worse prognosis because the mother's body
has not yet had time to form antibodies (formed 3-4
weeks after the virus enters the host's body) to then be
distributed to the fetus as a transplacental neutralizing
antibody and this will resulting in 30-57% of babies born
being infected with HSV with various complications
(microcephaly, hydrocephalus, calcification, intracranial,
chorioretinitis, and encephalitis). Ninety percent of
neonatal HSV infections occur during intrapartum,
namely when the baby passes through the birth canal and
comes into contact with lesions or the mother's genital
fluids. Mothers with primary infections 35%, recurrent
infections and. asymptomatic 0-4%.
d. Treatment
Several antiviral drugs have been proven effective against HSV
infection. All of these drugs inhibit viral DNA synthesis. This drug can
inhibit the reproduction of the herpes virus. However, HSV remains
latent in the sensory ganglia, and recurrence rates are not significantly
different in treated and untreated individuals.

One of the effective drugs for Herpes Simplex Virus infection is:
Cyclofir in topical, intravenous and oral forms, all of which are useful
for treating infections.
e. Prevention
1. Prevention of horizontal HSV transmission
a. Personal hygiene
1) Frequently clean yourself by bathing in clean
water. Ideally, during the summer, shower twice
in the morning and evening.
2) Change clothes at least twice a day after
showering to keep your body clean.
3) Wash the sheets, towels and clothes used in
clean water and use detergent.
4) Preventing contact with the saliva of HSV
sufferers can be done by avoiding kissing and
using the sufferer's eating utensils and using
 mouthwash containing antiseptics which can kill
the virus, thereby reducing the risk of infection.
b. Environment sanitation
1) Keep the environment clean.
2) Use clean water whose quality meets health
requirements
2. Prevention of vertical transmission of HSV
Vertical prevention can be done by detecting pregnant
women with initial screening at 14-18 weeks of gestation,
then cervical culture is carried out every week starting from
the 34th week of pregnancy in pregnant women with a
history of HSV infection and giving suppressive antiviral
therapy (given every day starting from 36 weeks of
gestation with acyclovir 400mg 3 times per day or 200mg 5
times per day) which can significantly reduce the
recurrence period during labor (36% VS 0%). However, if
before delivery, the final culture results are still positive
and there are active lesions in the genital area, then
caesarean delivery is the main choice. The postnatal period
is responsible for 5-10% of cases of neonatal HSV
infection. This infection occurs due to contact between the
neonate and the mother who is infected with HSV (100%
HSV-I primary infection, 17% HSV-II primary infection,
18% recurrent HSV-1, 0% recurrent HSV-II) and also due
to contact between the neonate and the worker. HSV-
infected health. Choosing the right prevention method
according to the transmission model can reduce the
incidence and transmission of HSV infection.

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