INFEKSI ORGAN REPRODUKSI

PRIA DAN WANITA

dr Dino Gagah Prihadianto SpOG,MKes

BAG KEBIDANAN DAN PENYAKIT KANDUNGAN

FAKULTAS KEDOKTERAN
UNIVERSITAS BATAM
Infeksi organ reproduksi
• adalah masuk dan berkembang biaknya kuman
penyebab infeksi kedalam saluran reproduksi.
Kuman penyebab infeksi tersebut dapat berupa
bakteri, jamur, virus dan parasit
• Perempuan lebih mudah terkena ISR
dibandingkan laki-laki, karena saluran reproduksi
perempuan lebih dekat ke anus dan saluran
kencing. ISR pada perempuan juga sering tidak
diketahui , karena gejalanya kurang jelas
dibandingkan laki-laki.
Infeksi organ reproduksi pria
• PENIS
• SCROTUM, TESTIS, & EPIDIDYMIS
• PROSTATE
 INFLAMMATORY LESIONS OF THE
PENIS
• SEXUALLY TRANSMITTED DISEASES
• BALANITIS (BALANOPOSTHITIS)
– INFLAMMATION OF THE GLANS (PLUS
PREPUCE)
– ASSOCIATED WITH POOR LOCAL HYGIENE
IN UNCIRCUMCISED MEN
• SMEGMA
– DISTAL PENIS IS RED, SWOLLEN, TENDER
• +/- PURULENT DISCHARGE
 INFLAMMATORY LESIONS OF THE
PENIS
• PHIMOSIS
– PREPUCE CANNOT BE EASILY RETRACTED
OVER GLANS
– MAY BE CONGENITAL
– USUALLY ASSOCIATED WITH
BALANOPOSTHITIS AND SCARRING
– PARAPHIMOSIS (TRAPPED GLANS)
• URETHRAL CONSTRICTION
 INFLAMMATORY LESIONS OF THE
PENIS
• FUNGAL INFECTIONS
–CANDIDIASIS
• ESPECIALLY IN DIABETICS
• EROSIVE, PAINFUL, PRURITIC
• CAN INVOLVE ENTIRE MALE
EXTERNAL GENITALIA
 NEOPLASMS OF THE PENIS
• SQUAMOUS CELL CARCINOMA (SCC)
– EPIDEMIOLOGY
• UNCOMMON – LESS THAN 1 % OF CA IN US MEN
• UNCIRCUMCISED MEN BETWEEN 40 AND 70
– PATHOGENESIS
• POOR HYGIENE, SMEGMA
• HUMAN PAPILLOMA VIRUS (16 AND 18)
• CIS FIRST, THEN PROGRESSION TO INVASIVE SQUAMOUS
CELL CARCINOMA
Squamous Cell Carcinoma
 SCC OF THE PENIS
• CLINICAL COURSE
– USUALLY INDOLENT
– LOCALLY INVASIVE
– HAS SPREAD TO INGUINAL LYMPH NODES IN 25%
OF CASES AT PRESENTATION
– DISTANT METS RARE
– 5 YR SURVIVAL
• 70% WITHOUT LN METS
• 27% WITH LN METS
LESIONS INVOLVING THE SCROTUM
• INFLAMMATION
– TINEA CRURIS (JOCK ITCH)
• SUPERFICIAL DERMATOPHYTE INFECTION
• SCALY, RED, ANNULAR PLAQUES, PRURITIC
• INGUINAL CREASE TO UPPER THIGH
• SQUAMOUS CELL CARCINOMA
– HISTORICAL SIGNIFICANCE
– SIR PERCIVAL POTT, 18TH CENTURY ENGLISH
PHYSICIAN
– CHIMNEY SWEEPS
 INFLAMMATORY LESIONS OF THE
TESTIS
• USUALLY INVOLVE THE EPIDIDYMIS FIRST
• SEXUALLY TRANSMITTED DISEASES
• NONSPECIFIC EPIDIDYMITIS AND ORCHITIS
– SECONDARY TO UTI
• BACTERIAL AND NON-BACTERIAL
– SWELLING, TENDERNESS
– ACUTE INFLAMMATORY INFILTRATE
INFLAMMATORY LESIONS OF THE TESTIS
• MUMPS
– 20% OF ADULT MALES WITH MUMPS
– EDEMA AND CONGESTION
– CHRONIC INFLAMMATORY INFILTRATE
– MAY CAUSE ATROPHY AND STERILITY
• TUBERCULOSIS
– GRANULOMATOUS INFLAMMATION
– CASEOUS NECROSIS
• AUTOIMMUNE GRANULOMATOUS ORCHITIS
– RARE FINDING IN MIDDLE AGED MEN
 PROSTATITIS
• ACUTE BACTERIAL PROSTATITIS
• CHRONIC BACTERIAL PROSTATITIS
• CHRONIC ABACTERIAL PROSTATITIS
 ACUTE BACTERIAL PROSTATITIS
• ETIOLOGY
– SAME ORGANISMS THAT CAUSE UTI
• E coli, OTHER GNR
• PATHOGENESIS
– ORGANISMS ASCEND FROM URETHRA AND
URINARY BLADDER
– RARELY, HEMATOGENOUS SPREAD
 ACUTE BACTERIAL PROSTATITIS
• MORPHOLOGY
– ACUTE INFLAMMATION, ESPECIALLY IN THE
GLANDS, WITH MICROABSESSES
– CONGESTION, EDEMA
• CLINICAL COURSE
– DYSURIA, FREQUENCY, LOW BACK PAIN, PELVIC
PAIN
– ENLARGED, EXQUISITELY TENDER
– +/- FEVER OR LEUKOCYTOSIS
– USUALLY RESOLVES WITH WITH AB RX
 CHRONIC PROSTATITIS
• ETIOLOGY
– MAY FOLLOW ACUTE PROSTATITIS
– MAY DEVELOP INSIDIOUSLY
– CULTURE POSITIVE (BACTERIAL)
• SAME ORGANISMS THAT CAUSE AP
– CULTURE NEGATIVE (ABACTERIAL)
• MAY BE RELATED TO
– CHLAMYDIA TRACHOMATIS
– UREAPLASMA UREALYTICUM
• MOST COMMON FORM OF CP
 CHRONIC PROSTATITIS
• MORPHOLOGY
– LYMPHOCYTIC INFILTRATE
– NEUTROPHILS AND MACROPHAGES
– SOME EVIDENCE OF TISSUE DESTRUCTION
• CLINICAL COURSE
– SIMILAR TO AP
• LESS ACUTE SYMPTOMS
• MORE RESISTANT TO AB RX
– CBP OFTEN ASSOCIATED WITH RECURRENT UTI
 Infeksi organ reproduksi wanita
• Radang Panggul / P I D
• Kelainan pada Mulut Rahim / Cervix
• Infeksi pada Vulva / Vagina
 Pelvic Inflammatory Disease (PID)
• Common infection of reproductive tract
– Particularly fallopian tubes and ovaries
• Includes:
– Cervicitis (cervix)
– Endometritis (uterus)
– Salpingitis (fallopian tubes)
– Oophoritis (ovaries)
• Infection either cute or chronic
• Short-term concerns: peritonitis, pelvic abscess
• Long-term concerns: infertility, high risk of ectopic
pregnancy
 PID—Pathophysiology
• Usually originates as vaginitis or cervicitis
– Often involves several causative bacteria
• Uterus  fallopian tube
– Edema, fills w/ purulent exudate
• Obstructs tube and restricts drainage into uterus
• Exudate drips out of fimbriae onto ovaries and surrounding tissue
– Peritoneal membrane attempts to localize but peritonitis may
develop
» Abscesses may form; life-threatening
» Cause septic shock
• Adhesions affect tubes and ovaries
– Lead to infertility and ectopic pregnancies
PID
 PID—Etiology
• Arise from sexually transmitted diseases
– Gonorrhea
– Chlamydiosis
• Prior episodes of vaginitis or cervicitis precedes
development
• Infection acute during or after menses
– Endometrium more vulnerable
• Can also result from IUD or other contaminated
instrument
– Can perforate wall and lead to inflammation and infection
 PID—Signs and Symptoms
• Lower abdominal pain (1st indication)
– Sudden and severe or gradually increasing in
intensity
• Tenderness during pelvic exams
• Purulent discharge at cervix
• Dysuria
• Fever and leukocytosis can occur
– Depends on causative organism
 PID—Treatment
• Aggressive antibiotics
– Cefoxitin, doxycycline
• Recurrent infections common
– Sex partners should be treated as well
• Follow-up appt to ensure eradication
 Carcinoma of the Cervix
• # deaths has decreased due to Pap smear
– Screening and early diagnosis while cancer in situ
• However, # cases of carcinoma in situ has
increased in the US
– Avg age of in situ onset is 35
– Invasive carcinoma manifests at 45
– Age range dropping to younger women
 Cervical Cancer—Pathophysiology
• Early changes in cervical epithelial tissue consist of dysplasia
– Mild then becomes severe (takes 10 yrs)
– Occurs at junction of columnar cells and squamous cells of external os
of cervix
• Cervical intraepithelial neoplasia (CIN) graded from I to III
– Based on amount of dysplasia and cell differentiation
– Grade III
• Carcinoma in situ
• Many disorganized, undifferentiated, abnormal cells present (severe
dysplasia)
– Takes 10 yrs from mild to carcinoma in situ so plenty of chances to
detect
 Cervical Cancer—Pathophysiology
• Carcinoma in situ is noninvasive stage
• Leads to invasive stage
• Invasive has varying characteristics
– Protruding nodular mass or ulceration
– Eventually all characteristics present in the lesion
• Carcinoma spreads in all directions
– Adjacent tissues (uterus and vagina); bladder, rectum, ligaments
• Metastases to lymph nodes occur rarely or in late stage
• Staging:
– 0: carcinoma in situ
– I: cancer restricted to cervix
– II to IV: further spread to surrounding tissues
Normal Cervix; Cancerous Cervix
 Cervical Cancer—Etiology
• Strongly linked to STDs
– Herpes simplex virus type 2 (HSV-2)
– Human papillomavirus (HPV)
• Virus exerts direct effects on host cell or may cause antibody
rxn
– Increased antibodies have been assoc w/ increasing dysplasia
• High risk factors
– Multiple sex partners
– Promiscuous partners
– Sexual intercourse in early teen years
– Pt history of STDs
• Environmental factors such as smoking can predispose
women
Cervical Cancer—Signs and Symptoms
• Asymptomatic in early stage
– Can be detected by Pap test
• Invasive stage indicated by slight bleeding or
spotting
• Anemia and wt loss can accompany
 Cervical Cancer—Treatment
• Biopsy to confirm diagnosis
• Surgery and radiation to treat
• 5 yr survival rate 100% if carcinoma still in situ
– Prognosis for invasive depends on the extent of
the spread of cancer cells