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GONORRHEA

GONORRHEA. Danny A. Hermawan, Dip Derm Medical Faculty of Ukrida JAKARTA. Synonym Gonore ; Kencing Nanah Drupper ; Clap ; Blenorrhoea History Hunter: Gonorrhoea infection = Syphilis 1879 : Neisser = isolasi Gonococcus 1885 : Bumm = membiak Gonococcus . Etiologi.

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GONORRHEA

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  1. GONORRHEA Danny A. Hermawan, Dip Derm Medical Faculty of Ukrida JAKARTA

  2. Synonym • Gonore ; Kencing Nanah • Drupper ; Clap ; Blenorrhoea History • Hunter: Gonorrhoea infection = Syphilis • 1879: Neisser = isolasi Gonococcus • 1885: Bumm = membiak Gonococcus

  3. Etiologi • Neisseria gonorrhoea (= Gonococcus) diplococcus gram negatif • Bentuk biji kopi, tersusun dua-dua: tunggal dan bergerombol • Pewarnaan Gram: kuman merah dengan latar belakang biru

  4. Sifat • Tak tahan udara bebas; kering mati • Tak tahan suhu > 39°C • Tak tahan zat desinfektan • Klutur lempeng  media Thayer Martin • 4 strain: • Koloni kecil : pili (+) = T1 & T2 patogen • Koloni besar: pili (-) = T3 & T4 non virulen

  5. Epidemiologi • PHS terbanyak : UGO ~ NSU • Sosio ekonomik  → prostitution • Sosio ekonomik  : habituasi, promiscuity, permissiveness • Penularan: (♀ = silent carrier) ~ Venerik : coitus suspectus (c.s) ~ Non venerik (jarang): melalui alat, tangan, partus (Ophthalmitis neonatorum)

  6. Simtomatologi Pria♂ • Masa tunas 2 – 5 hari (1 – 14 hari) = post c.s • Uretritis anterior: • Miksi gatal/ panas • Disuria • Sekret mukopurulen (duh tubuh/ ecoulement) • Darah (+) • Orificium Urethra Externum (O.U.E) • Merah, udem • Ektropion (mulut ikan) • Mukopurulen • KGB: unilateral/ bilateral >/ (-)

  7. Simtomatologi Pria♂ • Uretritis posterior: • Disuria/ polakisuria • Terminal hematuria • Duh tubuh < • 95% resolusi spontan • Infeksi asimptomatik • Komplikasi lokal & metastatik (hematogen)

  8. Simtomatologi Pria♂ Komplikasi : (pada anatomi genitalia pria) • Balanitis, phostitis • Tysonitis • Uretritis totalis: lacunitis, litritis, cowperitis • Prostatitis; (seminal); vesikulitis • Funikulitis • Epididimitis • Orchitis • Jarang: cystitis, uretritis, pyelitis • Striktur urethra • Steril

  9. Simtomatologi Wanita♀ • Neonatus, orang tua; vulvo-vaginitis • Dewasa, predileksi cervix (+), vagina (-)  Urethra Kelenjar Skene Kelenjar Bartholini • Masa tunas: ?? (c.s  gejala +) • Gejala : • Fluor albus yang masif (banyak) • Rasa sakit/ berbau • Kering di celana  kuning – hijau

  10. Simtomatologi Wanita♀ • DD/ fluor albus • susu pecah + gatal Kandidiasis • berbusa + gatal Trichomoniasis • Kolposkopi: portio oedem, ektropion, sekret mukopurulen • ♀ + fluor albus ringan & keluhan (-)  prostitusi “Asymptomatic Female Carrier of Gonococcus”

  11. Simtomatologi Wanita♀ • Komplikasi utama : 1. Skenitis 2. Bartholinitis 3. Wanita hamil : a. Abortus spontan b. Prematur (o.k. pecahnya selaput amnion) c. Chorio-amnionitis 4. Proctitis: ♀35 – 50% (ano-rectal ♂: 100% homosex) 5. Pharingitis Gonore: 90% asymptomatik 6. Urethritis 7. Endometritis, Salpingitis, Oophoritis 8. Steril (obstruksi bilateral) 9. Kehamilan Ektopik (perlekatan/ penyempitan) 10. Vulvo-vaginitis pada bayi/ balita dan wanita tua

  12. Gejala Infeksi Anorektal : • Pruritus ani, defekasi sakit, tenesmus • Fissura ani/ lecet • Faeces + nanah & darah • Proctoskopi: • Eksudat muko-purulen • Dinding rektum eritem dan oedem • Mudah berdarah

  13. Pili melekat Bactery Mucosa (fossa naviculare) 2 x 24 jam Reaksi inflamasi mukosa/ submukosa Eksudasi PMN >> Pernanahan Chronic inflammation  MN (Monosit >>) Complication Strain GO Infeksi asimptomatis DGI (Disseminated Genital Infection ) Negro > White skin akut Auxotypes A: Arginine H: Hypoxantine U: Uracyl PATOLOGI

  14. Lab/ Pemeriksaan Pembantu 1. Tes Thomson: Tes 2 gelas bed side Syarat : - V.U > 100 ml urin - Urin pagi 2. Pewarnaan Gram: • Gonokokus gram negatif • Intra/ ekstra seluler • ♂ : fosa naviculare ♀: urethra, kelenjar bartholini, serviks & rektum

  15. Lab/ Pemeriksaan Pembantu 3. Kultur: • Media tranfer: M. Stuart, M. Transgrow • Media pertumbuhan: M. Thayer Martin • + Vancomycin  m.o gram + • Colistimethate  m.o gram (-), kecuali proteus • Nystatin  jamur candida • Trimethoprim  proteus 4. Tes Oksidasi: Koloni + sol. Tetrametil paraphenil diamine 1% + : koloni merah muda hitam golongan Neisseria; gol. Vibrio; gol. Brucellae

  16. Lab/ Pemeriksaan Pembantu 5. Tes Fermentasi: 6. Tes Serologis: Complement Fixation Test (C.F.T) • Antigen gonokokus (standar) uji antibodi • Reaksi silang dengan N. meningitidis

  17. Terapi Tanpa Komplikasi – dosis tunggal epidemiologik 1. Penisilin a. ♂ 2,4 juta unit pp b. ♀ 4,8 juta unit pp 2. Ampicillin: 3,5 g 3. Amoxycillin: 3 g 4. Thiamphenicol (utk PPNG) Single dose 2,5 – 3,5 + 4 x 500 mg/ hari (4 – 5 hari) 5. Tetracycline !!! Dulu 8 capsul = 2 g single dose 6. Cotrimoxazole: • 4 tablet/ hari  5 hari • 2 x 4 tab/ hari  2 hari + 1 gram probenesid + 1 gram probenesid

  18. Terapi 7. Kanamycin 2 g i.m single dose 8. Spectinomycin 2 g i.m single dose 9. Azithromycin 500 mg + 1 x 250 mg/ hari  4 – 5 hari + 2 x 250 mg  4 hari 10. Kuinolon (Quinolone) • Siprofloksasin 250 – 500 mg o.d • Ofloksasin 400 mg o.d • Norfloksasin 800 mg o.d Dengan Komplikasi: • Penicilline 5 – 10 hari • Thiamphenicol 10 – 14 hari • Tetracycline 10 – 14 hari

  19. Penicillinase Producing Neisseria Gonorrhoea (PPNG) • 1976 : Timur Jauh, USA • 1980 : Indonesia oleh Utama Widjaja, dkk • Kriteria Tes : 1. Tes Jodometri  2. Tes Asidometri  3. M.I.C untuk penisilin ≥16 minggu 4. Chromogenic Cephalosporin

  20. ~ Thank You ~

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