Large Single Ulcer of The Prepuce: Ulkus Durum DG Ulkus Di KGB Inguinal

Large single ulcer of the
prepuce
Multiple ulceration of
the sulcus corona
Multiple ulcerations of the

sulcus corona and the frenulum
Ulkus durum dg ulkus di KGB

inguinal
Chancroid di penis, kissing effect
Ulkus mole
Ulcus Molle
ULKUS MOLE
DIAGNOSIS BANDING
• Herpes genitalis (HG)

• Sifilis std I/Ulkus durum (UD)
• LimfoGranulomaVenereum(LGV)
• Granuloma inguinale (GI)
ULKUS MOLLE
PENGOBATAN
1. Tetrasiklin capsul :
Dosis : 4 x 500 mg / hari, selama 10 – 20 hari
2. Kanamisin injeksi :
Dosis : 2 x 500 mg, IM. tiap hari, 6 – 14 hari.
3. Cotrimoxazole 2 dd 2 tab selama 10 hari

ULKUS MOLE
PENGOBATAN
4. Eritromisin
Dosis : 4x500 mg/hari selama 1 minggu.
5. Kuinolon
Ofloksasin dosis tunggal 400mg.
Ciprofloksasin 2x500 mg selama 3 hari.
6. Macrolide
Azithromycin dosis tunggal 1 gram per oral.
7. Ceftriaxone IM dosis tunggal 250 mg
Viral infection
wide spectrum of clinical manifestations
HPV & MCV

Healthy Children Immundeff
Colonize Benign Extensive

Without Proliferation Persistent
Lesions Transient Refractory
HPV = Human Papiloma Virus , MCV = Moluscum Contagiosum Virus

MOLUSCUM CONTAGIOSUM
widespreading
Lesi agak banyak
ATOPIK
HIV Terapi
infection Imuno
supressif
Lesi
Lesi banyak
sangat banyak
Multiple facial MC and Trunk widespreading
suggest HIV infection

Spektrum Klinis
Moluscum Contagiosum
sesuai tingginya imunitas tubuh Hospes
MC MC + ATOPY
MC+H I V
HUMAN PAPILOMA VIRUS
• HPV subclinical or wide variety lesions
• 150 types HPV infect skin and mucosa by trauma
Cutaneus Infection
Common Plantar Flat
warts warts warts
70 % 20 – 30 % 4%
Children >> Adult >> Child & Adult
Mucosal infection  Sexually Transmitted Disease Some HPV types

CONDYLOMA Can cause SCC in situ
Maternal transmitted to neonate baby

CONDYLOMA intra URETHRA
Moluscum Contagiosum
+ CONDYLOMA accum
CONDYLOMA peri ANAL

HUMAN HERPES VIRUS
8 groups of HHV :
• HHV 1 & 2 = HSV ( Herpes Simplex Virus 1 + 2)
• HHV 3 = VZV ( Varicella Zoster Virus )
• HHV 4 = EBV ( Eipstein Barr Virus )
• HHV 5 = CMV ( Cyto Megalo Virus )
• HHV 6-7-8 = Kaposi sarcoma ascociated Virus
3 groups HHV
HumanHerpesVirus
ALPHA BETA GAMMA
HSV 1 + 2 EBV
CMV HHV 6+7+8
VZV
Restricted host Lymphotropic
Variable host
Spread slowly Specific
Rapid destruction
Retina Either T or B
Latent infection
Pulmo & Colon lymphocyte
Sensory ganglia
HERPES SIMPLEX VIRUS
• Age of onset : Infancy – Young adult – Senescence
• Etiology : HSV-1 and HSV-2
LABIALIS
HSV-1 80%
HSV-2 20%
UROGENITALIS HERPETIC WHITLOW

HSV-1 20 % < 20 yr HSV-1
HSV-2 80 %
> 20 yr HSV-2
NEONATAL
HSV-2 =70 % HSV-1 =30%:
HERPES SIMPLEX VIRUS
• Acute muco-cutaneus infection

• Herpetiform group : Erythemal based vesicles
• Constitutional state : fever, malaise, anorexia
• Bacterial secondary Infection : Lesions soon
become purulent & crusted & ulcerated
• Latent episode  Recurrent periodically with
Precipitating factors.
HERPES SIMPLEX VIRUS INFECTION
Transmission: Skin- skin & Skin-mucosa

• Incubation: average 6 days
• Crowded living & Low SocioEconomy
• Wrestler  Herpetic whitlow  also Medical Staff
Precipitating factor of Recurrence:

• UV radiation
• Hormonal : Menstruation
• Fever & Influenza
• Altered Immunity : HIV infection, ChemoTherapy, Radiotherapy,
Steroid therapy, Malignancy: Leucemia
JENIS VIRUS
• HSV-Tipe I (Herpes Simplex Virus Type I)
• HSV-Tipe II (Herpes Simplex Virus Type II).

DD/ Herpes
SIMPLEX
• Ulkus Durum
• Ulkus pada infeksi
Herpes simplex
genital pria
Herpes Simplex Genital
+ Infeksi sekunder & Phymosis
HERPES SIMPLEX GENITALIS
+ INFEKSI SEKUNDER + Synechiae
FLUOR ALBUS pada WANITA
CANDIDOSIS
VAGINAL
TRICHO BACTERIAL
MONIASIS VAGINOSIS
PASANGAN PRIA sering TANPA GEJALA , tetap harus diobati
= BLIND TREATMENT =
FLUOR ALBUS
GARDNERELLA TRICHOMONAS
CANDIDOSIS
VAGINALIS VAGINALIS
DUH PUTIH DUH ABU2

DUH KUNING HIJAU
LENGKET ENCER
BERBUSA
BERGUMPAL TIDAK GATAL
GATAL NYERI
GATAL BAU
BAU
DYSPAREUNIA HUB SEX NORMAL
DYSPAREUNIA
TH/ TH/
TH/
ITRACONAZOL METRONIDAZOL
METRONIDAZOL
2dd200 MG 1 dd 2 GR
1 dd 2 GR
FLUCONAZOL Hari 1 dan 3
Single dose
1 dd 150 mg ( 2dd 500 mg= 7hr)
( 2dd 500 mg= 7 hr)
CANDIDOSIS VULVOVAGINALIS
PREDISPOSISI
• Diabetes
• OBESITAS
• KEHAMILAN
• TERAPI ANTIBIOTIKA
• TERAPI STEROID
• INFEKSI HIV
Lab: Pseudohifa(+)
Yeast cell(+)
VAGINOSIS BAKTERIAL Gardnerella vaginalis
= cocobasil Gram negatip
PREDISPOSISI
• Vaginal douching
• Akseptor IUD
• Promiskuitas & Lesbianism
GEJALA KLINIS
• Cairan putih encer berbusa
• 50 % bau amis, asimtomatik
Bau tercium saat senggama

atau saat ditetesi lar. KOH
Laboratorium : Clue cell (+)
TRICHOMONIASIS
ETIOLOGI : Protozoa brflagel terlihat pd sediaan basah dg Lar NaCl 0,9 %
= Trichomonas vaginalis
Predisposisi : Promiskuitas & kontaminasi WC umum

Pria asimptomatik, NSU ringan
Wanita :
Gatal Panas perih = dyspareunia Strawberry vagina
Fluor Kuning kehijauan

berbusa & bau busuk .
Trichomoniasis
Vaginalis
Cervicitis
ABSES atau KISTA
Kelenjar BARTHOLIN& SKENE
FAKTOR
KENAIKAN INSIDENS IMS
PERUBAHAN PERUBAHAN
DEMOGRAFIK SIKAP& NORMA
MODERNISASI tetapi KURANG PENDIDIKAN SEKS

INDUSTRI MAJU tetapi KURANG FASILITAS KESEHATAN
BANYAK KASUS ASIMPTOMATIK CARRIER ; PSK ♀
BANYAK TERSEDIA OBAT  CARA PAKAI TDK BENAR
GOLONGAN
RISIKO TINGGI IMS
• Umur muda : Pria 20 – 30 th

Wanita 16 – 24 th
• Kelompok sering berpergian/ Turis
• Suami isteri hidup terpisah tempat
• Pekerja Seks Komersial
• Kelompok Homoseksual /Napi
• Kelompok tinggi Pesona & Permisif
& Promiskuitas
PERLU KERJASAMA TERPADU
SEGI MEDIS
SEGI EPIDEMIOLOGIK
SEGI SOSIAL
DIAGNOSTIK DINI & LABORATORIS

TERAPI EFEKTIF  KONTROL LAB.
KONSELING & PROMOSI KONDOM
PEMERIKSAAN SEROLOGI
PEMBERITAHUAN PADA KELUARGA
• Setiap penyakit mempunyai stadium awal dan
stadium lanjut  Usahakan kenal lebih awal
• Ciri diagnostik membantu diagnosis dini
• Diagnosis banding sangat penting
• Distribusi, konfigurasi , morfologi penting !!
• Terapi > efektif : diagnosis tepat & cepat
FOTODOKUMENTASI KASUS YG DIDAPAT

BERMANFAAT DI LAIN SAAT
Laboratory Screening
• Pemeriksaan pra nikah sangat penting
karena dapat mengungkap kelainan Serologi
yg tidak terlihat pada kondisi fisik seseorang.
• Pemeriksaan yg dianjurkan
1. Kultur sekret uretra pria : Gonorrhoea
2. Pemeriksaan Trio sekret wanita
3. Serologi VDRL, TPHA, Anti HSV-1 & 2,
HbsAg, Anti HIV
4. Wanita di + Toksoplasma, antiCMV, Rubella
5. General Medical check up
Prurigo Nodularis berat  HIV infc
Lab Hiper Eosinofilia !!
Oral Hairy Plakia  HIV and EBV
infct
Lipodystrophy Syndrome
• Terjadi setelah 1 – 2 th terapi ARV
• Terutama Obat golongan protease
inhibitor
• Gambaran klinis :
– Lipo-hipertrofi : tengkuk, leher, dada,
abdomen
– Lipo-atrofi  pipi, ekstremitas atas bwh
proksimal
• Serum trigliserid + glukosa ⁭
• Dis Figure  Stigma AIDS orang kurus
cekung
• HIGH cure rate • PATIENT COMPLIANCE
• LOW price • CHOOSE ORALLY GIVEN
• AVAILABLE • TIME OF WELL ABSORBED
• HIGH tolerance • SAFE FOR PREGNANCY &
• LOW toxicity LACTATION
• LOW resistency • TIME TO FOLLOW UP
Usaha Penangulangan
• Segi Medis : Diagnosa tepat & Terapi efektif
Blind treatment Partner
Konseling(KIE = komunikasi, inform, edukasi)
Imunisasi Hepatitis & HPV pd remaja
• Epidemiologis : lintas sektoral pendidikan dan bidang sosial
• Sosial, Ekonomi, dan Budaya :

– Bekerjasama dengan yayasan sosial yang menangani
masalah AIDS, Narkoba, WHO, dsb
– Pendataan serologis penghuni di LP & para PSK,
– Pembinaan Medis Pra Nikah bagi calon mempelai
• Care management
• Counseling
• Contact therapy
FOUR C’s
• Condom promotion
KEPUSTAKAAN
• Wolff K, Johnson RA,Surmond D : Fitzpatrick’s color

atlas & synopsis of Clinical Dermatology, McGrawHill
USA, 5 th ed.2005
• Daili SF, Djuanda A : Ilmu Penyakit Kulit & Kelamin,
Penerbit FKUI Jakarta, 5th ed. Th. 2007
• Indriatmi W BMakes :
Materi AjarIlmuKesehatanKulit&Kelamin
Mahasiswa FKUI tahap Akademik th 2007
• Dwikarya M : Koleksi FotoDigital Dokumentasi pribadi

Large Single Ulcer of The Prepuce: Ulkus Durum DG Ulkus Di KGB Inguinal

Uploaded by

Copyright:

Available Formats

Large Single Ulcer of The Prepuce: Ulkus Durum DG Ulkus Di KGB Inguinal

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Large Single Ulcer of The Prepuce: Ulkus Durum DG Ulkus Di KGB Inguinal

Uploaded by

Copyright:

Available Formats

Large single ulcer of the

Multiple ulcerations of the

Ulkus durum dg ulkus di KGB

• Herpes genitalis (HG)

3. Cotrimoxazole 2 dd 2 tab selama 10 hari

HPV & MCV

Colonize Benign Extensive

HPV = Human Papiloma Virus , MCV = Moluscum Contagiosum Virus

Multiple facial MC and Trunk widespreading

suggest HIV infection

Mucosal infection  Sexually Transmitted Disease Some HPV types

Maternal transmitted to neonate baby

CONDYLOMA peri ANAL

UROGENITALIS HERPETIC WHITLOW

• Acute muco-cutaneus infection

Transmission: Skin- skin & Skin-mucosa

Precipitating factor of Recurrence:

• HSV-Tipe II (Herpes Simplex Virus Type II).

DUH PUTIH DUH ABU2

Bau tercium saat senggama

Predisposisi : Promiskuitas & kontaminasi WC umum

Fluor Kuning kehijauan

MODERNISASI tetapi KURANG PENDIDIKAN SEKS

• Umur muda : Pria 20 – 30 th

DIAGNOSTIK DINI & LABORATORIS

FOTODOKUMENTASI KASUS YG DIDAPAT

• Epidemiologis : lintas sektoral pendidikan dan bidang sosial

• Sosial, Ekonomi, dan Budaya :

• Wolff K, Johnson RA,Surmond D : Fitzpatrick’s color

You might also like