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Bacterial Vaginosis

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Definisi
Sindrom klinik akibat pergantian
lactobasillus Spp penghasil H2O2 yg mrpk flora normal vagina dgn bakteri anaerob dlm konsentrasi tinggi (Bacteroides Spp, Mobiluncus Spp, Gardnerella vaginalis & Mycoplasma hominis.   

ETIOLOGI :
Gardnerella vaginalis
Bakteri anaerob
Mycoplasma hominis

Anamnesis:
•Duh tubuh bau amis (bau tdk menyenangkan) nyata sesudah hub. Seksual
•Gatal/rasa terbakar didaerah vagina (ringan)
•Asimtomatik (50%)

Gambaran Klinik

Pemeriksaan Fisik:
Duh tubuh vagina jumlahnya > normal, berwarna putih abu-abu, tipis & homogen, tampak melekat pd dinding vagina, bau amis, tidak berbusa.
Eritema & inflamasi tdk ditemukan (biasanya)

Laboratorium
§  Sediaan basah, clue cells (+) (sel epitel vagina  yg granuler, diliputi kokobasil shg batas tdk jelas)
§  Pewarnaan Gram :
§  Batang – batang gram negatif yang banyak
§  Sel epitel dengan kokobasil banyak
§  Sedikit atau tanpa laktobasil

§  Biakan, media agar Casman dan Protease starch agar (jarang dilakukan)
§  Pemeriksaan gas likuid chromatography (untuk kepentingan riset)
§  Pemeriksaan lainnya :
§Mengukur pH vagina dengan kertas indicator (4,5 – 5,5)
§Tes amin (1 tetes larutan KOH 10 %) pada sekret vagina diatas kaca objek (Positif bila bau amis tercium)

DASAR DIAGNOSIS :
§Gejala klinik khas (sekret vagina abnormal)
§Ph > 4,5
§Tes amin positif pH 4,5 – 5,5
§Clue cells positif
Dx bisa ditegakkan ¨ 3 dari 4 kriteria ditemukan.
 Bl sediaan basah mikroskopik tdk dpt dilakukan, sediaan dgn pewarnaan gram yg diambil dari fornix post. dpt dilakukan utk mengidentifikasi clue cells (spesifitas & sensitifitas > tinggi dibanding kriteria lain).

           
DIAGNOSIS BANDING:
•Trikomoniasis
•Kandidosis Vulvovaginalis

TERAPI :
•Metronidazol 500 mg 2 x sehari selama 7 hari
•Metronidazol oral 2 gram dosis tunggal
•Klindamisin krem 2% intravaginal, aplikator penuh (5 gram), 7 hari dipakai saat akan tidur
•Metronidazol gel 0,75% intravaginal, aplikator penuh (5 gram) 2 kali sehari selama 5 hari
•Klindamisin 300 mg 2 kali sehari selama 7 hari
•500 mg amoksisilin + 125 mg asam clavulanat 3 kali sehari selama 7 hari
•Sefaleksin 500 mg 4 kali sehari selam 7 hari.
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