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Infeksi Genital Non-Spesifik

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Definisi
Infeksi traktus genital yg disebabkan penyebab non-spesifik
UNS: uretritis non spesifikàperadangan uretra yg penyebabnya dg lab tidak dpt dipastikan
UGN : uretritis non-gonoreàperadangan uretra bukan krn Neisseria gonorrhoea

Etiologi
Chlamydia trachomatis
Ureaplasma urealiticum
Lain-lain:
                - Trichomonas vaginalis
                - Ragi
                - virus herpes simplek
                - Adenovirus
                - Haemophilus sp
                - Bacteriodes ureoliticus
                - Mycoplasma genitalium

Chlamydia trachomatis
Penyebab tersering (25-65%)
Ditemukan dgL
Pembiakan: Mc Coy, BHK
Mikroskop langsung: badan retikulat & elementer
Deteksi Ag: ELISA, Imunofluoresen
Amplifikasi asam nukleat: PCR, LCR
Manifestasi klinis :
Pada Pria
o    CS (1-5 mg sebelum gejala)
o    Duh tubuh uretra: lendir jernih-keruh tu pagi tau bercak di celana dalam
o    Nyeri kencing/disuria
o    Gatal pd saluran kencing
o    Nocturia
o    Demam, Pembesaran kgb (jarang)
o    Pemeriksaan klinis:
        - muara uretra edema, sekret (+) serosa / seromukosa/ mukous
o    Epididimitis: nyeri skrotum, gejala uretritis (+)
o    Prostatitis: nyeri/edema prostat pd palpasi
o    Proctitis: rectal pain, perdarahan, duh mukous, diare à tu pd homoseksual
o    Reiter syndrome

Pada wanita
§        sering asimtomatik / sangat ringan
§         duh tubuh kekuningan
§        pasangan penderita UNS
§        Pemeriksaan klinis:
- kelainan serviks (hipertrofi ektopi, edematous, kongesti, mudah berdarah)
-erosi, mikro folikel pd servik
§        Dpt timbul:
                - bartolitinitis: duh purulen/seropurulen
                - endometritis: riw abN bleeding, dpt dgn
                - salfingitis
- perihepatitis (Fitz-Hugh-Curtis synd) (nyeri perut kanan atas, demam, nausea, vomiting, tubal scarring/adesi, inflamasi>>

Laboratorium
Apusan sekret uretra/serviks + pewrn Gram
Sekret uretra: lekosit >5/lp à p’bsran 1000X
Sekret servik: lekosit>30/lpà p’bsran 1000X
Tidak dijumpai diplokokus gram negatif
Tidak dijumpai T. vaginalis

Diagnosis
Anamnesis
   Riwayat CS
Pemeriksaan klinis: tanda2 uretritis
Tidak ditemukan kuman penyebab yg spesifik

Terapi
UI
Tetrasiklin  4X 500 mg à 1 mg/>
Eritromisin 4 X 500 mg à 1mg/> (♀ hamil) 
Doksisiklin 2 x 100 mg à 1mg/>
Azitromisin 1 gr SD
Kombinasi:
Tiamfenikol: 2,5gr hr I, 3x500 mgà 5 hari
Siprofloksasin 500 mg hr I, doksisiklin 2X100 à 7 hari
Azitromisin 1 gram
CDC
-Azitromisin 1 gram po SD atau
-Doksisiklon 2X 100 mg –7 hr
Alternatif:
-Eritromisin 4 X 500 mg à7 hr
-Ofloksasin 2 X 300 mg à7 hr
-Levofloksasin 1 x 500 mg à 7 gr

Follow up
Pemeriksaan & th/ mitra seksual (fenomena pingpong)
Sembuh à kontrol tiap 7 hr 3 mg berturut, keluhan & kuman (-)
IGNS persisten: tanda uretritis (+) setelah th/ selama 4 mg
IGNS rekuren: timbul keluhan uretritis setelah 2 mg th/ selesai

Komplikasi
PID
Infertilitas
Reiter syndrom
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