KASUS Problem Mr. D, laki-laki 36 tahun Keluhan utama : urethral discharge Keluhan lain : nyeri saat berkemih painful erection Keterangan berlangsung 3 hari urethral discharge : purulent, banyak terlihat tidak sehat vital sign : pulse T abdomen : tenderness di regio suprapubic urethra : purulent discharge, meatal hiperemis DRE : nyeri di jam 12, pembesaran prostat, rubbery Lab : Leukosit Urinalisis : leukosit esterase test (+), WBC/HPF Microbiology exam : gram (-) coccus Venereological status : Penis : External urinary meatus : hiperemin, discharge (+) Discharge : purulent, putih, banyak Scrotum (kanan) : membesar, hiperemi, tenderness, rugae menghilang Istri Mr. D Keluhan : vaginal dicharge sejak 3 bulan lalu, hot, gatal dan berbau Keluhan lain : demam, nyeri abdomen, nyeri saat berkemih Pemeriksaan fisik : Vital sign : T Abdomen : tenderness Ginaecological exam : discharge dari cervix, mucopurulent, hiperemia
Lab : leukositosis Urine : Makroskopis : keruh Mikroskopis : leukosit banyak Eritrosit 10-15/HPF Bakteri (+) Epitel (+) Specific gravity 1,025 Urobilinogen (+) Hipotesis (Mr. D) 1. Urethritis 2. STI e.c a. Gonorrhea b. Chlamydia c. Trichomonas d. Syphilis 3. Epididymitis 4. UTI e.c E.coli 5. Trauma urethra 6. Ulkus di glans penis 7. Penile cancer Hipotesis (istri Mr.D) 1. Cervicitis 2. Urethritis IDK 1. Perbedaan dan karakteristik warts, vesicle, erosi, ulkus 2. Peyronie s disease (manifestasi klinis, etiologi) 3. Mikrobiologi : Chlamydia trachomatis 4. Terapi bakteri gram negatif 5. Anatomi urethra 6. Histologi urethra 7. Kelenjar di uretra, fungsi, zat yang dihasilkan, presentase dari pembentukan semen
8. Komplikasi dari kasus 9. Inclusion body, khas pada infeksi apa?seperti apa? Akibat apa? 10. Bagaimana bila urin harus dibawa ke lab yang jauh? 11. Penyebab cervicitis 12. Pengambilan spesimen urin dari kateter 13. Mekanisme pengambilan spesimen dari urethral swab dengan dakron dan wire, media penyimpanannya 14. Terapi antibiotik untuk istrinya, dosis, jumlah, dan lama pemberian 15. Perbedaan N.gonorrhea dan N.meningitidis 16. Mikrobiologi : N.gonorrhea (intra dan ekstra sel, pewarnaan, mekanisme hingga menimbulkan discharge) 17. Histologi vagina, serviks (ekto dan endo) 18. Perbedaan ejeksi dan ereksi 19. Fisiologi ereksi dan ejakulasi 20. Lubrikan dari semen? 21. Zat pertama kali keluar saat ejakulasi? IDK Baru 1. Anatomi : seminal gland 2. Kecepatan dari mulai emisi hingga ejakulasi 3. Faktor yang mempengaruhi kecepatan emisi hingga ejakulasi 4. Anatomi vagina 5. Patogenesis N.gonorrhea dan N.meningitidis 6. Bagaimana bila urin harus dibawa ke lab yang jauh? 7. Terapi untuk pasien GO dengan chlamydia dan pasien GO tanpa chlamydia? 8. Kenapa pasien laki-laki diberikan obat selama 14 hari sedangkan pasien wanita diberikan obat selama 7 hari? 9. PP Doxycycline 10. PP Sefiksim 11. Pencegahan dan komplikasi penyakit tersebut 12. Patomekanisme, BHP, IIMC
13. Page 3 Discharge culture is taken from urethral swab and take to transport medium. After he was treated, were told to follow up three days later with his wife. His wife was known to have vaginal discharge since three moths ago, was hot but itchy and smelly. Accompanied by fever and pain in the abdomen and pain during mucturition. On physical examination found : Vital sign : T : 39,2 C RR : 24/minute PR : 115/minute BP : 110/70 mmhg Head to thorax examintaion was normal Abdomen : tenderness at suprapubic region Ginaecological examination with speculum : Discharge from cervix, mucopurulent, hyperemia Laboratorium : Blood : Hb : 12,5 gr/dl WBC : 12.500/mm³ Platelet : 240.000/mm³ Ht : 42% Urine : Macroscopic : cloudy Microscopic : leucocyte many Erythrocyte 10-15/HPF Bacteria positive Epitel positive ph 6,2 Specific gravity 1,025 Glucose (-) Protein (-) Urobilinogen (+) Bilirubin (-) Microbiology examination : from cervical swab looks inclusion bodie (giemsa staining) Urine culture is taken in a clean-catch midstream urine specimen. Her urine culture subsequently demostrated a pure growth of E.coli with > 100.000 CFU/ml Page 4 His wife should be treated, Doxycycline 100 mg orally twice a day for 7 days. Doni were given medicatioon sefiksim 400 mg 5 days + Doxycycline 100 mg orally twice a day for 7 days. Page 5 After recovering couples were given counseling about sex is good and safe, and also given counseling religious and marriage. HIV counseling.