Monday, April 1, 2013

Get to Know STD – Chlamydia

Today our STD topic in tag “Kenali IMS” or “Get to know STD” is about Chlamydia. This kind of STD sometimes forgotten since the sign and symptoms often blurred and misdiagnosed with other STDs. This article was taken from CDC fact sheet that you can personally download or view it here.

What is Chlamydia?
Chlamydia is a common sexually transmitted disease (STD) caused by a bacterium. Chlamydia can infect both men and women and can cause serious, permanent damage to a woman’s reproductive organs.

Chlamydia on male (Source:
How common is Chlamydia?
Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. In 2011, 1,412,791 cases of Chlamydia were reported to CDC from 50 states and the District of Columbia, but an estimated 2.86 million infections occur annually. A large number of cases are not reported because most people with Chlamydia do not have symptoms and do not seek testing. Chlamydia is most common among young people. It is estimated that 1 in 15 sexually active females aged 14-19 years has Chlamydia.
In Indonesia, Endang R. Sedyaningsih et al, in their publication named Prevalence of Sexually Transmitted Infections (STI) and High-Risk Behaviors Among NGO's Reached Out Male Street Children in Jakarta (Year 2000) mention the number of 7.4 % for Chlamydia prevalence. This number of prevalence perhaps already out of date since higher STD prevalence survey still very rare found in general publication or resources.

Chlamydia in cervix (Source:

How do people get Chlamydia?
People get Chlamydia by having sex with someone who has the infection. “Having sex” means anal, vaginal, or oral sex. Chlamydia can still be transmitted even if a man does not ejaculate. People who have had Chlamydia and have been treated can get infected again if they have sex with an infected person. Chlamydia can also be spread from an infected woman to her baby during childbirth. 

Who is at risk for Chlamydia?
Any sexually active person can be infected with Chlamydia. It is a very common STD, especially among young people. It is estimated that 1 in 15 sexually active females aged 14-19 years has Chlamydia.
Sexually active young people are at high risk of acquiring Chlamydia for a combination of behavioral and biological reasons. Men who have sex with men (MSM) are also at risk for Chlamydial infection since Chlamydia can be transmitted by oral or anal sex.

Pic source:
What are the symptoms of Chlamydia?
Chlamydia is known as a ‘silent’ infection because most infected people have no symptoms. If symptoms do occur, they may not appear until several weeks after exposure. Even when it causes no symptoms, Chlamydia can damage a woman’s reproductive organs.
In women, the bacteria first infect the cervix (structure that connects the vagina or birth canal to the uterus or womb) and/or the urethra (urine canal). Some infected women have an abnormal vaginal discharge or a burning sensation when urinating. Untreated infections can spread upward to the uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID can be silent, or can cause symptoms such as abdominal and pelvic pain. Even if PID causes no symptoms initially, it can lead to infertility (not being able to get pregnant) and other complications later on.
Some infected men have discharge from their penis or a burning sensation when urinating. Pain and swelling in one or both testicles (known as “epididymitis”) may also occur, but is less common.
Chlamydia can also infect the rectum in men and women, either through receptive anal sex, or possibly via spread from the cervix and vagina. While these infections often cause no symptoms, they can cause rectal pain, discharge, and/or bleeding (known as “proctitis”).

What complications can result from Chlamydial infection?
The initial damage that Chlamydia causes often goes unnoticed. However, Chlamydial infections can lead to serious health problems.
In women, untreated infection can spread upward to the uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID can be silent, or can cause symptoms such as abdominal and pelvic pain. Both symptomatic and silent PID can cause permanent damage to a woman’s reproductive tract and lead to long-term pelvic pain, inability to get pregnant, and potentially deadly ectopic pregnancy (pregnancy outside the uterus).
In pregnant women, untreated Chlamydia has been associated with pre-term delivery, and can spread to the newborn, causing an eye infection or pneumonia.
Complications are rare in men. Infection sometimes spreads to the tube that carries sperm from the testis, causing pain, fever, and, rarely, preventing a man from being able to father children.

What about Chlamydia and HIV?
Untreated Chlamydia may increase a person’s chances of acquiring or transmitting HIV – the virus that causes AIDS.
How does Chlamydia affect a pregnant woman and her baby?
In pregnant women, untreated Chlamydia has been associated with pre-term delivery, and can spread to the newborn, causing an eye infection or pneumonia. Screening and treatment of Chlamydia during pregnancy is the best way to prevent these complications. All pregnant women should be screened for Chlamydia at their first prenatal visit.

Who should be tested for Chlamydia?
Any sexually active person can be infected with Chlamydia. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should avoid having sex until they are able to see a health care provider about their symptoms.
Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.
CDC recommends yearly Chlamydia testing for all sexually active women age 25 or younger and older women with risk factors for Chlamydial infections (e.g., women who have a new or more than one sex partner), and all pregnant women. Any woman who is sexually active should discuss her risk factors with a health care provider who can then determine if more frequent testing is necessary.
Men who have sex with men (MSM) who have receptive anal sex should be tested for Chlamydia each year. MSM who have multiple and/or anonymous sex partners should be tested more frequently.
HIV-infected sexually active women who are age 25 or younger or have other risk factors, and all HIV-infected patients who report having receptive anal sex should be tested for Chlamydia at their first HIV care visit and then at least annually. A patient’s health care provider might determine more frequent testing is necessary, based on the patient’s risk factors.

How is Chlamydia diagnosed?
There are laboratory tests to diagnose Chlamydia. Specimens commonly used for testing include a cotton swab of the vagina (collected by the woman herself or her health care provider) or a urine sample.

What is the treatment for Chlamydia?
Chlamydia can be easily treated and cured with antibiotics. HIV-positive persons with Chlamydia should receive the same treatment as those who are HIV-negative.
Persons with Chlamydia should abstain from having sex for seven days after single dose antibiotics, or until completion of a seven-day course of antibiotics, to prevent spreading the infection to partners.
Repeat infection with Chlamydia is common. Persons whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple Chlamydial infections increases a woman’s risk of serious reproductive health complications, including pelvic inflammatory disease and ectopic pregnancy. Women and men with Chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their sex partners were successfully treated.
Infants infected with Chlamydia may develop conjunctivitis (infection of the membrane lining the eyelids) and/or pneumonia. Chlamydial infection in infants can be treated with antibiotics. 

What about partners?
If a person has been diagnosed and treated for Chlamydia, he or she should tell all anal, vaginal, or oral sex partners from the past 2 months so that they can see a healthcare provider and be treated. This will reduce the risk that the sex partners will develop serious complications from Chlamydia and will also reduce the person’s risk of becoming re-infected. A person with Chlamydia and all of his or her sex partners must avoid having sex until they have completed their treatment for Chlamydia (i.e., seven days after a single dose of antibiotics or until completion of a seven-day course of antibiotics) and until they no longer have symptoms.
To help get partners treated quickly, healthcare providers may give patients extra medicine or prescriptions to give to their sex partners. This is called expedited partner therapy or EPT. EPT is only available in some parts of the country. Consult a healthcare provider to find out if it is available in a specific area. Sex partners should still be encouraged to see a healthcare provider, regardless of whether they receive EPT. 

How can Chlamydia be prevented?
Latex male condoms, when used consistently and correctly, can reduce the risk of getting or giving Chlamydia. The surest way to avoid Chlamydia is to abstain from vaginal, anal, and oral sex or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Kenali IMS – Gonore/ Kencing Nanah

Kencing nanah atau gonore (bahasa Inggris: gonorrhea atau gonorrhoea) adalah penyakit menular seksual yang disebabkan oleh Neisseria gonorrhoeae yang menginfeksi lapisan dalam uretra, leher rahim, rektum, tenggorokan, dan bagian putih mata (konjungtiva). Gonore bisa menyebar melalui aliran darah ke bagian tubuh lainnya, terutama kulit dan persendian. Pada perempuan, gonore bisa menjalar ke saluran kelamin dan menginfeksi selaput di dalam pinggul sehingga timbul nyeri pinggul dan gangguan reproduksi.

GO pada laki-laki (Sumber:
Gonore merupakan penyakit infeksi yang menyerang lapisan epitel (lapisan paling atas dari suatu jaringan), bila tidak diobati, infeksi ini akan menyebar ke jaringan yang lebih dalam. Biasanya membentuk koloni di daerah mukosa, orofaring, dan anogenital

Neisseria gonorrhoeae merupakan bakteri gram negatif, nonmotil, tidak membentuk spora, berkembang berkoloni membentuk diplokokus, atau pun tunggal monokokus. Manusia merupakan satu-satunya inang (host) alami bakteri ini. Untuk menginfeksi, bakteri membutuhkan kontak langsung dengan mukosa tubuh, bisa lewat hubungan seks, atau penggunaan toilet duduk. Bakteri ini menempel dengan pilinya.

GO pada perempuan (Sumber:
Pada laki-laki, gejala awal gonore biasanya timbul dalam waktu 2-7 hari setelah terinfeksi. Gejalanya berawal sebagai rasa tidak enak pada uretra dan beberapa jam kemudian diikuti oleh nyeri ketika berkemih/ kencing serta keluarnya nanah dari penis. Selain itu ujung penis biasanya berwarna kemerahan dan bengkak. Sedangkan pada perempuan, gejala awal biasanya timbul dalam waktu 7-21 hari setelah terinfeksi. Penderita seringkali tidak merasakan gejala selama beberapa minggu atau bulan, dan diketahui menderita penyakit tersebut hanya setelah pasangan hubungan seksualnya tertular. Jika timbul gejala, biasanya bersifat ringan. Tetapi beberapa penderita menunjukkan gejala yang berat, seperti desakan untuk berkemih, nyeri ketika berkemih, keluarnya cairan dari vagina berwarna putih kekuningan, nyeri di rongga panggul dan demam. Infeksi dapat menyerang leher rahim, rahim, saluran telur, indung telur, uretra, dan rektum serta menyebabkan nyeri pinggul yang dalam ketika berhubungan seksual.

Perempuan dan laki-laki homoseksual yang melakukan hubungan seks melalui anus (anal sex) dapat menderita gonore pada rektumnya. Penderita akan merasakan tidak nyaman di sekitar anusnya dan dari rektumnya keluar cairan. Daerah di sekitar anus tampak merah dan kasar, serta tinjanya terbungkus oleh lendir dan nanah.

Hubungan seksual melalui mulut (oral sex) dengan seorang penderita gonore biasanya akan menyebabkan gonore pada tenggorokan (faringitis gonokokal). Umumnya infeksi tersebut tidak menimbulkan gejala, namun kadang-kadang menyebabkan nyeri tenggorokan dan gangguan untuk menelan.

Jika cairan yang terinfeksi mengenai mata, maka bisa menyebabkan terjadinya infeksi mata luar (konjungtivitis gonore). Bayi yang baru lahir juga bisa terinfeksi gonore dari ibunya selama proses persalinan sehingga terjadi pembengkakan pada kedua kelopak matanya dan dari matanya keluar nanah. Jika infeksi itu tidak diobati, maka akan menimbulkan kebutaan.

Pemeriksaan Laboratorium

  1. Pewarnaan Gram: hasil positif bila didapatkan gram negatif kokus intrasel dalam eksudat sel polimorfonuklear.
  2. Kultur: sampel diisolasi di media khusus, contoh: media coklat, atau media Thayer-Martin. Diagnosis juga dapat dilakukan berdasarkan tempat pengambilan spesimen. Contohnya laki-laki dari uretra, dan perempuan dari serviks.
  3. Pemeriksaan darah : hal ini dilakukan bila pasien juga dicurigai mengalami infeksi HIV.
Manajemen Terapi

  1. Terapi Awal  : Pemberian antibiotik
  2. Bila keadaan tidak membaik : ada beberapa golongan antibiotik yang sudah resisten terhadap Gonorrhea yaitu quinolones, Penisilin, Tetrasiklin, dan obat-obat golongan sulfa. Bila demikian, disarankan untuk kultur dari spesimen, serta mengganti golongan obat tersebut.

  1. Cara yang paling pasti untuk mencegah penyebaran penyakit menular seksual adalah dengan tidak melakukan hubungan seks sama sekali.
  2. Berhubungan seks secara monogami (satu pasangan), pastikan pasangan tidak terinfeksi. 
  3. Penggunaan kondom dapat mengurangi risiko penularan penyakit.
  4. Pastikan toilet yang digunakan higienis, hindari penggunaan toilet duduk ditempat umum. Mengenai penularan dari toilet ini memang masih banyak pendapat saling silang. Lihat di sini.
  5. Segera obati bila ada keluhan seperti diatas.

Sumber bacaan: