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Posts Tagged ‘genital’

Catcinoma Cervix / Cervix Cancer

May 13, 2008 1 comment

The cervix is the smooth organ that forms the entrance to a woman’s uterus. Cancer of the cervix has no symptoms. That’s why the only way to detect it is through a Pap smear, a standard life-saving screen that is performed as part of a woman’s yearly pelvic examination.

Every year, nearly 600,000 American women are diagnosed with cervical dysplasia; 9,710 women are diagnosed with cases of invasive cervical cancer. Early detection of abnormal changes can save lives. Unfortunately, of those women who die of cervical cancer today, 80 percent have not had a Pap smear in five years or more. Cervical cancer, even though falling 2 percent per year, is still the second most common cause of cancer deaths in women. Ironically, it is one of the most preventable and curable by “early identification” of cervical intra-epithelial neoplasia (CIN) and micro-invasive disease.

What is a Pap test?

A Pap test or Pap smear, named after the doctor (George Papanicolaou) responsible for initiating the procedure, is the main way doctors check to see if a woman has developed abnormal cells on the coating (the very top layer of cells) of her cervix. The test is quick, simple, and painless, and shows the presence of an infection, inflammation, abnormal cells, or cancer. The doctor collects a sample and the lab pathologist (cytology lab) analyzes the “smear” under a microscope.

The Pap test may reveal abnormal cell growth, or dysplasia (precancerous cell changes), in the area of the cervix. Abnormal cells look different microscopically from normal cells in that their nuclei show certain specific changes, and that they divide more quickly than normal cells.

How is a Pap test done?

A Pap test is done during an internal pelvic examination. During a Pap test, the doctor uses a tiny wooden spoon to painlessly scrape some cells from the surface of the cervix and smear these cells onto a small glass slide, which will be stained with a special dye that identifies abnormal cells.

For accurate results, a Pap smear should be done when a woman is not menstruating. Additionally, she should avoid douching, using vaginal medicines, spermicidal birth control foams, and other creams or jellies because these substances may wash away or hide abnormal cells. If that should happen, her doctor might mistakenly believe that the woman’s Pap test is normal.

Current guidelines from the National Cancer Institute recommend that all women who are or have been sexually active, or are 18 years of age or older, should have regular Pap tests and pelvic exams.

Why are Pap tests so important?

  • A Pap test can catch early signs of cancer before the disease spreads deeper into the cervix and before the cancer spreads to other parts of the body.
  • About 50 million Pap tests are performed every year in the United States, with up to 7 percent of the women tested having some type of abnormal results.
  • Between 60 percent and 80 percent of American women who are diagnosed with invasive cancer (cancer that spreads) each year, did not have a Pap smear in the earlier year, according to doctors at the Memorial Sloan-Kettering Cancer Center in New York City.

What is the link between the human papilloma virus and cervical cancer?

Research published in the British Journal of Obstetrics and Gynecology reveals that DNA from the human papilloma virus (HPV) is present in almost all invasive cervical cancers. Therefore, having a yearly Pap test, which screens for HPV, is crucial in detecting cervical cancer. Researchers have also discovered “compelling evidence” that persistent HPV infection is the “pivotal step” in the development of cervical cancer. In addition, there are high-risk types of HPVs: numbers 16 and 18 are “definite” carcinogens in humans and HPV 16 is the most common high-risk type. In fact, there are studies that show a greater odds ratio for “the association between HPV and cervical carcinoma than for smoking and lung cancer.”

How is cervical cancer diagnosed?

When a Pap test uncovers abnormalities, a diagnosis of cervical dysplasia is made, and the dysplasia is classified according to a system. Cervical dysplasia, also called cervical intraepithelial neoplasia (CIN), is rated as mild, moderate, or severe. Cervical dysplasia sometimes, but not always, evolves into cervical cancer. A Pap test can catch early signs of cancer before the disease spreads deeper into the cervix and before the cancer spreads to other parts of the body.

Abnormal cells are classified as atypical squamous cells of undetermined significance (ASCUS). Other abnormal cells that are mild but more definite are called low-grade squamous intraepithelial lesions (LSIL). How to handle these mild abnormalities is controversial; some physicians take a “wait-and-see” attitude. That’s because often the cell abnormalities clear up without treatment. So a more conservative physician recommends follow-up Pap tests at three or six months. Others suggest a more aggressive approach: colposcopy, a procedure that allows a physician to use a special microscope to provide closer examination of the cervix, and/or biopsy.

During the procedure the doctor may take tissue samples (a cervical biopsy) from the area. If still more tissue is needed, the patient undergoes a cold cone biopsy. The patient is put in the hospital under general anesthesia and a large tissue sample is taken. The cone biopsy often removes all the cancerous tissue. The reason for all these tests is to accurately match a patient’s medical condition with the most effective therapies available.

What are the signs of cancer of the cervix?

Signs and symptoms of cervical cancer usually don’t appear until precancerous cervical cells become cancerous and invade nearby tissue. Because precancerous changes in the cervix do not cause pain or abnormal bleeding, there are usually no signs that would make a woman suspect that she had precancerous cells in her reproductive organs.

The most common symptom of cervical cancer is abnormal bleeding. This could include:

  • Any spotting or bleeding that occurs between normal periods, after sexual intercourse, douching, or during an internal pelvic examination
  • Menstrual bleeding that lasts longer and is heavier than usual
  • Increased vaginal discharges
  • Painful intercourse
  • Bleeding after menopause

Risk factors for cervical cancer

Fortunately, cervical cancer is a slow-growing disease. Therefore, a yearly Pap smear will flag any abnormal changes in the cervix that need to be checked out to determine their exact cause, amount, behavior, and type. A physician will decide whether other risk factors warrant further testing. African-American, Hispanic, Native-American women, and women over age 65 are at increased risk because of their general lack of access to good medical care.

Other risk factors for cervical cancer and dysplasia are:

  • Starting sexual intercourse at an early age (16 or younger)
  • Having multiple sexual partners
  • Smoking cigarettes or passive smoking
  • Having a history of gynecological cancer
  • Using oral contraceptives for five years or more
  • Having a diet that is low in vitamin A
  • Having a history of sexually transmitted disease, especially HPV infection
  • Having the HIV (human immunodeficiency infection), which causes AIDS
  • Having been exposed to the drug known as DES (diethylstilbestrol), which had been used by the medical community between 1938 and 1971 to prevent miscarriages

In the journal Nature, some startling statistics in a Swedish study revealed that sometimes, there is a genetic link between women who had cervical cancer and their biological relatives. Over 126,000 relatives of over 71,000 cases of women with cervical cancer helped determine the conclusion of that study.

What is cervical cancer staging?

Cancer “staging” means determining the amount of a cancer a person has, especially when the disease has spread from one spot to another. It is very important to know the exact “grade” or amount of cancer a patient has developed, to plan the best treatment for her. Tissue removed during a cervical biopsy will be staged as follows:

  • Stage I: Cancer has not spread to nearby locations in the body.
  • Stage II: A small amount of cancer (only visible using a microscope) has spread. The cancer has extended beyond the cervix but not to the pelvic sidewall or the vagina.
  • Stage III: A large amount of cancer is deep in the cervix. The cancer extends to the pelvic sidewall, involves the lower third of the vagina or obstructs one or both ureters.
  • Stage IV: The cancer spreads to distant organs beyond the pelvis or involves the pelvis or involves the bladder or rectum.
  • Stage IVA: The five-year survival rate is between 20 percent to 30 percent
  • Stage IVB: It is unusual to survive five years.

The survival rate (living for five years or more after treatment) for women with stage I cancer is good: 80 percent to 85 percent. For women with stage IV cervical cancer, survival is less than 12 percent.

How is cancer of the cervix treated?

Cancer of the cervix is treated differently from other types of cancer in the body, and it may be treated differently from other types of cancer found in the female reproductive tract, such as the ovaries and uterus. Every cancer treatment will depend on the size, amount, and type of cancer a patient has developed. The most common cervical cancer treatments may include:

  • Some type of surgery.
  • Radiation therapy.
  • A combination of surgery and radiation.
  • Chemotherapy for advanced stage disease.
  • Laser surgery (a thin beam of light aimed at the abnormal cells) may be used to destroy abnormal cells, as well as those cells that have already turned into cervical precancer cells.
  • Surgery (cutting out abnormal cells) is used to remove cancerous cells that have already spread outside the cervix.
  • Hysterectomy (removal of the uterus, or the uterus and cervix) is used to treat patients whose cancer has spread from the cervix to other reproductive organs.
  • Combined radiation therapy and chemotherapy (cisplatin) is a powerful treatment that is used for patients whose cervical cancer has spread to other reproductive organs, and possibly to other places in the body.
  • Chemotherapy (5-FU with platinum) can enhance the value of radiotherapy for specific indications.

Preventing cancer of the cervix

Yearly pelvic examinations to identify and treat precancerous conditions remain the most effective ways to prevent cervical cancer. A woman should think preventively by avoiding partners with high-risk sexual histories and insisting on the use of a condom.

The good news is that scientists have developed a vaccine that can potentially prevent cancer of the cervix associated with HPV 16 and 18. The FDA recently approved this vaccine in June 2006 for use in young women ages 9 to 26.

Genital Herpes

May 12, 2008 3 comments

What Is It?

Genital herpes is caused by a virus called herpes simplex (HSV). There are two different types of herpes virus that cause genital herpes — HSV-1 and HSV-2. Most forms of genital herpes are HSV-2. But a person with HSV-1 (the type of virus that causes cold sores or fever blisters around the mouth) can transmit the virus through oral sex to another person’s genitals.

HSV-2 is a sexually transmitted disease (STD). It causes herpes sores in the genital area and is transmitted through vaginal, oral, or anal sex, especially from unprotected sex. Because the virus does not live outside the body for long, you cannot catch genital herpes from an object, such as a toilet seat.

Symptoms of a Genital Herpes Outbreak

Someone who has been exposed to the genital herpes virus may not be aware of the infection and may never have an outbreak of sores. However, if a person does have an outbreak, the symptoms can cause significant discomfort.

Someone with genital herpes may first notice itching or pain, followed by sores that appear a few hours to a few days later. The sores, which may appear on the vagina, penis, scrotum, buttocks, or anus, start out as red bumps that soon turn into red, watery blisters. The sores may make it very painful to urinate. The sores may open up, ooze fluid or bleed, and then heal within the next 2 to 4 weeks.

The entire genital area may feel very tender or painful, and the person may have flu-like symptoms including fever, headache, and swollen lymph nodes. If someone has an outbreak in the future, it will tend to be less severe and shorter in duration, with the sores healing in about 10 days.

How Long Until Symptoms Appear?

Someone who has been exposed to genital herpes will notice genital itching and/or pain about 2 to 20 days after being infected with the virus. The sores usually appear within days afterward.

What Can Happen?

After the herpes blisters disappear, a person may think the virus has gone away — but it’s actually hiding in the body. Both HSV-1 and HSV-2 can stay hidden away in the body until the next herpes outbreak, when the virus reactivates itself and the painful sores return.

Over time, the herpes virus can reactivate itself again and again, causing discomfort and episodes of sores each time. Usually a person has about four to five herpes outbreaks each year — but in some people, the number of outbreaks will lessen over time.

There is no cure for herpes; it will always remain in the body and can always be passed to another person with any form of unprotected sex. This is the case even if blisters aren’t present on the genitals. Many cases of genital herpes are transmitted when symptoms are not present.

Genital herpes also increases the risk of HIV infection. This is because HIV can enter the body more easily whenever there’s a break in the skin (such as a sore) during unprotected sexual contact. In addition, if a pregnant woman with genital herpes has an active infection during childbirth, the newborn baby is at risk for getting herpes infection. Herpes infection in a newborn can cause meningitis (an inflammation of the membranes that surround the brain and spinal cord), seizures, and brain damage.

How Is It Prevented?

The only surefire way to prevent genital herpes is document.write(defabstinence120) abstinenceabstinence. Teens who do have sex must properly use a latex condom every time they have any form of sexual intercourse (vaginal, oral, or anal sex). Girls receiving oral sex should have their partners use dental dams as protection. These sheets of thin latex can be purchased online or from many pharmacies.

If one partner has a herpes outbreak, avoid sex — even with a condom or dental dam — until all sores have healed. Herpes can be passed sexually even if a partner has no sores or other signs and symptoms of an outbreak.

How Is It Treated?

If you think you may have genital herpes or if you have had a partner who may have genital herpes, see your family doctor, adolescent doctor, gynecologist, or health clinic for a diagnosis. Right now, there is no cure for genital herpes, but a doctor can prescribe antiviral medication to help control recurring HSV-2 and clear up the painful sores. The doctor can also tell you how to keep the sores clean and dry and suggest other methods to ease the discomfort when the virus reappears.

Woman Genital Helath (2)

May 12, 2008 1 comment

Common genital problems

Vaginal problems

A variety of bacteria, yeasts and other micro-organisms occur naturally in the vagina. Specific bacteria (lactobacilli) normally keep the vagina slightly acidic, keeping the growth

of other bacteria under control.

The vaginal balance can be upset by external factors. This can lead to a change in the balance of the natural bacteria in the vagina, causing problems. Some women are more prone than others to disturbance of the vaginal environment.

A course of antibiotics may reduce the numbers of bacteria that the vagina needs to keep

its normal acidic balance. Stress, illness and hormone changes can also alter the vaginal environment.

Signs of a vaginal problem may be:

itching, irritation or soreness around the vaginal opening

a burning sensation when urinating

increased or unusual discharge

swelling of the labia

abnormal bleeding

uncomfortable or painful sex

an unpleasant odour

If you are experiencing any of the above problems, see a doctor or FPWA clinician.

Genital itch

Genital itch is a common problem among women. Many assume that any genital itch is due to thrush (see below for more information), but there are other conditions that can cause itching and soreness, such as eczema (dermatitis).

If you are experiencing persistent genital itch, it is important to see a doctor or FPWA clinician to get an accurate diagnosis, so that you can be given the right treatment.

Vulval pain

Vulval pain is a problem for many women, and can be caused by both physical and psychological factors. It can make inserting tampons or having sex difficult or impossible. Some women find the area too painful to even touch.

Some vulval problems have noticeable signs, such as a growth, sore or rash on the vulva. These can often indicate an infection or skin condition such as eczema or dermatitis, and need to be checked by a doctor.

Some women experiencing vulval pain have no other physical symptoms but experience pain some or all of the time, in particular when urinating or sitting for long periods.Because of the lack of other symptoms, these problems can be difficult to diagnose. Physical therapy is often used to treat vulval pain, but avoiding intercourse, wearing loose clothing and using cold packs can help. Your doctor may prescribe antidepressants or anti-epileptic medication to reduce the pain, or a special cream to apply to the area. Counselling or therapy may be beneficial if the pain is due to psychological causes.

Although not usually an indication of a serious condition, if you are experiencing recurring vulval pain it is important to see a doctor - dont try and treat the problem yourself. Occasionally however, pain can be related to conditions such as cancer.

Vaginal infections

Infection can be avoided by:

wiping from front to back when using toilet paper

being particularly careful with hygiene if you have a bowel upset e.g. washing rather than wiping

eating a healthy, well balanced diet

not douching (flushing liquids into the vagina)

Common vaginal infections

Thrush

This infection is also called monilia or candida. The organism is a yeast which is commonly found in the body without causing any problems. At times a woman may notice symptoms, particularly during pregnancy, or when she is on antibiotics or some other medication. Women who are diabetic or who have other illnesses may have recurring problems with thrush.


Common symptoms of thrush can include itchiness, burning, soreness, a thick white or yellow discharge, discomfort during intercourse and pain when urinating. Sometimes men may also notice irritation and redness of the penis after sex if their partner has thrush, but it is not considered to be a sexually transmissible infection (STI).

Thrush is diagnosed by examination and confirmed by taking swabs.

It may also be detected on a routine Pap smear.

Thrush does not have to be treated if it is not bothering you. Some women find their symptoms can be relieved by sitting in a warm salty bath or by using cold compresses.

If you are certain that thrush is the cause of your symptoms, antifungal vaginal creams and pessaries are available over the counter at pharmacies. If you are finding that thrush is a frequent problem it is advisable to visit your doctor or the FPWA clinic. Your doctor will examine you to confirm that thrush is the cause of your symptoms and may prescribe other treatments such as oral antifungal tablets. The doctor may take this opportunity to rule out the possibility of STIs, which can also cause irritation.

Putting yogurt on an irritated vulva will not get rid of the infection.

Bacterial vaginosis

This is a common condition in women and is caused by an overgrowth

of bacteria that normally live in the bowel but may be found in the vagina. The organisms often multiply in the vagina when the acid level falls.

Bacterial vaginosis may cause a white to grey discharge with an unpleasant ‘fish or stale odour. Vulval irritation can occur and sex may be uncomfortable. Bacterial vaginosis is diagnosed by an examination testing the acidity of the vaginal fluid, and confirmed by swabs.

Bacterial vaginosis does not have to be treated if it is not bothering you.

If it is a problem your doctor may prescribe antibiotics in the form of tablets or vaginal cream. The FPWA clinic or your doctor may also recommend treatment if you are planning to have an intrauterine contraceptive device fitted or any gynaecological operation.

Telling partners

It is a good idea to talk to your partner if you have a vaginal infection or are experiencing vulval pain, even though it can be embarrassing. They may find it helpful to read this pamphlet. It is generally better to avoid sexual intercourse if you have an infection, particularly if you have pain or discomfort, to prevent ongoing problems.

Ways of coping

Vaginal infections and vulval pain are very common, but can be a real problem for some women. If you are feeling distressed, it is important to talk to your doctor, nurse or a counsellor for further information and support. If you are experiencing pain, relaxation and stress management techniques may be of help.

Dampak Infeksi Genital Terhadap Persalinan Kurang Bulan

May 5, 2008 2 comments

Oleh Sofie Rifayani Krisnadi

PENDAHULUAN

Persalinan kurang bulan (PKB persalinan prematur) kejadiannya masih tinggi, baik di negara maju maupun di negara yang sedang berkembang; dan bayi kurang bulan (prematur) merupakan penyumbang tertinggi terhadap angka kematian bayi baru lahir.

Pencegahan persalinan kurang bulan umumnya sulit dan tidak efektif, antara lain karena etiologinya multifaktor, seperti status sosioekonomi, nutrisi, konstitusi, imunologi dan mikrobiologi di samping penyebab yang terkait dengan komplikasi obstetri (perdarahan antepartum, hipertensi pada kehamilan atau komplikasi medis lainnya).(1)

Banyak penelitian yang mengaitkan kejadian PKB dengan infeksi, terutama akibat korioamnionitis pada kejadian ketuban pecah dini (KPD). KPD meningkatkan risiko bayi terinfeksi, sehingga memperberat masalah akibat kurang bulannya (ketidak matangan paru, hipotermi, sindrom gawat nafas dan lain-lain). KPD atau korioamnionitis tanpa KPD sering dihubungkan dengan infeksi urogenital. Pada kehamilan normal cairan amnion steril; adanya mikroorganisme intraamnion berhubungan dengan kejadian PKB.(4)

Dari sekian banyak faktor penyebab PKB, infeksi merupakan penyebab sekitar 40% PKB(2) dan paling dapat dicegah dan diobati untuk menurunkan kejadian PKB. Karena ketuban pecah dini (KPD) merupakan faktor sangat penting terhadap kejadian infeksi, maka seyogyanya pemberian antibiotika dilakukan sebelum terjadi KPD(5) Pendapat ini masih diperdebatkan sampai saat ini terutama pada PKB dengan selaput ketuban intak.(6-7)

Infeksi urogenital yang dianggap berpengaruh terhadap kejadian KPD adalah:

1. Bakteriuri tanpa gejala(8,9)

2. Vaginosis bakterial

3. Trikomoniasis

4. Servisitis Gonorrhoeae

5. Infeksi Chlamydia trachomatis

BAKTERIURI TANPA GEJALA (asymptomatic bacteriuria)

Bakteriuri tanpa gejala didefinisikan sebagai terdeteksinya > 100.000 koloni satu spesies bakteri per ml urin yang dikultur dari sampel midstream. Kejadiannya pada ibu hamil ± 2-7 %.(9) Bakteri yang tersering dapat diisolasi adalah Escherichia coli. Kehamilan sendiri tidak meningkatkan kejadian bakteriuri tanpa gejala, akan tetapi pielonefritis akut terjadi pada 20-40% ibu hamil dengan bakteriuri tanpa gejala yang tidak diobati. Banyak penelitian menunjukkan bahwa kejadian PKB lebih banyak pada ibu dengan bakteriuri dibandingkan dengan pada ibu hamil tanpa bakteriuri. Sekitar 40-80% komplikasi kehamilan yang disebabkan oleh pielonefritis akut dapat dicegah dengan mengobati bakteriuri tanpa gejala; oleh karena itu mengobati bakteriuri tanpa gejala dapat menurunkan risiko PKB.

Penyebab lain bakteriuri adalah Streptokokus Grup Beta (GBS) yang sering berhubungan dengan kolonisasi GBS di daerah urogenital. The Center for Disease Control and Prevention (CDC) merekomendasikan agar ibu hamil dengan bakteriuri GBS diterapi pada saat diagnosis untuk mengurangi kemungkinan PKB dan pada saat persalinan untuk mencegah infeksi GBS pada neonatus. Setelah pengobatan selesai, biakan urin harus diulang untuk meyakinkan eradikasi GBS; jika masih positif berarti tergolong bakteriuri persistent atau recurrent. Untuk ini diberi pengobatan supresif 100 mg nitrofurantoin per hari p.o. sampai bayi lahir.(10)

VAGINOSIS BAKTERIAL (BV-Bacterial vaginosis)(11-18)

Suatu keadaan karakteristik yang ditandai oleh perubahan ekosistem vagina, yang ditunjukkan dengan berkurangnya Laktobasili, sedangkan beberapa bakteri fakultatif anaerob bertambah dengan mencolok yakni Mobiluncus species, Prevotella species, Gardnerella vaginalis, Mycoplasma hominis dan Ureaplasma urealyticum.

Kejadiannya pada ibu hamil sekitar 15-20%(13) keadaan ini merupakan faktor risiko persalinan kurang bulan spontan, ketuban pecah dini serta infeksi pasca salin/pasca operasi. Sekitar 15-40% penderita BV tidak menunjukkan gejala klinis, selebihnya mengeluhkan keluarnya duh tubuh vagina berbau amis.

Untuk praktisi klinik, diagnosis ditegakkan dengan kriteria Amsel, yakni apabila ada tiga dari empat kriteria di bawah ini :

1. Cairan vagina homogen, putih keabuan atau seperti susu.

2. Clue cells (terdapat pada > 20% epitel sel vagina pada pemeriksaan mikroskop dengan pembesaran 400x).

3. pH vagina >4.5

4. Bau amis sebelum atau setelah penambahan 10% KOH.

Di Indonesia, kejadian BV dalam kehamilan lebih tinggi dari penyakit infeksi dalam kehamilan lainnya (bakteriuri tanpa gejala, N. gonorrhoeae, C.trachomatis dan T. vaginalis) dan keberadaannya meningkatkan kejadian ketuban pecah dini/KPD dan persalinan kurang bulan/PKB. Secara teoritis pengobatan BV sangat potensial dapat menurunkan kejadian KPD dan PKB.(18)

Pengobatan BV telah banyak dilakukan. McGregor memakai krim klindamisin. Metronidazol oral terbukti menurunkan kejadian PKB dari 39% menjadi 18% (Morales, dikutip oleh McGregor, 2000). Hauth (1995) memakai metronidazol oral digabung dengan eritromisin, berhasil menurunkan kejadian PKB. Penelitian berikutnya yang memakai klindamisin oral dan metronidazol oral membuktikan penurunan kejadian PKB, tetapi Joesoef di Indonesia mendapatkan angka kejadian BBLR sedikit meningkat di kelompok terapi (dibanding plasebo).

INFEKSI TRICHOMONAS VAGINALIS

Infeksi protozoa ini merupakan PMS yang banyak ditemukan, namun dapat diobati dengan baik. Kejadiannya pada ibu hamil di Australia berkisar sebanyak 25%, di Indonesia tidak ditemukan data. Diagnosis ditegakkan pada saat Pap’s smear rutin wanita hamil atau dengan preparat basah pada ibu hamil dengan keluhan. Trikomoniasis dalam kehamilan dapat menyebabkan bayi terinfeksi saat persalinan dan dapat menyebabkan demam pada masa neonatal.(19) Cochrane review menyatakan dampak trikomoniasis terhadap hasil kehamilan, baik berupa KPD atau PKB belum jelas.(20)

Gejala yang timbul berupa duh vaginal berwarna hijau kekuningan, berbau busuk, gatal, dan nyeri saat berkemih atau saat bersanggama.(21) Pengobatan metronidazol pada ibu hamil tanpa gejala, gagal menurunkan angka kejadian PKB. Hal ini menggaris bawahi perlunya pengobatan trikomoniasis sebelum kehamilan.(19) Metronidazol cukup efektif, dosis tunggal biasanya diberikan hanya pada kehamilan trimester 2 atau 3. Efektifitas pengobatan akan meningkat jika pasangan seksual juga diobati.

SERVISITIS GONOROIKA

Neisseria gonorrhoeae dapat ditransmisikan dari ibu ke bayi pada saat persalinan, mengakibatkan oftalmia gonokokal atau infeksi sistemik pada neonatus. Servisitis N.gonorrhoeae juga meningkatkan kejadian PKB meskipun tidak ada penelitian plasebo-kontrol (karena melanggar etik). Keadaan ini juga dapat meningkatkan kejadian endometritis dan sepsis pasca salin.

Gejala servisitis gonoroika mirip klamidiasis (sering tanpa gejala), juga gejala sisanya; servisitis gonoroika lebih sering bergejala daripada klamidiasis. Diagnosis ditegakkan dengan melakukan apus serviks (diplokokus intraseluler) dan kultur atau PCR (Polymerase chain reaction). Tes resistensi/uji kepekaan antibiotika dilakukan bersamaan dengan pengambilan apus serviks. Pengobatan gabungan amoksisilin dengan probenesid unggul dibandingkan dengan spektinomisin (OR 2.40, 95%CI 0.71-8.12), juga jika dibandingkan dengan seftriakson (OR 2.40, 95%CI 0.71-8.12); tetapi seftriakson unggul dibandingkan dengan cefixime (OR 1.22, 95%CI 0.16-9.04). Penelitian ini dilakukan pada 346 ibu hamil.(22) Antibiotik yang diberikan hendaknya juga dapat meliputi pengobatan untuk klamidia, karena sering terjadi ko-infeksi.22

INFEKSI CHLAMYDIA TRACHOMATIS

Infeksi Chlamydia trachomatis (PMS) biasanya tidak bergejala, dapat menyebabkan servisitis, endometritis dan radang panggul dengan gejala sisa faktor tuba (infertilitas atau kehamilan ektopik).

Diagnosis ditegakkan dengan PCR (Polymerase chain reaction) DNA probe assay atau uji cepat dengan immunofluorescence dan enzyme immunoassay langsung (dapat dilakukan sendiri dengan apus serviks).(24) Pengobatan dengan amoksisilin sama efektifnya dengan eritromisin, bahkan lebih dapat ditolerir.(25) Klindamisin dan azithromisin hanya digunakan bila amoksisilin atau eritromisin tidak dapat diberikan.

Pengobatan mutakhir adalah dengan azitromisin. Uji klinik membuktikan bahwa dosis tunggal per oral preparat ini setara efektifitasnya dengan doksisiklin 100 mg dua kali sehari selama tujuh hari; keduanya dapat mencapai keberhasilan terapi 95%. Azitromisin juga efektif untuk non specific urethritis pada ibu hamil. Pengobatan yang tidak sempurna menyebabkan radang panggul pasca salin, nyeri panggul kronis, infertilitas dan kehamilan ektopik. Pemberian antibiotika dalam kehamilan umumnya ditujukan untuk prevensi morbiditas dan mortalitas perinatal pada ibu dan janin. Pada ancaman persalinan kurang bulan (PKB) harus dicari kemungkinan penyebab infeksi.

Pada kehamilan Chlamydia menyebabkan amnionitis dan endometritis postpartum. Transmisi dari ibu ke anak dapat terjadi saat persalinan dan dapat menyebabkan oftalmia dan/atau pneumonitis pada neonatus. (23) Selain infeksi genital, infeksi maternal seperti tifoid, pielonefritis, apendisitis, pneumoni atau infeksi lain dengan demam tinggi dapat menyebabkan PKB terutama karena toksin mikro-organismenya.

KEPUSTAKAAN

1. Romero R, Suplelveda W, Baumann P et al. The preterm labor syndrome: biochemical, cytologic, immunologic, pathologic, microbiologic, and clinical evidence that preterm labor is a heterogeneous disease. Am J Obstet Gynecol 1993, 168:288.

2. Gibbs R, Eschenbach D. Use of antibiotics to prevent preterm birth. Am J Obstet Gynecol 1997, 177:375–80.

3. Mertz HL, Ernest JM..Antibiotics and Preterm Labor. Current Women’s Health Reports 2001, 1:20–6.

4. Mazor M, Chaim W, Maymon E et al. The role of antibiotic therapy in the prevention of prematurity. Clin Perinatol 1998, 25:659–85.

5. Hay PE, Lamont RF, Taylor-Robinson D, Morgan DJ, Ison C, Pearson J. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994; 308:295-8.

6. Mercer B, Miodovnik M, Thurnau G et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. JAMA 1997, 278:989.

7. King J, Flenady V. Antibiotics for preterm labor with intact membranes. In:A comprehensive review of all clinical trials to date examining the use of antibiotics in patients with preterm labor and intact membranes. The Cochrane Database of Systematic Reviews.Oxford: The Cochrane Library; 2001.

8. Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins, JC, Bracken M. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol 1989;73:576-82.

9. Kinningham RB. Asymptomatic bacteriuria in pregnancy. Am Fam Physician 1993;47:1232-8.

10. Patterson TF, Andriole VT. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am 1997;11:593-608.

11. Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T,Holmes KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988;158:819-28.

12. Spiegel CA. Bacterial vaginosis. Clin Microbiol Rev 1991;4:485-502.

13. Eschenbach DA, Gravett MG, Chen KC, Hoyme UB, Holmes KK. Bacterial vaginosis during pregnancy: an association with prematurity and postpartum complications. Scand J Urol Nephrol Suppl 1984;86:213-22.

14. Eschenbach DA. Bacterial vaginosis and anaerobes in obstetric gynecologic infection. Clin Infect Dis 1993;16 Suppl 4:S282-7.

15. McGregor JA, French JI. Bacterial vaginosis in pregnancy. Obstet Gynecol Surv 2000;55:S1-19.

16. Ugwumadu AH. Bacterial vaginosis in pregnancy. Curr Opin Obstet Gynecol 2002;14:115-18.

17. Gibbs RS. Chorioamnionitis and bacterial vaginosis. Am J Obstet Gynecol 1993;169:460-62.

18. Joesoef MR, Hillier SL, Wiknjosastro G, Sumampouw H et al. Intravaginal clindamycin treatment for bacterial vaginosis: effects on preterm delivery and low birth weight. Am. J. Obstetr. Gynecol. 1995;173:1527-31.

19. Klebanoff MA, Carey JC, Hauth JC, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med 2001; 345: 487-93.

20. Gülmezoglu AM. Interventions for trichomoniasis in pregnancy. The Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD000220. DOI: 10.1002/14651858.CD000220.

21. Centers for Disease Control and Prevention. 1998 Guidelines for treatment of sexually transmitted diseases. MMWR 1998; 47(No. RR-1): 20-26, 52-74, 88-94

22. Brocklehurst P. Antibiotics for gonorrhoea in pregnancy. The Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000098. DOI: 10.1002/14651858.CD000098

23. Sawhney MPS, Batra RB. Chlamydia trachomatis seropositivity during pregnancy. Indian J Dermatol Venereol Leprol November-December 2003; 69 Issue 6,394-95.

24. Ostergaard L, Andersen B, Moller JK, Olesen F. Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomized 1-year follow-up study. Clin Infect Dis 2000; 31: 951-57.

25. Brocklehurst P, Rooney G. Interventions for treating genital chlamydia trachomatis infection in pregnancy. The Cochrane Database of Systematic Reviews 1998, Issue 4. Art. No.: CD000054. DOI: 10.1002/14651858.CD000054.

26. Martin DH, Mroczkowski TF, Dalu ZA et al. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group. N Engl J Med 1992; 327: 21-925.

G-SPOT

April 30, 2008 8 comments

G-spot adalah satu atau beberapa titik sensitif yang masih menjadi misteri bagi sebagian besar pria. Reaksi yang ditimbulkan biasanya cukup membuat pria ingin menemukan kembali sumber kenikmatan tersebut.

Huruf G dalam G-spot berasal dari nama seorang dokter. Ernst Grafenberg yang menemukannya pada 1950-an. Menurut sang dokter, G-spot pada tubuh wanita terletak di dalam Miss Ginie di dinding bagian atasnya. Daerah itu membengkak dan biasanya akan menghasilkan respon menyenangkan, sehingga pada sebagian wanita menyebabkan orgasme.

Reaksi terhadap stimulasi G-spot, menurut Grafenberg, seperti yang ditulis Joel D. Block, Ph.D, pada buku Secrets of Better Sex, sangat bervariasi. Ada sebagian wanita sangat sensitif, terlalu sensitif, atau tidak sensitif sama sekali. Jadi, sebaiknya wanitalah yang menyentuh dan memberitahu bagian sensitifnya itu.

Sebelum Anda menggali dan mulai mencari-cari G-spot, ingat bahwa otak Anda dan pasangan harus membuat pikiran dipenuhi dengan cinta dan kasih pusat dari orgasme. Jika Anda mampu membiarkan pikiran bebas tanpa merasa terbebani, dipastikan dia mencapai kesenangan yang sangat diharapkan.

Setelah melalui perdebatan panjang selama lebih dari satu setengah abad, akhirnya para peneliti dari Inggris menemukan lokasi G-Spot wanita.

G-Spot, pertama kali ditemukan keberadaannya pada tahun 1950. Nama itu kemudian muncul dari seorang ginekolog asal Jerman, Ernst Graefenberg.

Dia mengatakan, area sekitar vagina adalah daerah paling sensitif wanita. Bila dirangsang, seorang wanita dapat mencapai tingkat kepuasan atau orgasme.

Tetapi dimana G-Spot itu berada, sempat hilang karena adanya bukti subjektif, bahkan ada beberapa pakar menyatakan G-Spot itu sebenarnya tidak ada.

Sebagaimana dikutip dari AFP,  menurut peneliti asal Italia, Emmanuele Jannini, hanya beberapa wanita yang beruntung bisa mendapatkan kepuasan di area tersebut. Meski demikian, Jannini mengaku sependapat dengan para pakar bahwa G-Spot itu sebenarnya tidak ada.

Untuk membuktikannya, Jannini melakukan percobaan di Universitas L’Aquila. Dia menggunakan alat ultrasound pada sembilan orang wanita yang mengaku pernah melakukan orgasme vagina dan 11 wanita yang tidak melakukannya.

Targetnya adalah jaringan kulit tipis yang lokasinya berada di depan dinding vagina di belakang uretra. Untuk kelompok pertama, lebih tebal, dibanding grup yang kedua, kemudian pemeriksaan elektronis yang membuktikan percobaan itu.

Dalam penelitiannya di The Journal of Sexual Medicine, Jannini mengatakan, percobaan yang dilakukannya jelas, yakni wanita yang tidak tahu G-Spotnya tidak dapat memperoleh orgasme vagina.

Anatomi Genital Wanita

April 28, 2008 6 comments

Anatomi Genital Pria

April 27, 2008 1 comment

Alat genital pria terdiri dari bagian eksternal dan bagian internal. Bagian eksternal terdiri dari penis, skrotum dan rambut pubic. Bagian dalam terdiri dari terdiri dari berbagai organ dan saluran yang berfungsi untuk memproduksi dan menyalurkan sperma, yang meliputi epididymis (e), vas diferens (vas) dan prostat (pr). Bagian lain yang nampak pada gambar adalah tulang pubic (PU), ureter (u) dan testis (T).

Aspek yang sering dipermasalahkan pada organ reproduksi adalah penis. Penis terdiri dari tangkai dan kepala penis. Dibawah kulit penis (seperti nampak pada gambar berikut) terdapat tiga bagian yaitu corpus cavernosum, corpus spongisum dan ureter. Penis diikat pada tulang pelvic oleh dua ikatan otot fibrous yang disebut dengan root (R).

Ujung atau kepala penis biasa disebut glens adalah bagian yang paling sensitif pada tubuh pria karena banyak terdapat ujung-ujung syaraf. Kecuali jika disunat, glans tertutup oleh kulit yang disebut foreskin (f) atau prepuce. Kulit ini dapat disingkap sehingga Glan dapat terlihat.

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