STD

&
HIV/AIDS

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 Tujuan:
Memahami pengertian IMS & HIV/AIDS, faktor
penyebab, risiko, tanda-gejala dan cara
penularannya.
Mengidentifikasi manifestasi oral IMS &
HIV/AIDS
Mengelola kasus IMS & HIV/AIDS di mulut
secara komprehensif berkolaborasi dengan
profesi yang lain.

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 Sexually transmitted disease (STD)
Infections that are spread from person to
person through intimate sexual contact.
Sexually transmitted infection (STI)
Venereal disease (VD).
Penyakit menular seksual (PMS)
Infeksi menular seksual (IMS)

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 Why STDs are important :
Common
Often asymptomatic
Major complications and sequelae
Expensive
Synergy with HIV

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 STDs are caused by viruses and
bacteria and more than 20 STDs
affect both men and women.

The highest rate of infection occurs

between the age of 20-24 for males.

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 Why STDs are important :
Common
Often asymptomatic
Major complications and sequelae
Expensive
Synergy with HIV

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 Percent of Persons with STD Who Are
Asymptomatic
Men Women

100
90
80
70
60
50
40
30
20
10
0
Urethra Rectum Pharynx Cervix Urethra Rectum Any
Cervix
Chlamydia Genital herpes
Gonorrhea

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 Epidemilogy
is an infection or disease that mostly
transmitted through sexual contact .
(oral, anal, or vaginal)
attacked around the genitals but symptoms
can appear and attack the eyes, mouth,
gastrointestinal tract, liver, brain, and
other organs
More than 13 billion people globally are
infected with STDs each year

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 Common STDs
Estimated Annual Incidences
Humanpapilloma Virus: 5.5 million
Trichomoniasis: 5 million
Chlamydia: 3 million
Genital herpes: 1 million
Gonorrhea: 650,000
Hepatitis B: 120,000
Syphilis: 70,000

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 The Fact
Silent transmission
Chlamydial infection: 70% of women
and 50% of men are asymptomatic
Gonococcal infection: 50% of women
are asymptomatic.

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 The Fact
Many STDs are easily treatable some
have irreversible sequelae.
Chlamydial infection in women pelvic
inflammatory disease and tubal scarring
causing infertility or the risk of ectopic
pregnancy.
Untreated syphilis infection can cause
progressively destructive lesions of the
cardiovascular and central nervous systems.

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 The Fact

presence of a STI increases the chance of

contracting HIV infection.
Ulcers disrupt mucosal integrity and
increase the presence or activation, or
both, of HIV susceptible cells (for
example, CD4 lymphocytes)

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 Overview of Complications of
Sexually Transmitted Diseases
Fetal Wastage*
Low Birthweight*
Congenital Infection*

Upper Tract Systemic

Infection Infection

Infertility
Ectopic Pregnancy* STDs
Chronic Pelvic Pain
Cervical Cancer*
HIV Infection*

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* Potentially Fatal
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 Sexually Transmitted Diseases
bacterial infections
viral infections
fungal infections
protozoal infections
parasitic infestation

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 STD Transmission

S-S B-F

Chlamydia
Genital Herpes Gonorrhea
Genital Warts (HPV) HIV
Syphilis
Hepatitis A
Hepatitis B
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Hepatitis C
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 Common STDs
Bacterial diseases
Chlamydia (CT)
Gonorrhea (GC)
Syphilis
Trichomoniasis (Trich)

Viral diseases
Human Papillomavirus (HPV)
Genital herpes (HSV-2 or HSV-1)
Hepatitis B

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Two Kinds of Sexual Transmission
1) Skin to Skin S-S
Infected/ Contact with
infested skin + susceptible skin transmission

2) Body Fluid N B-F

Body Fluid (blood, Entry into Body

semen, vaginal fluids (needle, open transmission
& breast milk) skin, mucous
membrane)
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 STD Transmission

S-S B-F

Chlamydia
Genital Herpes Gonorrhea
Genital Warts (HPV) HIV
Syphilis Hepatitis A
Hepatitis B
Hepatitis C

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 Primary
Chancre appears at
site of infection
Secondary
Other symptoms appear--
rashes, fever, fatigue
Syphilis
Transmission: contact with rash or
chancre
Symptoms: (at left)
Time to onset: 10-90 days

Latent Phase Pregnancy: perinatal infection may

No Symptoms cause blindness or infant death
Diagnosis: blood tests
Treatment: antibiotics very effective

Late Phase
Damage to nervous
system and death

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 Manifestasi Oral

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 congenital syphilis hutchinson
teeth

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 Manifestasi Oral

The primary stage of syphilis usually lasts three to six weeks,

while the chancre can heal spontaneously with or without
antibiotic therapy

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 secondary syphilis is maculo-papular lesion

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 the mucous
patch stage

fever
swollen lymph
glands
sore throat
patchy hair
loss
headaches
weight loss
muscle aches
fatigue

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 Herpes (HSV)

HSV-1 HSV-2

Cold sores Genital lesions

Oral-genital frequent Genital-oral infrequent

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 HSV1

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 HPV

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 Main risk factors for acquiring a
sexually transmitted infection (STI)
multiple sexual partners
young age
unmarried status
concurrent sexual partners
unprotected sexual intercourse.
asymptomatic nature of the infection.

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 PENATALAKSANAAN

Eliminasi
kausa / f. risiko
Medikasi
Vaksinasi
Mencegah kekambuhan

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 Global strategy for the prevention
and control of sexually transmitted
infections: 2006 - 2015. Breaking the
chain of transmission

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 HIV and other STDs are
connected.
same behaviors
increased transmission
feelings of susceptibility and personal
concern

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 HIV AIDS
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H Human Hanya menginfeksi manusia

Menyerang sistem imunitas

Immuno- sehingga pertahanan tubuh
I Deficiency menjadi lemah

Suatu organisme dengan

karakteristik memperbanyak
V Virus
diri dengan bantuan sel
manusia

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 Ditularkan dari orang satu ke orang
A Acquired lain. Bukan diwariskan.
Mempengaruhi sistem imunitas , yang
I Immune-
biasanya digunakan untuk melawan
mikroorganism seperti virus dan

D Deficiency
bakteri

Menyebabkan melemahnya sistem

S imun.

Syndrome Penderita AIDS mengalami berbagai

penyakit berbeda beda dan infeksi
oportunistik

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 1 HIV di dalam aliran darah.
2&3 Virus menempel dan memasuki
sel CD4-T virus melepaskan
informasi keturunannya ke dalam
sel.
4. Melalui sebuah proses yang unik
informasi tersebut menjadi
bagian dari CD4-T
5. Sel CD4-T ini sudah terinfeksi HIV
untuk selama-lamanya
6 .Virus mulai mengkopikan diri
7. Akhirnya sel-sel ini meledak.
8 Ribuan virus baru dilepas ke dalam
aliran darah. Virus baru ini akan
menginfeksikan sel CD4-T baru.

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 Perjalanan Infeksi HIV
1. Pajanan terhadap virus dan berhasil masuk
kedalam tubuh
2. Periode Jendela (Window Period : 2-12
minggu -sampai 6 bulan)
3. Infeksi HIV - asymptomatic, 8 -10 tahun
People with HIV look and act just like
anyone without HIV infection
4. AIDS - 6 bulan to 2 tahun
5. Meninggal

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 PERKEMBANGAN
DARI HIV MENJADI AIDS
Tertular

Periode
Jendela HIV + AIDS

3 - 6 BULAN 3 - 10 TAHUN 1 - 2 TAHUN

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Iceberg phenomenon of
disease
Penyakit yang
manifest

Penyakit belum
terdiagnose atau kondisi
subklinik

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 WHO classification of HIV-associated clinical disease

Classification of HIV-
associated clinical WHO Clinical Stage
disease

1
Asymptomatic

2
Mild

3
Advanced

4
Severe

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 Stadium (Klinis) HIV-AIDS (WHO)
stadium Gambaran Klinis
I Asymptomatic
Persistent generalized lymphadenopathy
II Moderate unexplained* weight loss (under 10% of presumed or
measured body weight)**
Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis
media, pharyngitis)
Herpes zoster
Angular chelitis
Recurrent oral ulceration
Papular pruritic eruptions
Seborrhoeic dermatitis
Fungal nail infections

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 Stadium Gambaran klinis

III Unexplained* severe weight loss (over 10% of presumed or measured

body weight)**
Unexplained* chronic diarrhoea for longer than one month
Unexplained* persistent fever (intermittent or constant for longer than
one month)
Persistent oral candidiasis
Oral hairy leukoplakia
Pulmonary tuberculosis
Severe bacterial infections (e.g. pneumonia, empyema, pyomyositis,
bone or joint infection, meningitis, bacteraemia)
Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
Unexplained* anaemia (below 8 g/dl), neutropenia (below 0.5 billion/l)
and/or chronic thrombocytopenia (below 50 billion/l)
IV HIV wasting syndrome
Pneumocystis pneumonia

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 Recurrent severe bacterial pneumonia
Chronic herpes simplex infection (orolabial, genital or anorectal of more than
one months duration or visceral at any site)
Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
Extrapulmonary tuberculosis
Kaposi sarcoma
Cytomegalovirus infection (retinitis or infection of other organs)
Central nervous system toxoplasmosis
HIV encephalopathy
Extrapulmonary cryptococcosis including meningitis
Disseminated non-tuberculous mycobacteria infection
Progressive multifocal leukoencephalopathy
Chronic cryptosporidiosis, Chronic isosporiasis
Disseminated mycosis (extrapulmonary histoplasmosis, coccidiomycosis)
Recurrent septicaemia (including non-typhoidal Salmonella)
Lymphoma (cerebral or B cell non-Hodgkin)
Invasive cervical carcinoma
Atypical disseminated leishmaniasis
Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy
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 Oral candidiasis (OC) is the most common lesion among
patients with HIV

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 Oral Candidiasis

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 Linear Gingival Erythema
(HIV gingivitis, red-band gingivitis)

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 Necrotizing Ulcerative Gingivitis

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 Necrotizing Stomatitis in Children

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 Necrotizing Ulcerative Periodontitis

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 Oral Hairy Leukoplakia

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 Herpes Simplex Infection

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 Aphthous Ulcer:
Minor

Aphthous Ulcer: Major

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 Kaposis Sarcoma

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 Cara penularan?

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 PENULARAN HIV
Kontak seksual
Kontak seksual dengan penetrasi vaginal,
anal dan oral.
Penularan dari Ibu ke anak:
Penularan dari ibu Hiv + ke bayi (transmisi
vertikal 25-45%, terjadi melalui: plasenta
(intra uterin) persalinan (intrapartum) ASI
Pajanan oleh darah terinfeksi, produk
darah atau transplatansi organ/jaringan
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 HIV didapatkan di:..

cairan sperma

cairan vagina

darah
air susu ibu
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 Berhubungan Seks

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 Tranfusi Darah

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 penularan dari ibu ke janin atau bayi
melalui ASI

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 Berciuman???
Bila keduanya ada luka terbuka
di bagian mulut maka ada kemungkinan
terjadi penularan HIV

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 STOP STIGMA
&
DISKRIMINASI
O D H A !!!

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 Resiko Tinggi Infeksi
Silang
(Cross Infection)

Status kesehatan pasien

beragam
Tidak semua pasien tahu
akan penyakit yang sedang
di derita
Peralatan dan perawatan
gigi unik
Waktu perawatan relatif
lama

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 USAF Dental Evaluation & Consultation Service

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 Global strategy for the prevention
and control of sexually transmitted
infections: 2006 - 2015. Breaking the
chain of transmission

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 Clinical Contact
Surfaces

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 Pencegahan

EVALUASI PASIEN
UNIVERSAL PRECAUTIONS
( Standard Precautions )

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PENCEGAHAN PRIMER (PRIMARY PREVENTION)

(ABSTINENSI), (Be Faithfull),

artinya absen seks artinya bersikap
atau tidak melakukan saling setia
hubungan seks bagi B kepada satu
orang yang belum A pasangan seks
menikah (tidak berganti-
Konsep ganti)
ABCD
(Condom),
artinya mencegah (Drug No),
D
penularan HIV dengan C artinya dilarang
memakai kondom. bila menggunakan
salah satu pasangan Narkoba suntik
telah terinfeksi HIV
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 PENATALAKSANAAN
VCT (voluntary counselling and
testing) Test HIV/AIDS
Managemen faktor risiko dan
Infeksi Opostunistik
Medikasi
ART
Monitoring
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