8akLerl penyebab S1u / PS

8lyanl Wlkanlngrum
8aglan Mlkroblologl
lku?
1op 1en S1u
Crgan|sm D|sease Comment 1reatment
aplllomavlruses
(Lypes 6 and 11
assoclaLed wlLh
vlslble genlLal
warLs)
CenlLal warLs
dysplaslas
1he commonesL of
all S1us assoclaLed
wlLh cancer of
cervlx penls eLc
odophyllln
cryoLherapy
cblomyJlo
ttocbomotls (uk
seroLypes)
nonspeclflc
ureLhrlLls
lncreaslng
lncldence
uoxycycllne
azlLhromycln
c ttocbomotls (L1
L2 L3 seroLypes)
Lymphogranuloma
venereum
Malnly Lroplcal
counLrles
uoxycycllne
LeLracycllne
eryLhromycln
cooJlJo olblcoos vaglnal Lhrush
balanlLls
very common
predlsposlng facLors
nysLaLln
fluconazole
1op 1en S1u
Crgan|sm D|sease Comment 1reatment
@tlcbomooos
voqloolls
vaglnlLls ureLhrlLls very common can
be asympLomaLlc
MeLronldazole
Perpes slmplex
vlrus Lypes 1 and 2
CenlLal herpes lncreaslng problem
of laLency and
reacLlvaLlon
Aclclovlr
valaclclovlr
famclclovlr
Nelssetlo
qooottboeoe
Conorrhea uecreaslng
lncldence ln
resourcerlch
counLrles
CefLrlaxone
clprofloxacln
Plv AluS lncldence
lncreaslng
worldwlde
nucleoslde
nucleoLlde and
nonnucleoslde
reverse
LranscrlpLase
lnhlblLors fuslon
lnhlblLors proLease
lnhlblLors
1op 1en S1u
Crgan|sm D|sease Comment 1reatment
@tepooemo
polllJom
Syphllls uecreaslng
lncldence ln
resourcerlch
counLrles
enlclllln
PepaLlLls 8 vlrus PepaLlLls 330 mllllon carrlers
worldwlde
Lamlvudlne
adefovlr lnLerferon
alpha
noemopbllos
Jocteyl
Chancrold Malnly Lroplcal LryLhromycln
cefLrlaxone
Lher S1u
Crgan|sm D|sease Comment 1reatment
colymmotoboctetlom
qtooolomotls
Cranuloma lngulnale 1roplcal uoxycycllne
azlLhromycln
5otcoptes scoblel CenlLal scables Common ermeLhrln cream
lbtbltos pobls edlculoses publs Common ermeLhrln
cream/shampoo
Mycoplosmo
uteoplosmo (1
sLralns)
nonspeclflc
ureLhrlLls
Less lmporLanL Lhan
chlamydla
uoxycycllne
azlLhromycln
LryLhromycln
CotJoetello voqloolls vaglnlLls AcLs LogeLher wlLh
anaerobes
MeLronldazole
Mlcrobes Lo combaL hosL defenses
ost defenses M|crob|a| strateg|es Lxamp|es
ComplemenL C3d recepLor on mlcrobe
blnds C3b/d and reduces
C3b/dmedlaLed
polymorph phagocyLosls
cooJlJo olblcoos
lnflammaLlon lnduce sLrong
lnflammaLory response yeL
evade consequences
Conococcus c olblcoos
PSv chlamydla
AnLlbodles (especlally lgA) roduce lgA proLease Conococcus
CellmedlaLed lmmune
response (1 cells
lymphoklnes naLural klller
cells eLc)
AnLlgenlc varlaLlon allows
relnfecLlon of a glven
lndlvldual wlLh an anLlgenlc
varlanL
oorly undersLood facLors
cause lneffecLlve cell
medlaLed lmmune
response
Conococcus chlamydla
paplllomavlruses (noL PSv
or @ polllJom)
@ polllJom Plv
ost defenses M|crob|a| strateg|es Lxamp|es
lnLegrlLy of mucosal
surface
Speclflc aLLachmenL
mechanlsm
Conococcus or chlamydla
Lo ureLhral eplLhellum
urlne flow (for ureLhral
lnfecLlon)
Speclflc aLLachmenL
lnduce own upLake and
LransporL across ureLhral
eplLhellal surface ln
phagocyLlc vacuole
Conococcus
lnfecLlon of ureLhral
eplLhellal or subeplLhellal
cells
Perpes slmplex vlrus (PSv)
chlamydla
hagocyLes (especlally
polymorphs)
lnduce negllglble
lnflammaLlon
@tepooemo polllJom
mechanlsm unclear
perhaps poorly acLlvaLes
alLernaLlve complemenL
paLhway due Lo slallc acld
coaLlng
8eslsL phagocyLosls Conococcus (capsule) @
polllJom(absorbed
flbronecLln)
SlllLlS
Splral rganlsms
am||y Genus Spec|es Subspec|es D|sease
5pltocboetoceoe @tepooemo polllJom lolllJom Syphllls
polllJom letteooe ?aws
cototeom lnLa
8ottello tecotteotls 8elapslng fever
botqJotfetl Lyme dlsease
leptospltoceoe leptosplto lotettoqoos (Serovar)
lctetoboemottbo
qloe
LepLosplrosls
(Wells dlsease)
Introduction
Pathogenic members of this genus
incIude:
- %5,idum
- %50rt0nu0
- %c,r,t0um
Introduction
Pathogenic treponemes are associated with
4 diseases :
1. VenereaI syphiIis -%5,idum5,idum
2. Yaws -%5,idum50rt0nu0
3. Endemic syphiIis (bejeI) - %5,idum
0nd0micum
4. Pinta - %c,r,t0um
1he Lreponemes responslble for Lhese dlseases cannoL be dlsLlngulshed
serologlcally morphologlcally or by genome analysls and Lhey have noL
been successfully culLlvaLed on arLlflclal medla
%r05on0m,!,idum
%hin
MotiIe
ExtremeIy fastidious
Survive onIy briefIy outside host
Not cuItivated successfuIIy on artificiaI
media
%r,nsmission
D|rect sexua| contact w|th u|cerat|ve |es|ons of
sk|n or mucous membranes
1rans p|acenta|
1yp|ca||y dur|ng second ha|f of pregnancy
As ear|y as 6 weeks of gestat|on
regnant w|th pr|mary or secondary syph|||s are more
||ke|y to transm|t the d|sease than those w|th |atent
(not c||n|ca||y apparent) d|sease
CannoL be spread Lhrough conLacL wlLh LolleL seaLs doorknobs swlmmlng pools
hoL Lubs baLhLubs shared cloLhlng or eaLlng uLenslls

Sp|rochetes Sp|rochetes
W Gram negative Gram negative
W W long, thin, helical, motile long, thin, helical, motile
W axial filaments axial filaments
locomotion locomotion
between peptidoglycan layer/outer membrane between peptidoglycan layer/outer membrane
runs parallel runs parallel
@ polllJom
naLural PlsLory of unLreaLed Syphllls
Cllnlcal resenLaLlon of Syphllls

1reponemo po//idum 1reponemo po//idum

W transmission transmission
genital/genital genital/genital
in utero in utero or during birth or during birth

Syph|||s Syph|||s
chron|c chron|c
s|ow|y progress|ve s|ow|y progress|ve
Syphllls rlmer

W W primary lesion primary lesion - - chancre chancre

10 to 60 days 10 to 60 days
area of ulceration/inflammation area of ulceration/inflammation
many organisms many organisms
Syphllls Secunder

W W $econdary (2 $econdary (2- -10 weeks later) 10 weeks later)

systemic spread systemic spread
flu flu- -like symptoms like symptoms
skin, particularly skin, particularly
many organisms many organisms
mouth muosa
LaLenL syphllls
aLlenLs are asympLomaLlc
Serologlc LesLlng poslLlve
Larly laLenL dlsease
aLlenLs are poLenLlally lnfecLlous
1 year
LaLe laLenL dlsease
aLlenLs no longer lnfecLlous
1 year
Longer duraLlon of Lherapy recommended
Syphllls 1erLler
ulagnosls LaboraLorlum
Mlkroskopls
Sample kerokan lesl blopsl LCS
Langsung Mlkroskop lapangan gelap
ewarnaan
lmpregnansl perak
lmunofluoresens
Serologl
non 1reponemal LesL (vu8L 88 W8)
1reponemal LesL (l1AA8S 1A 1PA)

M|crob|o|og|ca| d|agnos|s M|crob|o|og|ca| d|agnos|s

W W not culturable not culturable
W W dark field microscopy dark field microscopy
actively motile organisms actively motile organisms
brightly lit against dark backdrop brightly lit against dark backdrop
light shines at an angle light shines at an angle
reflected from thin organisms reflected from thin organisms
enters objective enters objective
W W conventional light microsrcopy conventional light microsrcopy
light shines through light shines through
NOT visualized NOT visualized

% f|uorescence m|croscopy
ant|body sta|n|ng
1es Serologl unLuk Slfllls
1est
Cond|t|ons assoc|ated w|th fa|sepos|t|ve
resu|ts
nonspeclflc (nonLreponemal)
vu8L
88
vlral lnfecLlon collagen vascular dlsease
acuLe febrlle dlsease posLlmmunlzaLlon
pregnancy leprosy malarla drug mlsuse
Speclflc (nonLreponemal)
l1AA8S
1A
1PA
ulseases assoclaLed wlLh lncreased or
abnormal globullns lupus eryLhemaLosus
Lyme dlsease auLolmmune dlsease
dlabeLes melllLus alcohollc clrrhosls vlral
lnfecLlons drug mlsuse and pregnancy
88
A deflnlLe clumplng of Lhe charcoal parLlcles ls reporLed as
react|ve (k)
no clumplng ls reporLed as nonreact|ve (N)

Secondary and 1ert|ary Syph|||s Secondary and 1ert|ary Syph|||s

sero|ogy sero|ogy
W W screening method screening method
W W antibodies to cardiolipin antibodies to cardiolipin
W W specific diagnosis specific diagnosis
W W antibodies to treponemal antigen antibodies to treponemal antigen

Auto|mm|nty Auto|mm|nty
card|o||p|n card|o||p|n
se|f ant|gen se|f ant|gen

Treatment & Prevention: Treatment & Prevention:

W W no vaccine no vaccine
W W antibiotics (e.g. penicillin) antibiotics (e.g. penicillin)
effective effective

Cther treponema| d|seases Cther treponema| d|seases

be[e| be[e| yaws and yaws and p|nta p|nta

-eisserio qonorrhoeoe
NLISSLkIA NLISSLkIA

W W Gram negative Gram negative

W W diplococci diplococci (pairs of (pairs of cocci cocci) )
W W oxidase oxidase positive positive
W W culture culture
W W Thayer Martin. Thayer Martin.
selective selective
chocolate agar chocolate agar
heated blood heated blood (brown) (brown)
eisseria eisseria

W W found only in man found only in man

W W gonorrhea gonorrhea
W W second most common venereal disease second most common venereal disease
gonorrhoeae gonorrhoeae
the "Conococcus" the "Conococcus"
lnfeksl C
ManlfesLasl kllnls lnfeksl Conokokus
pLhalmla neonaLorum

Smear Smear
po|ymorphonuc|ear ce|| po|ymorphonuc|ear ce||
Gram negat|ve cocc| Gram negat|ve cocc|
many |n ce||s many |n ce||s
Sedlaan langsung sekreL

W gonoccocal arthritis gonoccocal arthritis

~septic arthritis ~septic arthritis
W W dermatitis dermatitis
Dissemination Dissemination - -gonococci gonococci

W lactamase lactamase- -resistant cephalosporin resistant cephalosporin

e.g. e.g. ceftriaxone ceftriaxone
W W resistant strains resistant strains
common common
produce produce lactamases lactamases
destroy penicillin destroy penicillin
Antibiotic therapy Antibiotic therapy
vlrulence lacLor of Conococcus

W W adhesion to genital epithelium adhesion to genital epithelium

outer membrane outer membrane
pili pili
Antigenicity Antigenicity
highly variable among strains highly variable among strains
W no vaccine no vaccine
W IgA protease IgA protease
also also meningitidis meningitidis
Pathogensis Pathogensis

W Tissue injury Tissue injury

lipopolysaccharide lipopolysaccharide
peptidoglycan peptidoglycan
gonorrhoeae gonorrhoeae
nfeksi nfeksi pada pada feminina feminina::
Cervisitis Cervisitis simtomatik simtomatik
Berlanjut Berlanjut menjadi menjadi PD PD
nfeksi nfeksi pada pada maskulina maskulina::
Urethritis Urethritis
Berlanjut Berlanjut menjadi menjadi epididimitis epididimitis
CAMDIA 1kACCMA1IS
Pendahuluan
Bakteri Gram (-), tdk mampu memproduksi
enersi untuk metabolisme, tdk dapat mensintesa
%P parasit intrasel obligat atau parasit enersi
Spesies:
Chlamydia trachomatis
Chlamydia pneumoniae
Chlamydia psittaci
C. pneumoniae dan C. Psittaci
digolongkan pada Genus ChIamydophiIa
Mempunyai dua bentuk:
Iementary body (300 3250nm)
bentuk ekstraseluler dari chlamydia
nfeksius
Metabolisme tidak aktif
ReticuIate body (800 1000nm)
Bentuk intrasel Chlamydia
Non-infeksius
Metabolisme sangat aktif
Slklus Chlamydla
Bakteri berukuran kecil, dapat diwarnai
dengan pewarnaan GEMS
Hasil pewarnaan GEMS
C. trachomatis badan inklusi yang matur
berwarna ungu, masa padat dekat nukleus.
Pewarnaan untuk glikogen (+) Glycogen
inclusion (+)
C. psittaci badan inklusi merupakan
agregat intrasel yang merata
Intrace||u|ar Inc|us|ons of trochomotis
Serovarian
C. trachomatis 15 serovar
, B, Ba, C K, L1 L3
C. psittaci beberapa serovar
C. pneumoniae satu serovar
nfeksi Chlamydia pada Manusia
%RAK%&$ G%AL:
Laki-Iaki:
Urethritis, epididymitis, proctitis C.
trachomatis (D K)
Perempuan
Urethritis, cervicitis, proctitis, PD C.
trachomatis (D K)
borsi, lahir mati C. psittaci
Laki-Iaki & Perempuan
Limfogranuloma venereum C. trachomatis
(L1 L3)
nfeksi genital
Penyebab S%D / PHS yang penting
Disebabkan oleh C. trachomatis serovar D
K
Mengakibatkan sterilitas dan kehamilan
ektopik
Sekret genital orang dewasa yang
terinfeksi self-inoculation inclusion
conjunctivitis
Limfogranuloma Venereum
Disebabkan oleh C. trachomatis L1 L3
Merpakan S%D, inkubasi beberapa hari
s/d beberapa minggu
Klinis: Papul/vesikel pad genital externa
sembuh spontan limfadenopati regional
lnn. Pecah discharge mukopurulen,
bersifat kronis fibrosis
Lymphogranuloma venereum
Cara penularan Chlamydia
c ttocbomotls A 8 8a C
Manusla Manusla
LalaL
1angan
c ttocbomotls u k
Lakllakl erempuan
neonaLus
Cara penularan Chlamydia (lanj)
c poeomooloe
Manusla Manusla Manusla
c pslttocl
8urung 8urung
Manusla
Manusla
Diagnosis Laboratorium
Sediaan langsung pewarnaan GEMS
Kultur biakan sel dan telur berembrio
Deteksi ntigen immunofluoresensi
Serologi
%erapi dan Kontrol
Drug of choice:
%etrasiklin
Eritromisin
Penisilin dan chloramphenicol
chlamydiostatic
Pembuatan vaksin belum berhasil
ALMCIDS DDCkLI
Chancrold
8akLerl berbenLuk baLang kecll pleomorflk Cram
() membuLuhkan fakLor perLumbuhan khusus
unLuk lsolaslnya
lakLor perLumbuhan darah aLau derlvaLnya
Spesles penLlng
n lofloeozoe
n oeqyptlos
n Jocteyl
n potolofloeozoe n opbtopbllos n potoopbtopbllos
8erdasarkan kebuLuhan fakLor x dan v
Spesies Faktor X
Faktor V Hemolisa
. Influenzae
. aegyptius
+ +
. Parainfluenzae +
. Ducreyi +
. aemolyticus + + +
. parahaemolyticus
+ +
. aphrophilus
n Jocteyl
enyebab penyaklL menular seksual (MS)
cahncrold (sofL chancre)
ulkus yang saklL pada penls dlserLal llmfedenlLls (bubo)
uu slfllls herpes slmpleks llmfogranuloma venereum
8akLerl benLuk baLang Cram () membuLuhkan
fakLor x
1erapl
CefLrlaxon lm
1rlmeLoprlm erlLromlsln oral 2 mlnggu