Made Wardhana; Martina Windari; Marrietta Sugiarti Sadeli; Anak Agung Gde Putra Wiraguna; Ni Made Dwi Puspawati; I Gusti Ayu Agung Elis Indira; Pande Agung Mahariski

doi:10.15562/ism.v12i2.1069

Peran sirkumsisi sebagai pencegahan infeksi herpes genetalis: suatu studi kohort retrospektif

Made Wardhana ,

Martina Windari ,

Marrietta Sugiarti Sadeli ,

Anak Agung Gde Putra Wiraguna ,

Ni Made Dwi Puspawati ,

I Gusti Ayu Agung Elis Indira ,

Pande Agung Mahariski ,

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DOI: https://doi.org/10.15562/ism.v12i2.1069 |
Published: 2021-08-26

Abstract

Background: Recurrent genital herpes (RGH) is a sexually transmitted infection that is a serious public health problem and is quite prominent in most countries worldwide. Management for this infection is antiviral and circumcision. Male circumcision significantly reduces human immunodeficiency virus (HIV) infection and other sexually transmitted infections. This research aims to evaluate circumcision efficacy as the prevention for herpes simplex virus type 2 (HSV-2) infection compared with oral acyclovir.

Methods: This research is an experimental study with a retrospective cohort approach. We included 45 males, 24 subjects circumcised and 21 subjects without circumcision and took oral acyclovir as standard treatment. RGH was diagnosed based on typical clinical manifestation. Follow up treatment every two weeks and continued to 2 months after circumcised and given with oral acyclovir. Successful treatment was stated without recurrent genital herpes.

Results: Of 24 circumcised subjects, 19 were cured, and five non-circumcised subjects suffered recurrent genital herpes (not cured). Among 21 subjects without circumcision was cured, and 12 subjects were not cured. Based on these results, the value of NNT= 2.7.

Conclusion: Circumcision can be considered effective in reducing the incidence of HGR and prevent recurrence of HGR with the NNT value of 2.7.

Latar Belakang: Herpes genetalis rekuren (HGR) merupakan infeksi menular seksual menjadi masalah kesehatan masyarakat yang serius dan cukup menonjol pada sebagian besar negara di dunia. Penanganannya adalah oral dengan antivirus dan tindakan sirkumsisi. Sirkumsisi pada pria secara signifikan mengurangi insiden infeksi human immunodeficiency virus (HIV) dan penyakit infeksi menular lainnya. Penelitian ini mengevaluasi efikasi sirkumsisi sebagai pencegahan infeksi virus herpes simpleks tipe 2 (HSV-2) dibandingkan dengan pemberian obat asiklovir.

Metode: Studi ekperimental dengan pendekatan retrospektif kohort dengan mengikutsertakan 45 subjek pria dewasa, 24 subjek disirkumsisi dan 21 tanpa sirkumsisi dan hanya diberikan asiklovir sebagai obat standar. Diagnosis HGR dilakukan secara klinis dengan yang manifestasi klinis yang khas da pemeriksaan Tzanck. Setelah pemberian terapi dilakukan kontrol setiap 2 minggu sampai 2 bulan. Terapi dinyatakan berhasil bila tidak ada kekambuhan.

Hasil: Dari 24 subjek disirkumsisi, 19 subjek dinyatakan sembuh dan 5 subjek mengalami kekambuhan (tidak sembuh). Dari 21 subjek tanpa sirkumsisi, 9 subjek dinyatakan sembuh dan 12 subjek dinyatakan tidak sembuh. Berdasarkan hasil ini didapatkan nilai NNT=2,7.

Simpulan: Sirkumsisi dapat dinilai cukup efektif mengurangi angka kejadian HGR dan dapat mencegah kekambuhan HGR dengan nilai NNT 2.7.

References

Groves MJ. Genital herpes: a review. Am Fam Physician. 2016;93(11):928–34.
Patel R, Kennedy OJ, Clarke E, Geretti A, Nilsen A, Lautenschlager S, et al. 2017 European guidelines for the management of genital herpes. Int J STD AIDS. 2017;28(14):1366–79.
Sauerbrei A. Herpes Genitalis: Diagnosis, Treatment and Prevention. Geburtshilfe Frauenheilkd. 2016;76(12):1310–7.
Mehta SD, Moses S, Parker CB, Agot K, Maclean I, Bailey RC. Circumcision status and incident herpes simplex virus type 2 infection, genital ulcer disease, and HIV infection. AIDS. 2012;26(9):1141–9.
Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66.
Tobian AAR, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, et al. Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis. N Engl J Med. 2009;360(13):1298–309.
Van Howe RS. Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis. ISRN Urol. 2013;2013:1–42.
Jerath VP, Mahajan VK. Does circumcision influence recurrences in herpes genitalis? Indian J Dermatol Venereol Leprol. 2009;75(6):575–8.
Joelle ST, Taljaard D, Lissouba P, Zarca K, Puren A, Lagarde E, et al. Effect of HSV-2 serostatus on acquisition of HIV by young men: Results of a longitudinal study in orange farm, South Africa. J Infect Dis. 2009;199(7):958–64.
Gray RH, Serwadda D, Tobian AAR, Chen MZ, Makumbi F, Suntoke T, et al. Effects of genital ulcer disease and herpes simplex virus type 2 on the efficacy of male circumcision for HIV prevention: Analyses from the Rakai trials. PLoS Med. 2009;6(11):1–8.
Macon MK. Does Male Circumcision Prevent Herpes Simplex Virus Type 2 in Sexually Active Males Aged 18-50? PCOM Physician Assist Stud Student Scholarsh. 2014;(173):1–15.
Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006;82(2):101–9.
Luis H, Fridayantara WD, Mahariski P, Wignall FS, Irwanto I, Gedela K. Evolving ART crisis for people living with HIV in Indonesia. Lancet HIV. 2020;7(6):e384–5.
Somia IKA, Merati TP, Sukmawati DD, Indira IGAAE, Dwija IBNP, Prasetia MYO, et al. Prevalence of and risk factors associated with anal HPV infection among men who have sex with men in Bali, Indonesia. Bali Med J. 2020;9(3):646–53.
Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, et al. Association between male circumcision and women’s biomedical health outcomes: a systematic review. Lancet Glob Heal. 2017;5(11):e1113–22.

[1] Groves MJ. Genital herpes: a review. Am Fam Physician. 2016;93(11):928–34.

[2] Patel R, Kennedy OJ, Clarke E, Geretti A, Nilsen A, Lautenschlager S, et al. 2017 European guidelines for the management of genital herpes. Int J STD AIDS. 2017;28(14):1366–79.

[3] Sauerbrei A. Herpes Genitalis: Diagnosis, Treatment and Prevention. Geburtshilfe Frauenheilkd. 2016;76(12):1310–7.

[4] Mehta SD, Moses S, Parker CB, Agot K, Maclean I, Bailey RC. Circumcision status and incident herpes simplex virus type 2 infection, genital ulcer disease, and HIV infection. AIDS. 2012;26(9):1141–9.

[5] Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66.

[6] Tobian AAR, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, et al. Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis. N Engl J Med. 2009;360(13):1298–309.

[7] Van Howe RS. Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis. ISRN Urol. 2013;2013:1–42.

[8] Jerath VP, Mahajan VK. Does circumcision influence recurrences in herpes genitalis? Indian J Dermatol Venereol Leprol. 2009;75(6):575–8.

[9] Joelle ST, Taljaard D, Lissouba P, Zarca K, Puren A, Lagarde E, et al. Effect of HSV-2 serostatus on acquisition of HIV by young men: Results of a longitudinal study in orange farm, South Africa. J Infect Dis. 2009;199(7):958–64.

[10] Gray RH, Serwadda D, Tobian AAR, Chen MZ, Makumbi F, Suntoke T, et al. Effects of genital ulcer disease and herpes simplex virus type 2 on the efficacy of male circumcision for HIV prevention: Analyses from the Rakai trials. PLoS Med. 2009;6(11):1–8.

[11] Macon MK. Does Male Circumcision Prevent Herpes Simplex Virus Type 2 in Sexually Active Males Aged 18-50? PCOM Physician Assist Stud Student Scholarsh. 2014;(173):1–15.

[12] Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006;82(2):101–9.

[13] Luis H, Fridayantara WD, Mahariski P, Wignall FS, Irwanto I, Gedela K. Evolving ART crisis for people living with HIV in Indonesia. Lancet HIV. 2020;7(6):e384–5.

[14] Somia IKA, Merati TP, Sukmawati DD, Indira IGAAE, Dwija IBNP, Prasetia MYO, et al. Prevalence of and risk factors associated with anal HPV infection among men who have sex with men in Bali, Indonesia. Bali Med J. 2020;9(3):646–53.

[15] Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, et al. Association between male circumcision and women’s biomedical health outcomes: a systematic review. Lancet Glob Heal. 2017;5(11):e1113–22.

Peran sirkumsisi sebagai pencegahan infeksi herpes genetalis: suatu studi kohort retrospektif

Abstract

References

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