Kondiloma lata perianal yang awalnya diduga bowenoid papulosis disertai balanitis candida pada remaja laki-laki

Joice Gunawan Putri; Ni Made Dwi Puspawati; Herman Saputra

doi:10.15562/ism.v14i1.1421

Kondiloma lata perianal yang awalnya diduga bowenoid papulosis disertai balanitis candida pada remaja laki-laki

Joice Gunawan Putri ,

Ni Made Dwi Puspawati ,

Herman Saputra ,

pdf |
DOI: https://doi.org/10.15562/ism.v14i1.1421 |
Published: 2023-01-19

Abstract

Background: Condyloma lata is a form of secondary syphilis that manifest in moist, flat, firm boundaries papules or plaques with macerated surface that resembles the appearance of bowenoid papulosis. Differentiating this disease requires supporting examinations so that appropriate treatment can be determined. This case report discusses a case of condyloma lata, which was originally suspected to be bowenoid papulosis and accompanied by balanitis candida.

Case: A 14 years teenage boy, complained of warts near the anus and white spots on the gland penis since 1 month ago. Dermatovenereology examination on the perianal region showed a hyperpigmented solitary plaque, well-defined margin, geographic shape, flat surface and a solitary ulcer at the edges. On the glans penis, multiple white plaques, well defined, geographic shape, moist surface. Acetowhite examination was negative and a dark field microscope (DFM) examination of perianal lesions found Treponema pallidum. The potassium hydroxide examination on the glans penis found pseudohyphae and blastospores. Gram examination was found normal. The VDRL serology examination was reactive (1:64), and the TPHA was found to be reactive. The patient was diagnosed with condyloma lata coinfection with balanitis candida. Treatment involves a single intramuscular injection of benzathine penicillin 2.4 million IU and fluconazole 150 mg capsules intraorally single dose. Observations within 1 month showed clinical improvement in condyloma lata and balanitis.

Conclusion: This case provides an understanding of condyloma lata's clinical course, which mimics other diseases in an immunocompetent patient. Treatment based on etiology provides a good clinical improvement in patients.

Latar belakang: Kondiloma lata merupakan suatu bentuk sifilis sekunder yang dapat bermanifestasi berupa papul maupun plak yang lembab, datar, berbatas tegas dengan permukaan maserasi. Bowenoid papulosis adalah penyakit yang menyerupai gambaran kondiloma lata. Membedakan penyakit ini diperlukan pemeriksaan penunjang sehingga dapat menentukan pengobatan yang sesuai. Laporan kasus ini membahas kasus kondiloma lata yang semula diduga bowenoid papulosis dan disertai balanitis candida pada remaja laki-laki.

Kasus: Seorang remaja laki-laki, usia 14 tahun, mengeluhkan adanya kutil di dekat dubur dan bercak putih pada kelamin sejak 1 bulan yang lalu. Status dermatovenereologi pada regio perianal didapatkan plak soliter hiperpigmentasi, batas tegas, bentuk geografika, permukaan rata dan di tepinya terdapat ulkus soliter. Pada glans penis didapatkan plak putih multipel, berbatas tegas, bentuk geografika, permukaan lembab. Pemeriksaan acetowhite didapatkan negatif, pemeriksaan dark field microscope (DFM) pada lesi perianal didapatkan Treponema pallidum. Pemeriksaan kalium hidroksida (KOH) pada glans penis didapatkan adanya pseudohifa dan blastospora. Pemeriksaan gram pada glans penis tidak ditemukan adanya leukosit, kokus gram positif maupun batang gram negatif. Pemeriksaaan serologi Venereal Disease Research Laboratory (VDRL) reaktif 1:64 dan Treponema Pallidum Haemagglutination Assay (TPHA) didapatkan reaktif. Pasien didiagnosis kondiloma lata disertai balanitis candida. Penatalaksanaan dengan injeksi benzatin penisilin 2,4 juta IU intramuskular dosis tunggal dan flukonazol kapsul 150 mg intraoral dosis tunggal. Pengamatan dalam 1 bulan didapatkan perbaikan klinis pada kondiloma lata dan balanitis.

Simpulan: Kasus ini memberikan pemahaman mengenai klinis kondiloma lata yang menyerupai dengan penyakit lain dan disertai koinfeksi candida pada pasien imunokompeten. Penanganan berdasarkan etiologi memberikan perbaikan klinis yang baik pada pasien.

References

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Trovato E, Tognetti L, Campoli M, Cinotti E, Rubegni P. Syphilis Diagnosis and Treatment: State of The Art. Dermatology. 2021;1–11.
Pandya I, Shinojia M, Vadukul D, Marfatia Y. Approach to balanitis/balanoposthitis: Current guidelines. Indian J Sex Transm Dis. 2014;35:155–7.
Fahmy M. Infectious Complications of Circumcision. In: Fahmy M, editor. Complications in Male Circumcision. New York: Elsevier; 2019. p. 73–98.
Arunkumar S, Murugan S, Sowdhamani B, Sureshkumar R. Balanitis and Balanoposthitis - Review article. Int J Res Heal Sci. 2014;2(1):375–92.
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018 Adolescents and young adults [Internet]. CDC. 2018 (Diakses pada: 23 September 2022). Available from: https://www.cdc.gov/std/stats18/adolescents.htm
Hernandez I, Johnson A, Reina-Ortiz M, Rosas C, Sharma V, Teran S, et al. Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador. Am J Mens Health. 2017;11(4):823–33.
Anonim. Buku Register Kunjungan Poliklinik Kulit dan Kelamin Rumah Sakit Umum Pusat Sanglah Denpasar 2019. 2019.
Kementerian Kesehatan Republik Indonesia. Situasi Kesehatan Reproduksi Remaja [Internet]. Kemenkes RI. 2015 (Diakses pada: 21 September 2022). Available from: https://www.kemkes.go.id/resources/download/pusdatin/infodatin/infodatin reproduksi remaja-ed.pdf
Shannon C, Klausner J. The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Curr Opin Pediatr. 2018;30:137–43.
Wulandari A. Karakteristik Pertumbuhan Perkembangan Remaja dan Implikasinya Terhadap Masalah Kesehtan dan Keperawatannya. J Keperawatan Anak. 2014;2(1):39–43.
Franjić S. Adolescent Venereal Diseases. Madridge J Immunol. 2019;3:95–9.
Federick P, Morion N, Swartz, Daniel M, Musher, Bernadine P. Clinical Manifestation of Syphilis. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al., editors. Sexually Transmitted Diseases (Holmes), 4th edition. New York: McGraw-Hill; 2008. p. 661–84.
Peeling RW, Mabey D, Kamb ML, Chen X, David J, Benzaken AS, et al. Syphilis. Nat Rev Dis Prim. 2018;3(17073):1–49.
Chamli A, Zaouak A. Bowenoid Papulosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. p. 1–23.
Batan NW, Puspawati D. Kondiloma lata sebagai manifestasi klinis sifilis sekunder pada kehamilan trimester kedua. Medicina (B Aires). 2019;50(2):249–54.
Baughn E, Musher D. Secondary Syphilitic Lesions. linical Microbiol Rev. 2016;32(2):206–16.
Deshpade D, Nayak C, Dhurat R. Verrrucous Condyloma Lata Mimicking Condyloma Akuminata: An unsual Presentation. Indian J Sex Transm Dis. 2009;30(2):100–2.
Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):39–56.
Kar S, Choudhury A, Singh A. Understanding normal development of adolescent sexuality: A bumpy ride. J Hum Reprod Sci. 2015;8(2):70–4.
Marrazzo J, Cates W. terventions to prevent sexually transmitted infections, including HIV infection. Clin Infect Dis. 2011;53(Suppl 3):S64–78.
Porter S, Qureshi R, Benenson I. Understanding congenital syphilis. Infants Young Child. 2018;31(4):287–96.
Levy S, Gunta J, Edemekong P. Screening for Sexually Transmitted Diseases. Prim Care - Clin Off Pr. 2019;46(157):73-5.

[1] Tuddenham S, Zenilman J. Syphilis. In: Kang S, Amagi M, Bruckner A, Enk A, Margolis D, McMichael A, et al., editors. Fitzpatrick’s Dermatology 9th Edition. New York: McGraw-Hill Education; 2019. p. 3145–72.

[2] Trovato E, Tognetti L, Campoli M, Cinotti E, Rubegni P. Syphilis Diagnosis and Treatment: State of The Art. Dermatology. 2021;1–11.

[3] Pandya I, Shinojia M, Vadukul D, Marfatia Y. Approach to balanitis/balanoposthitis: Current guidelines. Indian J Sex Transm Dis. 2014;35:155–7.

[4] Fahmy M. Infectious Complications of Circumcision. In: Fahmy M, editor. Complications in Male Circumcision. New York: Elsevier; 2019. p. 73–98.

[5] Arunkumar S, Murugan S, Sowdhamani B, Sureshkumar R. Balanitis and Balanoposthitis - Review article. Int J Res Heal Sci. 2014;2(1):375–92.

[6] Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018 Adolescents and young adults [Internet]. CDC. 2018 (Diakses pada: 23 September 2022). Available from: https://www.cdc.gov/std/stats18/adolescents.htm

[7] Hernandez I, Johnson A, Reina-Ortiz M, Rosas C, Sharma V, Teran S, et al. Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador. Am J Mens Health. 2017;11(4):823–33.

[8] Anonim. Buku Register Kunjungan Poliklinik Kulit dan Kelamin Rumah Sakit Umum Pusat Sanglah Denpasar 2019. 2019.

[9] Kementerian Kesehatan Republik Indonesia. Situasi Kesehatan Reproduksi Remaja [Internet]. Kemenkes RI. 2015 (Diakses pada: 21 September 2022). Available from: https://www.kemkes.go.id/resources/download/pusdatin/infodatin/infodatin reproduksi remaja-ed.pdf

[10] Shannon C, Klausner J. The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Curr Opin Pediatr. 2018;30:137–43.

[11] Wulandari A. Karakteristik Pertumbuhan Perkembangan Remaja dan Implikasinya Terhadap Masalah Kesehtan dan Keperawatannya. J Keperawatan Anak. 2014;2(1):39–43.

[12] Franjić S. Adolescent Venereal Diseases. Madridge J Immunol. 2019;3:95–9.

[13] Federick P, Morion N, Swartz, Daniel M, Musher, Bernadine P. Clinical Manifestation of Syphilis. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al., editors. Sexually Transmitted Diseases (Holmes), 4th edition. New York: McGraw-Hill; 2008. p. 661–84.

[14] Peeling RW, Mabey D, Kamb ML, Chen X, David J, Benzaken AS, et al. Syphilis. Nat Rev Dis Prim. 2018;3(17073):1–49.

[15] Chamli A, Zaouak A. Bowenoid Papulosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. p. 1–23.

[16] Batan NW, Puspawati D. Kondiloma lata sebagai manifestasi klinis sifilis sekunder pada kehamilan trimester kedua. Medicina (B Aires). 2019;50(2):249–54.

[17] Baughn E, Musher D. Secondary Syphilitic Lesions. linical Microbiol Rev. 2016;32(2):206–16.

[18] Deshpade D, Nayak C, Dhurat R. Verrrucous Condyloma Lata Mimicking Condyloma Akuminata: An unsual Presentation. Indian J Sex Transm Dis. 2009;30(2):100–2.

[19] Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):39–56.

[20] Kar S, Choudhury A, Singh A. Understanding normal development of adolescent sexuality: A bumpy ride. J Hum Reprod Sci. 2015;8(2):70–4.

[21] Marrazzo J, Cates W. terventions to prevent sexually transmitted infections, including HIV infection. Clin Infect Dis. 2011;53(Suppl 3):S64–78.

[22] Porter S, Qureshi R, Benenson I. Understanding congenital syphilis. Infants Young Child. 2018;31(4):287–96.

[23] Levy S, Gunta J, Edemekong P. Screening for Sexually Transmitted Diseases. Prim Care - Clin Off Pr. 2019;46(157):73-5.

Kondiloma lata perianal yang awalnya diduga bowenoid papulosis disertai balanitis candida pada remaja laki-laki

Abstract

References

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