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Kondiloma Akuminata Perianal Disertai Sifilis Sekunder Dan Infeksi HIV Stadium II Pada Remaja Laki-Laki Yang Berhubungan Seksual Dengan Laki-Laki: Laporan Kasus

  • Putu Yunita Primasari ,
  • I.G.A.A. Elis Indira ,
  • Anak Agung Indah Jayanthi ,

Abstract

Introduction: Men who have sex with men (MSM) have a high proportion of HIV infection. This is due to anal intercourse, multi-partner relationships, and low use of protection such as condoms. The difficulty of reaching the MSM community is one of the factors behind the high prevalence of HIV in this group. One study found that the majority of HIV prevalence was among MSM aged 25-49 years. Even though from this proportion, the number of MSM with HIV positive is not among teenagers, it does not rule out the possibility that there will be changes in the trend of rapid technological development and high levels of promiscuity. HIV infection that is not handled properly can cause patients to experience other types of STIs. For this reason, the group of MSM infected with HIV and other STI infections needs further review. This case report will discuss cases of condyloma acuminata in the perianal region accompanied by secondary syphilis and Stage II HIV infection in young boys who have sex with other men.

Case Description: Male patient aged 17 years, had a lump in his anus which grew 9 months ago. The patient also experienced weight loss. The patient had first sexual intercourse at the age of 15 years, then frequently changed partners with six different men. The patient never had sex with a woman. Sexual intercourse is carried out anogenitally. Acetowhite examination on verrucous papules-tumor lesions was positive. Darkfield microscopy (DFM) examination on papules lesions revealed treponemes and reactive results were obtained on VDRL (titer 1:256) and TPHA (titer >1:5120). PITC examination was reactive with a CD4 count of 27.65%/779 cells/mm3 and a CD8 count of 51.01%/1436 cells/mm3. Treatment given were trichloroacetic acid (TCA) 80% weekly topically on condyloma acuminata lesions, injection of benzathine penicillin G 2.4 million international units single dose intramuscularly for secondary syphilis treatment, and antiretroviral (ARV) tenofovir/lamivudine/dolutegrafir 300/300/50 mg 24 hours intraorally for HIV treatment.

Conclusion: Clinical manifestations of condyloma acuminata and secondary syphilis improved after therapy. Currently, the patient's prognosis is still dubious.

 

Pendahuluan: Laki – laki yang berhubungan seksual dengan sasama laki-laki memiliki proporsi yang tinggi mengalami HIV. Hal tersebut dikarenakan hubungan seksual melalui anus, hubungan multi partner, dan rendahnya penggunaan pelindung seperti kondom. Sulitnya menjangkau komunitas LSL menjadi salah satu faktor tingginya prevalensi HIV pada kelompok tersebut.  Sebuah penelitian menemukan mayoritas prevalensi HIV di kalangan LSL berusia 25-49 tahun. Meskipun dari proporsi tersebut, angka LSL dengan positif HIV tidak dari kalangan remaja, namun tidak menutup kemungkinan akan terjadi perubahan trend dikarenakan perkembangan teknologi yang pesat dan tingginya tingkat pergaulan bebas. Infeksi HIV yang tidak tertangani dengan baik dapat menyebabkan pasien mengalami jenis IMS lainnya. Untuk itu, kelompok LSL yang terhjangkit HIV dengan infeksi IMS lainnya perlu dikaji lebih lanjut. Pada laporan kasus ini akan dibahas kasus kondiloma akuminata regio perianal disertai sifilis sekunder dan infeksi HIV Stadium II pada remaja laki-lagi yang berhubungan seksual dengan sesama laki-laki.

Deskripsi Kasus: Pasien laki-laki berusia 17 tahun, mengalami benjolan pada anus yang membesar sejak 9 bulan lalu. Pasien juga mengalami penurunan berat badan. Pasien melakukan hubungan seksual pertama kali pada usia 15 tahun, kemudian berganti-ganti pasangan dengan sekitar enam laki-laki yang berbeda. Pasien tidak pernah berhubungan seksual dengan perempuan. Hubungan seksual dilakukan secara anogenital. Pemeriksaan penunjang acetowhite pada lesi papul-tumor verukosa didapatkan hasil positif. Pemeriksaan dark field microscopy (DFM) pada lesi papul didapatkan treponema serta didapatkan hasil yang reaktif pada pemeriksaan VDRL (titer 1:256) dan TPHA (titer >1:5120). Pemeriksaan KTIP pada pasien reaktif dengan jumlah CD4 27,65%/779 sel/mm3 dan jumlah CD8 51,01%/1436 sel/mm3. Tatalaksana yang diberikan yaitu tutul Trichloroacetic Acid (TCA) 80% setiap minggu pada lesi kondiloma akuminata, injeksi benzatin penisilin G 2,4 juta internasional unit intramuskular dosis tunggal untuk tatalaksana sifilis sekunder dan antiretroviral (ARV) yaitu tenofovir/lamivudine/dolutegrafir 300/300/50 mg per 24 jam intra oral untuk tatalaksana HIV.

Simpulan: Manifestasi klinis pada kondiloma akuminata dan sifilis sekunder mengalami perbaikan setelah terapi. Prognosis pasien adalah dubius.

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How to Cite

Primasari, P. Y., Elis Indira, I. ., & Indah Jayanthi, A. A. (2022). Kondiloma Akuminata Perianal Disertai Sifilis Sekunder Dan Infeksi HIV Stadium II Pada Remaja Laki-Laki Yang Berhubungan Seksual Dengan Laki-Laki: Laporan Kasus. Intisari Sains Medis, 13(3), 764–770. https://doi.org/10.15562/ism.v13i3.1534

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Putu Yunita Primasari
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I.G.A.A. Elis Indira
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Anak Agung Indah Jayanthi
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