Kondiloma akuminata perianal pada seorang laki-laki biseksual disertai infeksi HIV stadium III yang diterapi dengan kombinasi asam trikloroasetat 80% dan seng oral

Rahel Lisana Debora Hutagalung; Anak Agung Gde Putra Wiraguna

doi:10.15562/ism.v12i1.869

Kondiloma akuminata perianal pada seorang laki-laki biseksual disertai infeksi HIV stadium III yang diterapi dengan kombinasi asam trikloroasetat 80% dan seng oral

Rahel Lisana Debora Hutagalung ,

Anak Agung Gde Putra Wiraguna ,

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DOI: https://doi.org/10.15562/ism.v12i1.869 |
Published: 2021-04-01

Abstract

Background: Condyloma acuminata in the homosexual population caused by anogenital sexual behavior causes more microabrasion to occur which increases the risk of infection with human papilloma virus (HPV) and HIV. This case report aims to provide an overview of the clinical outcome of condyloma acuminata in homosexual patients with HIV grade III.

Case: Male, 26 years old with an itchy and painless lump around the genitals and anal canal since two months ago. The new patient was diagnosed with HIV since two weeks before the visit to the Sanglah Hospital polyclinic. It was found that the patient was a homosexual with a history of multiple partners and had been going on for five years. Physical examination of the perianal region revealed multiple skin-colored tumors, geographic shape, 3x5cm - 3x5.5cm in size, with a verrucous surface, and solid consistency with a positive acetowhite test that concluded as perianal condyloma acuminata. It was decided to give tricolor acetate (TCA) 80% spotted therapy and oral zinc sulfate 100mg/day. Up to 2 TCA session therapy and oral zinc administration in approximately three weeks, the lesion was getting better with efflorescence in the form of multiple papules, color of the mucosa that confluent to form a tumor, geographic shape, size 3x2cm - 3x3cm, smooth surface, solid consistency.

Conclusion: The response to treatment with TCA 80% for 2 times and oral zinc for 3 weeks was quite good, the number of lesions was reduced and the size of the lesions was reduced. The prognosis of the patient is dubious because even if the condyloma acuminata lesion has been repaired, the presence of HIV infection can lead to the risk of recurrence and the risk of progression to malignancy.

Latar belakang: Kondiloma akuminata pada populasi homoseksual diakibatkan oleh perilaku seksual secara anogenital menyebabkan lebih banyak mikroabrasi yang terjadi yang menyebabkan peningkatan risiko infeksi human papilloma virus (HPV) dan HIV. Laporan kasus ini bertujuan untuk memberikan suatu gambaran luaran klinis dari kondiloma akuminata pada pasien homoseksual dengan HIV derajat III.

Kasus: Laki-laki, 26 tahun dengan benjolan risakan gatal dan tidak nyeri pada sekitar kelamin dan lubang anus sejak dua bulan yang lalu. Pasien baru terdiagnosa HIV sejak dua minggu sebelum kunjungan poliklinik RSUP Sanglah. Diketahui pasien merupakan seorang homoseksual dengan riwayat berganti-ganti pasangan dan sudah berlangsung selama lima tahun. Pemeriksaan fisik region perianal menunjukkan tumor sewarna kulit multipel, bentuk geografika, ukuran 3x5cm – 3x5,5cm, dengan permukaan verukosa, dan konsistensi padat dengan hasil tes acetowhite positif yang disimpulkan sebagai suatu kondiloma akuminata perianal. Diputuskan untuk memberikan terapi tutul tricolor acetat 80% dan seng sulfat oral 100mg/hari. Hingga terapi 2 kali tutul dan pemeberian seng oral dalam jangka waktu kurang lebih tiga minggu terjadi perbaikan lesi dengan efloresensi berupa papul multipel sewarna mukosa yang berkonfluen membentuk tumor, bentuk geografika, ukuran 3x2cm – 3x3cm, permukaan licin, konsistensi padat.

Simpulan: Respon pengobatan dengan TCA 80% selama 2 kali dan seng oral selama 3 minggu cukup baik, jumlah lesi berkurang dan ukuran lesi mengecil. Prognosis dari pasien adalah dubius karena walaupun telah terjadi perbaikan lesi kondiloma akuminata, adanya infeksi HIV dapat menyebabkan risiko terjadinya rekurensi dan risiko perkembangan ke arah keganasan.

References

Winer RL, Koutsky LA. Genital Human Papillomavirus Infection. In: Holmes KK, Sparlingman PF, Stamm WE, Piot P, Wasserheit JN, Corey L, Cohen MS, Watts DH. Sexually Transmitted Disease. 4th edition. New York: McGraw Hill; 2008; p. 490-501.
Androphy EJ, Welton ML. Human Papilloma Virus Infections. In : Wolff K, Goldsmith LA, Katz S, Gilchrest BA, Pallen AS, Leffell DJ, eds. Fitzpatrick’s Dermatology in General Medicine. 8th edition. New York: MacGraw-Hill; 2012; p.2421-33.
Dhumale SB, Sharma S, Gulbake A. Ano-genital warts and HIV status- a clinical study. J of Clin Diagnostic Res. 2017;11(1);1-4.
Gormley RH, Kovarik CL. Human papilloma virus-related genital disease in the immunocompromised host: part I. J Am Acad Dermatol. 2012;66(6):867.e1-e17
Wang HY, Xu JJ, Zou HC, Reilly KH. Sexual Risk Behaviour and HIV Infection among Men and Women in China: evidence From A Systematic Review and Meta- Analysis. BioMed Research International. 2015;6:1-12.
Anonim. Register pasien poliklinik Kulit dan Kelamin Rumah Sakit Umum Pusat Sanglah Denpasar. Januari 2019-maret 2020. Tidak dipublikasikan.
Mayer KH, Carballo-Dieguez A. Homosexual and Bisexual Behavior in Men in Relation to STDs and HIV Infection. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, Cohen MS, Watts DH, eds. Sexually Transmitted Diseases. Fourth edition. New York: McGraw-Hill; 2008:203-218.
Sianturi Hanami E. Gambaran psychological well-being pada individu biseksual yang berpacaran. Universitas Sumatera Utara Institusional Repository; 2011:19-31.
Lau JTF, Wang M, Wong HN, Tsui HY. Prevalence of Biseksual Behaviors Among Men Who Have Sex With Men (MSM) in China and Associations Between Condom Use in MSM and Heterosexual Behaviors. Sexually Transmitted Diseases. 2008;35(4):406-413.
Mayer KH. Sexually Transmitted Disease in Men Who Have Sex With Men. CID. 2011;53(3):S79-S83.
Fernandes JV, Fernandes TAA. Human Papillomavirus: Biology and Pathogenesis. In: Broeck DV, editors. Human Papillomavirus and Related Diseases-From Bench to Bedside-A Clinical Perspective. InTech;2012:3-41.
Pitts MK, Couch MA, Smith AM. Men who have sex with men (MSM); How much to assume and how to ask?. eMJ. 2006;185(8):450-2.
WHO. Rapid Assessment and Response Adaptation Guide on HIV and Men Who Have Sex with Men. WHO, Geneva. 2004:1-61.
Murtiastutik, D. Penatalaksanaan Kondiloma Akuiminata. In: Barakbah J, Lumintang H, Martodiharjo S, eds. Buku Ajar Infeksi Menular Seksual. First Edition. Surabaya: Airlangga University Press;2007; p.170-80.
Desphande DJ, Nayak CS, Mishra SN, Dhurat RS. Verrucous condyloma lata mimicking condyloma acuminata: An unusual presentation. J Sex Transm Dis. 2009;30:100-102.
Doorbar J, Egawa N, Griffin H, Murakami I. Human papillomavirus molecular biology and disease association. Rev Med Virol. 2016;25:2-23.
Fathi R, Tsoukas MM. Genital warts and other HPV infections: Established and novel therapies. Clinics in Dermatology. 2014;32:299-306.
Egelkrout EM, Galloway DA. The Biology of Genital Human Papillomaviruses. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, Cohen MS, Watts DH, editors. Sexually Transmitted Diseases. 4th ed. New York: McGrawHill. 2008; p. 463-488.
Wulan IGAK, Agusni I. Penggunaan Imunomodulator Untuk Berbagai Infeksi Virus Pada Kulit (Immunomodulators for a Variety of Viral Infections of The Skin). Berkala Ilmu Kesehatan Kulit dan Kelamin (Periodical of Dermatology and Venerology). 2015; 27(1):63-69.
Raza N, Khan DA. Zinc Deficiency in Patients with Persistent Viral Warts. Journal of The College of Physicians and Surgeons Pakistan. 2010;20(2):83-86.
Naseri M, Shahbaz S, Handjani F, Ghariheh A. Serum Zinc Level in Patients with Multiple Warts. Journal of Pakistan Association of Dermatologist. 2009;19:4-8.
Kalio IS, Adjugah OGE. Immunomodulatory Trace Element (Zinc) in HIV Sero Positive Individuals. IOSR Journal of Nursing and Health Service. 2014;55-57.
Shanmugasundaram S, You J. Review Targeting Persistent Human Papillomavirus Infection. Viruses. 2017;229(9):1-14.
Shabaka FH, et all. Zinc Deficiency and Oral Zinc Sulphate Treatment in Patients With Persistent Viral Wart. World Journal of Pharmaceutical and Medical Research. 2017;2(6):221-225.
Prasad AS. Zinc: Role in Immunity, Oxidative Stress, and Chronic Inflammation. Curr Opin Clin Nutr Metab Care. 2009;12:646-652.
Gracia L, et al. Oral Zinc Sulfate for Unresponsive Cutaneous Viral Warts: Too Good To Be True? A Double-Blind Randomized, Placebo-Controlled Trial. British Association of Dermatologist. 2009;34:e984-e985.