This document discusses oral manifestations of sexually transmitted infections. It begins by explaining that oral ulcers are commonly seen and can be caused by local factors, infections, or systemic diseases, with similar clinical signs and symptoms. It emphasizes the importance of thorough subjective and objective examination of oral ulcers. Several sexually transmitted infections are then discussed in more detail, including syphilis, gonorrhea, and HIV/AIDS. For each, the document covers etiology, clinical presentation, diagnosis, differential diagnosis, treatment and prevention. It stresses the role of dentists in identifying oral lesions and preventing manifestations of HIV/AIDS in the oral cavity.

1. 1
Manifestasi Oral
Penyakit Menular
Seksual
Adiastuti Endah P, drg, & Bagus Soebadi, drg

2. Latar Belakang, Tujuan ,
Manfaat
 Lesi ulser oral sering dijumpai
 Penyebab ulser : faktor lokal, infeksi, penyakit sistemik
 Gejala & tanda klinis dari suatu kelainan hampir sama
 Meningkatkan ketelitian dalam pemeriksaan subyektif,
obyektif lesi ulser oral melalui pemeriksaan visual
 Meningkatkan dalam membedakan lesi ulser oral berdasar
gejala & tanda klinis
 Identifikasi ulser oral dapat menentukan pemriksaan
pendukung
 Holistic Approach : pendekatan terhadap suatu
masalah/gejala dengan memandang bahwa masalah/gejala
yang ditemukan sebagai suatu kesatuan yang utuh

3. Penyakit Menular Seksual
( PMS)
 Infeksi, menular melalui hubungan
seks
* Vaginal
* Anal
* Oral

4. Bagaimana Gejalanya ?
 Timbul benjolan, luka, lepuhan : - penis
- VAGINA
- ANUS
- MULUT

5. 5
ETIOLOGY AND
PREDISPOSING FACTORS
 Caused by Treponema pallidum
through contact with primer
lesion
 Transmitted by sexual activity
with manifestation on glans penis,
vulva, vagina, and cervix
 Transmitted by intimate contact
with manifestation on lips,
tongue, or finger
SYPHILIS

6. SYPHILIS
stadium
primer
(chancre)
Ulcer dilapisi fibrin
(Hertel, et al. 2014)
6

7. PRIMARY SYPHILIS
(STAGE I OF SYPHILIS)
Ulseration and
erithematous lession on
buccal mucossa
(Neville, 2016)
7

8. PRIMARY SYPHILIS
(STAGE I OF SYPHILIS)
 Lesions are seen on the lips, oral mucosa, lateral of the tongue,
soft palate, tonsils, pharynx and gingiva
 Intraoral lesions are coated by a grayish-white coating and
cause pain. Tonsillar involvement with edema, redness,
accompanied by ulceration and erosional lesions
(Ghom, 2014)
8

9. SYPHILIS
Sekunder
(mucous patch)
Mucous patch
9

10. SECONDARY SYPHILIS
(STAGE II OF SYPHILIS)
 Sign of mucus patch
 Lesions are usually found on the tongue, buccal mucosa,
tonsillar, pharyngeal, and lips
 Lesions are covered by a grayish-white membrane. The
presence of trauma results in bleeding in the lesion.
 Usually accompanied by pain in the lesion.
(Ghom, 2014)
10

11. SYPHILIS
Tersier
(Gumma)
Perforasi palatum
(Kinghorn, 2016)
11

12. TERTIER SYPHILIS
(STAGE III OF SYPHILIS)
 Gumma can occur in all parts of the oral cavity, but most often
on the palate, and tongue
 Lesions of the gingiva can manifest as deep solitary lesions,
accompanied by ulceration of the mucos
 characterized by the perforation of the palate.

13. DIAGNOSIS
SUBJECTIVE EXAMINATION
The history of syphilis begins with the chronology of
the patient's complaints. Syphilis develops in one third
of untreated patients. Patients are usually infected by
other people through social (rare) and sexual contact,
especially in the first year (primary and secondary
syphilis). Exploring the social life history of the patient
is very important.
(Janier, 2014)

14. DIAGNOSIS
 OBJECTIVE EXAMINATION
The clinical presentation of syphilis is very diverse and
occurs within a few decades after the initial infection.
Syphilis, if left untreated, can go through four stages:
primary, secondary, latent and late. (Kinghorn, 2016)

15. CONGENITALSYPHILIS
 Hutchinson’s Triad (Interstitial keratitis, malformed teeth
Hutchinson incisors and mulberry molars, and eighth nerve
deafness).
 There may also be a deformity on the nose known as saddle
nose deformity
 destruction of the palate, and development of the nasal septum
(Ghom, 2014)

16. CONGENITAL SYPHILIS
 Chronic fluid, and
lesions in the corner of
the mouth
 Hutchinson’s incisors
 Mulberry Molar

17. SUPPORTIVE
EXAMINATION
 Dark Field Examination Microscopy
used to identify Spirochete in stage I and II syphilis. Cannot be used for oral lesions.
 Biopsy
useful when the lesion contains various microorganisms, in the case of stage III syphilis.
 Treponemal Antigen Test
to evaluate the success of syphilis therapy.
 Non Treponema Antigen Test
used on Veneral Disease Research Laboratory (VDRL), and Rapid Plasma Reagin (RPR).
(Ghom,2014)

18. SUPPORTIVE
EXAMINATION
 Histopatology of
secondary syphilis,
shown the hyperplasia
of psoriasiformis on
epidermis
(Kinghorn, 2014)

19. SUPPORTIVE
EXAMINATION
 Treponema pallidum on
dark ground microscopy
 Immunofluoresent of
Treponema pallidum
(Kinghorn,2016)

20. DIFFERENTIAL DIAGNOSIS
 Primary Syphilis
Herpes simplex is easily distinguished from syphilis because in
herpes simplex there are multiple lesions, and vesicles (Bill and
Dirk, 2016)
Infeksius Noninfeksius
 Herpes simplex
 Chancroid
 Granuloma inguinal
 Vaccinia
 Limfogranuloma venereum
 Ulkus aphthous
 Vulvitis atau balanitis candida erosif
 Erosi akibat trauma atau ulkus
 Penyakit Behcet
 Karsinoma sel skuamosa
 Karsinoma sel basal
 Fixed drug eruption

21. DIFFERENTIAL DIAGNOSIS
 Secondary Syphilis
In stage II syphilis the differential diagnosis is candidiasis, leukoplakia, hairy
leukoplakia, lichen planus, herpetic gingivostomatitis, erythema multiforme,
tuberculosis. (Greenberg, et al. 2014)

22. DIFFERENTIAL DIGNOSIS
 Tertiary Syphilis
Palatal perforation due to syphytic gumma may be
confused by clinical features of granulomatosis,
midline lethal granuloma, malignant reticulosis,
mucormycosis, and antral carcinoma. (Silverman,2011)

23. DIFFERENTIAL DIGNOSIS
 Congenital Syphilis
Some conditions that may be diagnosed differentially
with congenital syphilis lesions such as traumatic ulcer,
apthous ulcer, herpetic ulcer, candidiasis, and
mononuclear infection. (Delong, L., 2008)

24. COMPREHENSIVE
TREATMENT
 benzathine penicillin IM, tetracycline hydrochloride 500 mg orally 4 times a
day for 15 days. Patients who are allergic to the drug penicillin, can be given
erythromycin 500 mg orally 4 times a day for 15 days. Treponema pallidum can
disappear 24 hours after treatment begins.
 Follow-up on the patient is a physical examination, and repetition of the VDRL
test at month 1, 3, 6, 9, 12, 18, and 24. At the end of the 24th month if the
VDRL test results are negative , the patient is cured from syphilis.
 sexual education of patients, not changing sexual partners, and not having
sexual relations with people who have been infected. Local antibiotic use in
pregnant women suspected of being infected. Prevention of congenital syphilis
can be done by examining pregnant women for antenatal and postnatal
examinations.
(Ghom, 2014)

25. PROGNOSIS
 the discovery of penicillin, the prognosis for syphilis
becomes better. Microbiologic healing (all T.
pallidum dies) is not possible. Cured syphilis means
clinically cured for life, not transmitted to others
(Bill and Dirk, 2016)

26. Gonorrhoea

27. Definition
 Gonorrhoea is sexually transmitted infection caused
by Neiserria gonorrhoea
 N gonorrhoea is a gram negative aerob bacteria
 Gonorrhoea in Mouth is oropharyngeal gonorrhoea

28. Tanda Klinis
Gonorrhoea
Kemerahan ; lidah, tenggorokan
(orofaringeal gonorrhea)

29. ETHIOLOGY AND PREDISPOSING FACTOR
 Ethiology of Oropharyngeal gonorrhoeae was
Neisseria gonorrhoea
 Predisposing factor :
 Oral sex with person infected of gonorrhoea
 Men sex Men

30. ETHIOPATOGENESIS
 Neiserria gonorrhoea  mouth colonisation
mucossal  entering tissue

31. DIAGNOSIS AND SUPPORTIVE
EXAMINATION
 Oropharyngeal gonorrhoea is rare in symtom
 Symptom could be shown in 7 – 21 days after contact
 Intra oral lesion show redness on throat and tongue,
inflammation.
 Supportive Examination :
 Kultur
 (nucleic acid amplification testing (NAAT)

32. Histopathology of Neiserria gonorrhoea
N
N

33. DIFFERENTIAL DIAGNOSE
Pharyngitis

34. COMPREHENSIVE TREATMENT
 ceftriaxone 125 mg intramuscular,
 cefixim 400 mg oral dose
 azithromycin 1 gram.
 Evidence Based Medicine showed that Ceftriaxone
intra muscular more effective to cure oropharyngeal
gonorrhea compared to Chephalosporins oral
 OMEGA ( oral mouthwash use to Eradicate
Gonorrhea)

35. 35

36. Non farmakological
- Use Condom
- No oral sex

37. PROGNOSIS
 Oropharyngeal gonorrhoea is self limitted disease


38. APA ITU?
APA BEDANYA?
BAGAIMANA PENULARANNYA?
BAGAIMANA PENGOBATANNYA?
BAGAIMANA PENCEGAHANNYA?
APA KAITANNYA DENGAN KITA,
PARA DOKTER GIGI?
Infeksi HIV dan AIDS

39. Why so destructive ?
Sel target untuk inangnya = CD4+
 Komponen sistem imun
CD4+ ↘ ↘ ↘
Sistem imun ↘ ↘ ↘
Infeksi oportunistik ↗↗↗
†

40. Bagaimana
penularannya ?

41. cairan sperma & vagina
darah
air susu ibu
saliva

42. PENASUN
90% narkoba suntik ternyata juga HIV (+)

43. Child sexual abuse
Sex violence
Child trafficking

44. Penggunaan jarum
suntik

45. Tattoo & Piercing
Unhealthy lifestyle

46. Dapatkah disembuhkan ?
Dapat diobati
Highly Active Anti Retroviral Therapy
(HAART)
 Menggunakan 1 macam ARV atau kombinasi
beberapa jenis mampu menekan HIV sehingga
tidak bereplikasi
 Orang dengan HIV dan AIDS (ODHA) harus
didukung untuk tertib minum obat dan kontrol
 Kualitas hidup ↗  usia harapan hidup ↗

47. Pencegahan Transmisi secara
Seksual
A – Always
B – Be
C – Careful
Abstain
Be Faithful
Condom

48. •Jangan gunakan bergantian
•Jarum suntik
•Pisau cukur
•Sikat gigi
•Sisir rambut yang tajam
•Hindari gaya hidup berisiko
•Dugem-night life
•Alkohol
•Narkoba
•Tattoo & piercing

49. Apa hubungan masalah ini
dengan dunia kedokteran gigi ?

50. WHO ( 2003 )
 Salah satu Program Kesehatan Mulut :
Mengutamakan Pencegahan efektif
dari Manifestasi Rongga Mulut
HIV/AIDS
melalui IDENTIFIKASI lesi Mulut

51. Radithia, D., Soebadi, B., Hendarti, HT., Triyono, EA. 2009
Common Dental-
Related Complaints
Adult
Childre
n
Dental caries 80% 100%
Dental & root decay 97% -
M3 impaction 26% -
Marginal gingivitis 68% 80%

52. Bagaimana cara mengenali
ODHA di antara pasien yang
datang
ke praktek kita?
 Manifestasi HIV/AIDS di rongga mulut
 Kelainan khas terkait infeksi HIV dan AIDS
 Penampilan fisik
 Keadaan umum
 Penampilan & gaya hidup berisiko
 Anamnesis
 Screening

53. Pseudomembrane Candidiasis
Titik-titik / spot putih kekuningan
Tx : topikal nistatin/gentian
violet : 1-2 ml 4x/hari
Sistemik : ketokonasol (10
mg/kg/hari) a/ flukonasol
1x/hari

54. Patient in orthodontics treatment

55. Erythematous
•Mukosa erosif
atrofi, licin
memerah
•Tidak mudah
berdarah
•Perih
Candidiasis

56. ERYTHEMATOUS CANDIDIASIS

57. Chronic Hyperplastic
•Lapisan putih
seperti kerak
•Tidak mudah
dikerok
•Tidak mudah
berdarah
•Tidak sakit
Candidiasis

58. Oral Hairy
Leukoplakia
•Lesi putih
berombak atau
berambut pada
lateral lidah
•Tidak dapat
dikerok ,
asimtomatik.
•Terasosiasi
infeksi virus
Epstein-Barr
•sering
ditumpangi
candida

59. Linear Gingival Erythema
•pita merah
•OH tidak selalu buruk
•tanpa ulserasi, tanpa poket
•asimtomatik, kadang berdarah
•Kemungkinan subgingival candida infection

60. Periodontal diseases
… mild, moderate, severe…
Tx : scaling, irigasi povidone iodine 10%, kumur klorheksidin
NUG : antibiotik : metronidazole, amoxcillin/clavulanate
potassium a/ clindamycin

61. Sarkoma Kaposi
•Makula /
nodula merah
keunguan
•palatum,
lidah, gingiva
•Terasosiasi
dengan infeksi
Herpes virus
tipe 8

62. Necrotizing ulcerative stomatitis
•Bisa jadi
terkait infeksi
mycobacteria
l
Non specific lesions

63. Ulcers
•Traumatic ulcers
•Aphthous ulcers
•Recurrent
aphthous stomatitis
Tx : topikal :
Triamcinolone in
Carboxymethylcellulose
Non specific lesions

64. Primary herpetic gingivostomatitis
Infeksi virus Herpes Simplex
• Ulser minor multipel berkelompok, menyatu
menjadi ulser mayor dengan tepi ireguler
• Lesi bilateral, didahului gejala prodromal

65. Herpes labialis
•Reaktivasi infeksi virus
Herpes Simplex
•Vesikula multipel
berkelompok di bibir
HERPES SIMPLEX
Tx : Sistemik :
Acyclovir 10 mg/kg

66. Herpes Zoster
•Reaktivasi
infeksi virus
Varicella
Zoster
•Lesi
unilateral
segmental

67. HIV Salivary
gland disease
(HIV-SGD)
•Sialadenopathy
• Inflammatory
• Cystic
Tx: anti inflamasi,
analgesik, antibiotik

68. Thrombocytopenic purpura
•Ptechiae
•Ecchymoses
•Hematoma

69. Oral Warts
“kutil” pada mukosa rongga mulut
Infeksi virus Human Papilloma

70. TERIMA KASIH