Herpes Genitalis dengan Gambaran Klinis Tidak Khas pada Penderita AIDS

Abstract

Dilaporkan sebuah kasus herpes genitalis dengan gambaran klinis yang tidak khas pada seorang laki-laki penderita acquired immuno deficiency syndrome (AIDS) berusia 27 tahun. Penderita datang dengan lesi pada pubis, korpus penis, dan skrotum bagian 1/3 atas, berupa ulkus dangkal multipel, dengan bentuk tidak teratur, tidak terdapat indurasi maupun nyeri tekan. Diagnosis kerja pada saat itu adalah ulkus genital nonspesifik yang ditegakkan setelah diagnosis banding berbagai etiologi disingkirkan melalui berbagai pemeriksaan penunjang. Pada bulan ke-6, tampak lesi baru di sekitar ulkus berupa vesikel, erosi, dan ekskoriasi, sehingga diagnosis kerja menjadi herpes genitalis. Pada pemeriksaan serologis ulang didapatkan hasil IgM antivirus herpes simpleks (VHS) (+), dan Ig G anti-VHS-2 (+). Terapi topikal diberikan kompres, sedangkan untuk terapi sistemik diberikan antibiotik yang sesuai dengan hasil tes resistensi. Terapi asiklovir sistemik dengan dosis 5x400 mg/hari diberikan setelah diagnosis kerja menjadi herpes genitalis.

ATYPICAL GENITAL HERPES AND NON SPECIFIC CHARACTERISTIC IN AIDS PATIENT

A case of genital herpes with atypical clinical feature in a 27-year-old man with AIDS was reported. The patient presented with multiple shallow ulcers in the pubic area, penile shaft, and 1/3 upper scrotum, with irregular shape, without induration, nor pain. The working diagnosis of nonspecific genital ulcer was made after the differential diagnoses of various etiologies were eliminated through further examination. On the sixth month of follow-up, there were new lesions found around the genital ulcers, which were vesicles, erosions, and excoriations, therefore the working diagnosis turned to genital herpes. Result from second serological examination revealed positive anti-HSV2 IgM, and positive anti-HSV2 IgG. Topical treatment consisted of compress and systemic antibiotic was also given based on resistency test result. Then, 400 mg acyclovir 5 times daily was given after the working diagnosis of genital herpes was established.