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All Journal E-Jurnal Medika Udayana Berkala Ilmu Kesehatan Kulit dan Kelamin WMJ (Warmadewa Medical Journal) Al Qalam: Jurnal Ilmiah Keagamaan dan Kemasyarakatan ISM (Intisari Sains Medis) : Jurnal Kedokteran Jurnal Biomedika dan Kesehatan Bali Dermatology and Venereology Journal JOURNAL LA MEDIHEALTICO Bioscientia Medicina : Journal of Biomedicine and Translational Research Seminar Ilmiah Nasional Teknologi, Sains, dan Sosial Humaniora (SINTESA) Bali Dermatology Venereology and Aesthetic Journal Indonesian Journal of Biomedicine and Clinical Sciences
Ni Made Dwi Puspawati
Departemen Dermatologi And Venereologi, Fakultas Kedokteran, Universitas Udayana-RSUP Sanglah Denpasar, Bali, Indonesia
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Veterinary

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Gonococcal and Non-Gonococcal Urethritis in a Global Travel Hub: A Retrospective Analysis of Syndromic Management, Suboptimal Cefixime Monotherapy, and the Public Health Crisis of Patient Retention in Bali, Indonesia Andrew Wicaksono; I Gusti Ayu Agung Elis Indira; Ni Made Dwi Puspawati; Aditya Permana; Nyoman Suryawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1447

Abstract

Background: The inexorable rise of antimicrobial resistance (AMR) in Neisseria gonorrhoeae represents a formidable threat to global public health, jeopardizing the efficacy of last-line treatments for gonococcal urethritis (GO). Southeast Asia is a recognized epicenter for the emergence and dissemination of AMR, yet granular surveillance data from many high-risk localities remain critically sparse. This study aimed to provide a comprehensive characterization of the clinical epidemiology, frontline management practices, and patient outcomes of male urethritis at a tertiary referral center in Bali, Indonesia—a major international crossroads for tourism and migration. Methods: A retrospective, cross-sectional analysis was conducted on the medical records of male patients diagnosed with urethritis at the Dermatology and Venereology Polyclinic of Ngoerah Hospital between January 1st, 2021, and December 31st, 2024. A rigorous screening process of 215 initial records was undertaken to identify eligible cases. Data on sociodemographics, behavioral risk factors, clinical presentation, syndromic diagnosis, prescribed pharmacotherapy, and follow-up adherence were systematically extracted and analyzed using descriptive and comparative statistics. Results: From the initial cohort, 58 male patients met the final inclusion criteria. The cohort was predominantly diagnosed with GO (n=39, 67.2%) over non-gonococcal urethritis (NGO) (n=19, 32.8%). Patients were primarily of productive age (25–44 years, 58.6%) and reported high-risk behaviors, including multiple sexual partners (65.5%). A critical deviation from international treatment guidelines was identified: 97.4% (38/39) of GO patients received oral cefixime 400 mg monotherapy, a regimen no longer recommended for first-line use due to AMR concerns. Furthermore, a profound fracture in the care cascade was evident, with an overall loss-to-follow-up rate of 58.6% (34/58). This failure was most pronounced in the GO cohort, where 76.9% (30/39) of patients did not return for scheduled follow-up, a rate significantly higher than the 21.1% (4/19) observed in the NGO cohort (p<0.001). Conclusion: The clinical management of gonorrhoea at this major Indonesian referral center is defined by two systemic failures: the routine prescription of a suboptimal antimicrobial monotherapy and a near-total collapse of patient follow-up. This combination, situated in a high-transience international hub, creates an unmonitored, high-risk environment for the selection, amplification, and global dissemination of antimicrobial-resistant N. gonorrhoeae. These findings signal an urgent imperative to align local therapeutic protocols with evidence-based global standards and to implement robust, innovative strategies to ensure patient retention and verify the cure.
A retrospective study of condyloma acuminata profile in outpatient clinic of dermato-venereology Sanglah General Hospital Denpasar, Bali-Indonesia period 2015-2017 Ni Made Dwi Puspawati; Sissy; Dewi Gotama
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 1 No. 1 (June 2018)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/wcxze973

Abstract

Introduction: Condylomata acuminata (CA) is human papillomavirus (HPV) infection, and one of the most common sexually transmitted disease, characterized with papul or papillomatous nodule in genital, perineum and anal, this disease can be asymptomatic as well. Some study proved sexually transmitted infection increases the incidence of Human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS), and vice versa. Management of CA is Trichloroacetic acid (TCA), Tincture Podophyllin, and Electrocautery. This study aims to determine profile of condyloma acuminata in Dermatovenereology Outpatient Polyclinic Sanglah General Hospital Denpasar Bali period 2015-2017. A retrospective study during three years (2015-2017). Method: Data was obtained from medical record in Dermatovenereology Outpatient Polyclinic Sanglah General Hospital Denpasar Bali period 2015- 2017. Result: Total patient condyloma acuminata is 260 patients (5.48%), male is dominant 70 patients (67.31%), range age 12-35 years old (123%), there was 59 patient who infected with HIV (22.31%), with five pregnancy (1.92%). Most therapy is given trichloroacetic acid (TCA) (79.62%). Conclusion: Men suffered from condyloma acuminata more commonly than women, the most common treatment for this condition is trichloroacetic acid (TCA)
Lichen amyloidosis with combined topical therapy: a case report Made Sanitca Indah; Ni Made Dwi Puspawati; Herman Saputra
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 2 No. 2 (December 2019)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/24tjs491

Abstract

Introduction: Lichen amyloidosis (LA) is a rare case, characterized by circumscribed, highly pruritic, hyperkeratotic, and hyperpigmented papules occurring typically over the shins, outer aspects of upper arms, and on the upper back with amyloid deposits in the papillary dermis. Several therapeutic strategies, including topical steroids, oral antihistamines, cyclosporine, retinoids, laser, phototherapy, cryosurgery, and surgical interventions, have been reported as treatment options for patients with LA, but no standardized treatment has been established. Case report: A 58-year-old man came to the Dermatovenereology Outpatient Department complaints of itchy blackish-brown papules on the shins. Dermatology examination found discrete multiple hyperpigmentation papules and plaque covered with white scale. A scar-like center surrounded by brownish circles or white edges was found from the dermoscopic examination. The histopathological examination found thickened keratin with compact orthokeratosis and hyaline materials in the papillary dermis with dendritic melanophages. The patient diagnosed with LA and treated by combining desoximetasone cream 0.25% with 3% salicylic acid. The papules on the legs had flattened in the patient, with a significant improvement in the severe itching after three weeks. Conclusion: Combination therapy of potent corticosteroids and keratolytic seems to be an appropriate modality and well-tolerated by LA patients. Skin lesion becomes thinner, and pruritus is reduced.
Secondary syphilis with stage III HIV in an adolescent deaf male with a history of sexual relationship with men: a case report Tritya Mudita; Ni Made Dwi Puspawati; I Gusti Ayu Agung Sattwika; Andrew Yoshihiro Wirya
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 4 No. 1 (June 2021)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/vv3kt473

Abstract

Introduction: Syphilis is an infection caused by Treponema pallidum of the spirochaete family. Case: A 19-year-old Balinese came with a complaint of red spots on the palms of the hands and feet one month ago. The patient has a hearing disability and is currently enrolled in a special-needs school in Denpasar. VDRL examination with reactive results with titer 1:256 and TPHA reactive with TPHA titer 1:5120. The patient received benzathine penicillin G 2.4 million units intramuscularly. Significant improvement was obtained, and the serological test was decreased. Discussion: Syphilis transmits through sexual contact, vertically from pregnant women to their fetuses, through needle sharing. People with hearing disabilities and adolescents are considered vulnerable as objects of harassment and sexual violence. Conclusion: People with disabilities and adolescents are vulnerable to sexually transmitted diseases. Information on reproductive health and sexually transmitted diseases need to be more readily available for people with disabilities. Secondary syphilis therapy with a single dose of benzathine penicillin is effective from clinical or serological observations.
Prevalence and Profile of Adolescents with Sexually Transmitted Infections at the Dermatology and Venereology Polyclinic of Ngoerah Hospital, Bali, Indonesia Intaran, Kadek Devi Aninditha; Puspawati, Ni Made Dwi; Elis Indira, I Gusti Ayu Agung; Pemana, Aditya
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 37 No. 3 (2025): DECEMBER
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V37.3.2025.190-194

Abstract

Background: Sexually Transmitted Infections (STIs) have been considered a public health threat in all countries, both in developed and developing countries. STIs have a direct impact on sexual and reproductive health through stigmatization, infertility, cancer, and pregnancy complications that can increase the risk of HIV. Purpose: This study aims to identify cases of adolescent patients with STIs at Ngoerah Hospital, Denpasar, Bali in the period 2021 to 2023. Methods: This study uses a descriptive observational study with a cross-sectional design. The research was conducted at the Dermatology and Venereology Polyclinic and the Medical Record Installation of Ngoerah Hospital, Denpasar, Bali. After the data was collected, it was tabulated in tabular form and grouped descriptively. Result: A total of 46 patient samples were obtained, with an average age of 16.7 years. Adolescents with STIs were more commonly found in female (63%). Based on their last education, the highest number of patients were junior high school graduates (58.7%) with a history of multipartner sexual intercourse (56.5%). Only 15.2% claimed to be married. The most common type of STIs was syphilis (50%), followed by condyloma acuminata (45.6%). A total of 67.4% of adolescents were known to have HIV-positive status. Conclusion: The picture of STIs in teenagers is more common in female with a junior high school education. Most teenagers have multi-partner partners with a history of having sexual relations with commercial sex workers (CSWs). The most common type of STIs in teenagers is syphilis (50%), and 67.4% are infected with HIV.
Pengaruh Pemberian Penyuluhan terhadap Stigma Penyakit Kusta pada Pasien dan Keluarga Kontak: Suatu Pre - Post Study Sari, Luh Putu Sustiana Kartika; Karna, N. L. P Ratih Vibriyanti; Rusyati, Luh Made Mas; Karmila, I. G. A. A Dwi; Puspawati, Ni Made Dwi; Winaya, Ketut Kwartantaya
Jurnal Biomedika dan Kesehatan Vol 8 No 3 (2025)
Publisher : Fakultas Kedokteran Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/JBiomedKes.2025.v8.317-328

Abstract

Background Stigma toward leprosy patients remains a barrier to efforts to control this disease. Educational interventions are needed to increase public knowledge and reduce prejudice toward patients. This study aims to evaluate the effect of education on leprosy stigma among patients and their family contacts at Prof. Dr. I.G.N.G. Ngoerah General Hospital. Methods This study used a quasi-experimental design with a one-group pretest-posttest approach. The study was conducted at the Dermatology and Venereology Polyclinic of Prof. Dr. I.G.N.G. Ngoerah General Hospital in Denpasar, Bali, from February to July 2025. Data analysis was performed using SPSS version 26.0 at a significance level of α = 0.05. Results A total of 50 respondents were included, comprising 37 leprosy patients and 13 family members. A significant relationship was observed between stigma before and after health education (p = 0.031). Educational level (p = 0.001), clinical presentation (p = 0.002), and economic level (p = 0.029) were also significantly associated with stigma after health education. Respondents with higher education showed a significant decrease in stigma (OR = 11.245; 95% CI: 2.044–61.862; p = 0.005). Similarly, respondents with non-neurological disorders showed lower levels of stigma (OR = 12.415; 95% CI: 2.208–69.808; p = 0.004). Conclusions The findings of this study indicate that health education significantly reduced leprosy-related stigma, with educational level and clinical presentation identified as key determinants.
The Role of Micronutrients in Human Immunodeficiency Virus Infection: A Narrative Review Putu Evindya Vipascitadewi Nandanaya Bharata; I. G. A. A. Elis Indira; Ni Made Dwi Puspawati; Anak Agung Gede Kresna Naria Putra
WMJ (Warmadewa Medical Journal) Vol 11 No 1 (2026): May 2026
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.11.1.13669.54-62

Abstract

Human Immunodeficiency Virus (HIV) remains a major global health burden, with micronutrient deficiency being a frequent complication that worsens disease progression. Deficiencies in vitamins A, D, E, and zinc have been linked to impaired immune responses, increased susceptibility to opportunistic infections, and poor treatment outcomes. This narrative review aims to explore the role of micronutrients, particularly vitamins A, D, E, and zinc, in the clinical course and management of HIV infection. A literature-based narrative review was conducted using PubMed, Scopus, and Google Scholar. Articles discussing the association between micronutrients and HIV progression, immune response, and treatment outcomes were synthesized. A total of 847 articles were initially identified; after screening and applying inclusion criteria, 42 articles were included in this review. Evidence shows that vitamin A influences mucosal immunity and reduces mother-to-child transmission; vitamin D modulates immune cell proliferation and autophagy; vitamin E acts as an antioxidant reducing oxidative stress; and zinc supports T-cell function and reduces opportunistic infections. Vitamin D supplementation significantly increased serum 25(OH)D levels (p<0.0001) but did not significantly alter CD4 counts or viral load in clinical trials. Overall, supplementation outcomes remain inconsistent. While multiple micronutrient supplementation may improve immune markers, its impact on mortality and viral load reduction is still inconclusive. Micronutrient deficiency is common among HIV patients and negatively affects disease progression. Although supplementation may improve nutritional and immunological status, robust evidence regarding long-term survival and virological outcomes is lacking. Further high-quality studies are required to establish clear recommendations.
Hubungan Polimorfisme Toll-Like Receptor 2 Dan Sifilis Okular Puspawati, Ni Made Dwi; Indira, I Gusti Ayu Agung Elis; Permana, Aditya
Seminar Ilmiah Nasional Teknologi, Sains, dan Sosial Humaniora (SINTESA) Vol. 7 (2024): PROSIDING SINTESA
Publisher : LPPM Universitas Dhyana Pura

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36002/snts.v7i.3535

Abstract

Sejak pandemi HIV terjadi peningkatan kasus sifilis okular. Hal ini perlu menjadi perhatian karena penyakit ini terutama dijumpai pada kelompok usia produktif, adanya risiko penyulit berupa gangguan penglihatan bahkan kebutaan, dan yang terpenting sampai saat ini pengobatan lini pertama untuk sifilis okular belum tersedia di Indonesia. Untuk itu sangat penting mengetahui faktor risiko yang mempengaruhi kejadian tersebut. Sifat genetik juga dapat berperan penting sebagai faktor risiko sifilis okular. Beberapa polimorfisme gen diperkirakan menjadi faktor risiko endogen terjadinya sifilis okular salah satunya adalah polimorfisme Toll-like receptor 2 (TLR2). TLR memegang peranan kunci dalam garis pertahanan pertama melawan patogen karena kemampuannya untuk mengenali pathogen-associated molecular patterns (PAMP). Saat ini telah diidentifikasi 10 TLR pada manusia yaitu TLR1 sampai TLR10. Beberapa TLR sangat spesifik dalam mengenali dan mengikat beberapa ligan tertentu, seperti TLR2 yang secara spesifik mengenali dan berikatan dengan lipoprotein bakteri. Treponema pallidum, adalah agen penyebab sifilis yang membran luarnya berupa lipoprotein sebagai penentu virulensi. Saat T. pallidum masuk kedalam tubuh host maka akan mengekspresikan banyak lipoprotein, kemudian merangsang sel imun bawaan melalui TLR2. Sehingga polimorfisme pada TLR2 diduga dapat merusak respon imun bawaan terhadap lipopeptida dan lipoprotein spirochetal. Suatu penelitian mendapatkan polimorfisme pada gen TLR2 berhubungan dengan penurunan respons terhadap stimulasi lipoprotein T47L dari T. pallidum dan secara signifikan berhubungan dengan neurosifilis dan sifilis okular. Perlu dilakukan penelitian lebih lanjut untuk mengetahui pengaruh polimorfisme TLR 2 sebagai faktor risiko kejadian sifilis okular.
Co-Authors Aditya Permana Aditya Permana Aditya Permana Anak Agung Gde Putra Wiraguna Anak Agung Gede Kresna Naria Putra Andrew Wicaksono Andrew Yoshihiro Wirya Andrew Yoshihiro Wirya Ariana Ariana Aurelia Stephanie Darmaputra, I Gusti Nyoman Devi, Putu Akopita Dewi Gotama Dewi Gotama Elice Wijaya Elis Indira, I Gusti Ayu Agung Firly Clarissa Suyanto Gotama, Dewi Herman Saputra Herman Saputra Herman Saputra I Dewa Made Rendy Sanjaya I Gde Nengah Adhilaksman I Gde Nengah Adhilaksman Sunyamurti Wirawan I Gusti Ayu Agung Dwi Karmila I Gusti Ayu Agung Elis Indira I Gusti Ayu Agung Praharsini I Gusti Ayu Agung Praharsisni I Gusti Ayu Agung Sattwika I Gusti Ayu Sattwika I Gusti Nyoman Darmaputra I Ketut Agus Somia I Komang Arimbawa I. G. A. A. Elis Indira Ida Ayu Trisna Dewi Ida Ayu Uttari Priyadarshini Indah, Made Sanitca Indira, I Gusti Ayu Agung Elis Intaran, Kadek Devi Aninditha Jordaniel Setiabudi Karmila, I. G. A. A Dwi Karna, N. L. P Ratih Vibriyanti Ketut Kwartantaya Winaya Ketut Wida Komalasari Krisnaputri, Nandya Putu Luh Made Mas Rusyati Luh Made Shanti Maheswari Made Hermina Laksmi Made Martina Windari Made Sanitca Indah Made Sanitca Indah Made Swastika Adiguna Made Wardhana Mahariski, Pande Agung Marrietta Sugiarti Sadeli Martalova AJ, Adelia Martina Windari Michael Hostiadi Michael Hostiadi, Michael Mudita, Tritya Murti, Nyoman Indra Karunia Natih, Sintha Aprillia Gita Ni Kadek Setyawati, Ni Kadek Ni Luh Putu Ratih Vibriyanti Karna Ni Putu Candra Nirmalasari P Ni Putu Wina Widyastuti Nyoman Suryawati Nyoman Yoga Maya Pramita Nyoman Yoga Maya Pramita Pande Agung Mahariski Pemana, Aditya Prima Saraswati Sanjiwani Sudarsa Putu Ayu Dewita Ganeswari Putu Evindya Vipascitadewi Nandanaya Bharata Putu Gde Hariwangsa Ricky Fernando Maharis Rikcy Fernando Maharis Sari, Luh Putu Sustiana Kartika Sattwika, I Gusti Ayu Setyono, Alfred Sissy Sissy Sissy Sissy, Sissy Sutiawan, Indry Salonika Tiara Evangelista Triatmakusuma, Yogi Tritya Mudita Tritya Mudita Vanessa Vijayamurthy Winaya, Ketut Kwartantaya Wirya, Andrew Yoshihiro