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Moluskum kontagiosum dengan human immunodeficiency virus stadium IV yang diterapi dengan KOH 20% Michael Hostiadi; I Gusti Ayu Agung Elis Indira; Ni Made Dwi Puspawati; Ketut Wida Komalasari
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: The prevalence of molluscum contagiosum (MC) was found to increase in the HIV population with a prevalence of 5-18%. Persistent molluscum lesions gradually increase in size. Some develop into giant, tumor-like, nodular lesions that can exceed 1 cm in diameter and cause esthetic defects in HIV-positive patients. Conventional treatment is usually not effective enough and requires additional therapy in immunocompromised cases. Case: A 31-year-old woman with stage IV HIV had the main complaint of a skin-colored rash near the genital area. Venereological examination found multiple papules with smooth, shiny surfaces with central umbilication discrete configuration and localized distribution. The molluscum body comes out after being squeezed. The treatment given is 20% potassium hydroxide spots on MC lesions every 24 hours topically. Two weeks after therapy was given, no new lesions were found without any side effects. Conclusion: Administration of 20% potassium hydroxide can be considered an MC treatment option in HIV patient with minimal side effects and is easy to use. Latar Belakang: Prevalensi moluskum kontagiosum (MK) didapatkan meningkat pada populasi human immunodeficiency virus (HIV) dengan prevalensi 5-18%. Lesi moluskum persisten yang secara bertahap bertambah besar, beberapa berkembang menjadi raksasa, seperti tumor, lesi nodular yang dapat melebihi diameter 1cm, dan dapat menyebabkan kecacatan secara estetik sering ditemui pada pasien dengan HIV positif. Pengobatan konvensional biasanya tidak cukup ampuh dan membutuhkan tambahan terapi lainnya pada kasus imunokompromais. Kasus: Seorang perempuan usia 31 tahun, HIV positif stadium IV dengan keluhan utama berupa bintil-bintil bewarna serupa kulit di dekat area genital, bila ditekan keluar bintik putih seperti nasi. Pemeriksaan venereologis ditemukan papul multipel permukaan licin berkilat dengan umbilikasi sentral konfigurasi diskret dengan distribusi lokalisata. Penatalaksanaan yang diberikan adalah tutul kalium hidroksida (KOH) 20% pada lesi MK setiap 24 jam topikal. Dua minggu setelah terapi diberikan tidak ditemukan adanya lesi baru dan tanpa adanya efek samping. Simpulan: Pemberian KOH 20% dapat dipertimbangkan sebagai pilihan terapi MK pada HIV dengan efek sampung minimal dan mudah digunakan.

Karsinoma sel basal tipe campuran yang diterapi dengan eksisi dan island pedicle flap: laporan kasus I Dewa Made Rendy Sanjaya; I Gusti Nyoman Darmaputra; Ketut Kwartantaya Winaya; I Gusti Ayu Agung Elis Indira; Herman Saputra
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Introduction: Basal cell carcinoma (BCC) is a malignant neoplasm originating from non-keratinized cells. The incidence increases worldwide and one of the triggering factors is excessive exposure to ultraviolet (UV) rays. The therapy aims to eradicate the tumor and maintain optimal organ function and cosmetic results after the procedure, one of which is the excision technique accompanied by an island pedicle flap. Case Description: A man, 67 years old, came with a complaint of a black lump on the left cheek accompanied by a wound that did not heal. Based on the history, physical examination, and investigations, the patient was diagnosed with mixed type BCC. Excision and wound closure were performed with the island pedicle flap technique. Conclusion: The treatment chosen in this case is surgical excision and island pedicle flap. Although the wound healing is classified as good, the prognosis of the patient is dubius. Considering the location of the lesion and the histopathological results showing an aggressive tumor with a tendency to metastasize, the patient is advised to take precautions. Pendahuluan: Karsinoma sel basal (KSB) adalah neoplasma ganas yang berasal dari sel non keratin. Terjadi peningkatan insiden KSB di seluruh dunia dan salah satu faktor pencetusnya adalah paparan sinar ultraviolet (UV) berlebih. Terapi yang dilakukan bertujuan untuk mengeradikasi tumor serta tetap mempertahankan fungsi organ dan hasil kosmetik yang optimal paska tindakan, salah satunya dalah dengan teknik eksisi yang disertai island pedicle flap. Deskripsi kasus: Seorang laki-laki, usia 67 tahun, datang dengan keluhan benjolan kehitaman pada pipi kiri yang disertai luka yang tidak kunjung sembuh di atas benjolan. Berdasarkan anamnesis, pemeriksaan fisik dan penunjang, pasien terdiagnosis KSB tipe campuran. Dilakukan tindakan eksisi dan penutupan luka dengan teknik island pedicle flap. Simpulan: Tatalaksana yang dipilih pada kasus ini adalah pembedahan eksisi serta island pedicle flap. Meskipun penyembuhan luka tergolong baik, namun prognosis pasien dubius. Mengingat lokasi lesi dan hasil histopatologi yang menunjukkan tumor agresif yang memiliki kecenderungan metastase, pasien disarankan untuk melakukan pencegahan.

Disseminated Herpes Zoster in Elderly with Human Immunodeficiency Virus (HIV) Infection: A Case Report Aurelia Stephanie; IGAA Elis Indira; Hermina Laksmi; Nevristia Pratama
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 11 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i11.609

Background: Disseminated herpes zoster (HZ) is one of the complications of HZ in the form of the appearance of the main lesion accompanied by the spread of solitary vesicles on the body. This condition occurs in 2% of the general population and 15-30% of immunodeficient patients, such as the elderly and HIV infection. Case presentation: A 64-year-old man came with the complaint of rashes all over his body four days ago. Vesicles and erosions are multiple in 1 dermatome and are discrete and scattered throughout the body on dermatological examination. The diagnosis of disseminated HZ, in this case, was established based on history, physical examination, and Tzank examination. HZ spread is less common and is characterized by the appearance of more than 20 vesicles or more than 2 consecutive dermatomes. Old age and HIV infection are immunocompromised conditions causing reactivation of the varicella-zoster virus and other infections. The patient received oral acyclovir, vitamins B1, B6, and B12, salicylic powder and topical fusidic acid, antiretrovirals (ARVs), azithromycin, intraoral cotrimoxazole, ceftriaxone, and intravenous fluconazole for 10 days. Skin lesions improved in 10 days without complications. Conclusion: Disseminated HZ in HIV patients should be considered because of complications, recurrence, more difficult with a treat, and a higher risk of acyclovir resistance.

Disseminated Herpes Zoster in Elderly with Human Immunodeficiency Virus (HIV) Infection: A Case Report Aurelia Stephanie; IGAA Elis Indira; Hermina Laksmi; Nevristia Pratama
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 11 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i11.609

Background: Disseminated herpes zoster (HZ) is one of the complications of HZ in the form of the appearance of the main lesion accompanied by the spread of solitary vesicles on the body. This condition occurs in 2% of the general population and 15-30% of immunodeficient patients, such as the elderly and HIV infection. Case presentation: A 64-year-old man came with the complaint of rashes all over his body four days ago. Vesicles and erosions are multiple in 1 dermatome and are discrete and scattered throughout the body on dermatological examination. The diagnosis of disseminated HZ, in this case, was established based on history, physical examination, and Tzank examination. HZ spread is less common and is characterized by the appearance of more than 20 vesicles or more than 2 consecutive dermatomes. Old age and HIV infection are immunocompromised conditions causing reactivation of the varicella-zoster virus and other infections. The patient received oral acyclovir, vitamins B1, B6, and B12, salicylic powder and topical fusidic acid, antiretrovirals (ARVs), azithromycin, intraoral cotrimoxazole, ceftriaxone, and intravenous fluconazole for 10 days. Skin lesions improved in 10 days without complications. Conclusion: Disseminated HZ in HIV patients should be considered because of complications, recurrence, more difficult with a treat, and a higher risk of acyclovir resistance.

Anal human papillomavirus genotype distribution and its associations with abnormal anal cytology among men who have sex with men I Ketut Agus Somia; Tuti Parwati Merati; Dewi Dian Sukmawati; Ni Wayan Winarti; IGAA Elis Indira; Ida Bagus Dwija Putra; Made Yogi Oktavian Prasetia
Universa Medicina Vol. 41 No. 3 (2022)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2022.v41.246-253

BACKGROUND Anal human papillomavirus (HPV) is associated with the severity of anal cytologic abnormalities that are precancerous lesions. Knowledge of HPV type distribution in populations at risk for anal cancer is needed. This study investigated anal HPV infections and cytological abnormalities among men who have sex with men (MSM). METHODS A cross-sectional study was conducted involving 90 men aged >30 years with a history of anal sexual intercourse with men. Demographic characteristics and sexual behaviors were collected by using a self-completed questionnaire. Anal cytological results were examined, and HPV genotyping was performed by the Linear Array HPV genotyping test. Descriptive analyses of subject characteristics, prevalence, and 95% confidence intervals (CI) were performed. A chi-square test was used to determine their associations with high-risk HPV infection and cytological abnormalities. RESULTS The overall prevalence of abnormal cytology was 32% (24/75), atypical squamous cells of undetermined significance (ASCUS) 17.33 % (13/75), 14.66% (11/75) were classified as low-grade SIL (LSIL) and no participant had high-grade SIL (HSIL). Prevalence of HPV infection with normal cytology was 86.27% (44/51), ASCUS 92.30% (12/13), and LSIL 100% (11/11). The most common types of anal HPV in participants with cytological abnormalities are HPV 16, HPV 18 for high-risk HPV, and HPV 11, HPV 6 for low-risk HPV. There were no associations between the predictor variables and the abnormal cytology (p>0.05). CONCLUSION There was a high prevalence of HPV infection in MSM with abnormal anal cytology. A routine anal Pap smear program and vaccination are needed to prevent HPV infection and anal dysplasia in MSM.

Patterns of Mucocutaneous Disorders in HIV-seropositive Patients and Relations with CD4 Counts at Sanglah General Hospital, Denpasar, Bali Made Wardhana; Nila Wardani; Ivana Sugiarto; Made Puspawati; Elis Indira; Wiraguna, Swastika Adiguna
Journal of Global Pharma Technology .
Publisher : Journal of Global Pharma Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: It is well known that more than 90% of HIV-infected patients will develop at least one type of dermatologic disorder during their HIV infection. As a result of the acquired immunodeficiency or the effect of the treatment, with an increased risk infectious skin condition which caused by viral, bacterial, and fungal infections, as well as inflammatory skin disease, have all been reported to increase as CD4+ T cells depleted.Objective: Our purpose was to evaluate the cutaneous manifestation in HIV/AIDS patients in dermatology-venerology polyclinic, Sanglah Hospital Denpasar. Subjects and Methods: Data was collected from medical records of HIV/AIDS patient whose came to the dermato-venerology department, Sanglah Hospital period 2007-2009.Results: During the three years period, noted 260 HIV/AIDS patients with cutaneous manifestation, 183 males, and 77 females. Those patients mostly in the age group 21-30 years old. Five most common cutaneous manifestation was condyloma acuminate for 59 patients (22,7%), dermatitis 27 patients (10,4%), drug eruptions 26 patients (10,0%), prurigo 24 patients (9,2%) and seborrheic dermatitis 23 patients (8,8%). Conclusion: Cutaneous manifestation in HIV/AIDS patients which dominated by males gender and age group 21-30 years old was very varied, in which the most common cutaneous manifestation is condyloma acuminate.Keywords: Cutaneous manifestations, HIV/AIDS.

The Landscape of Condyloma Acuminata and Concomitant STIs in Denpasar: A Retrospective Analysis with Implications for Public Health Strategies Ni Putu Wina Widyastuti; Ni Made Dwi Puspawati; I Gusti Ayu Agung Elis Indira; Aditya Permana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1345

Background: Condylomata acuminata (CA) is a prevalent sexually transmitted infection (STI). Research into the risk factors and characteristics associated with CA is crucial for developing effective prevention strategies. This study aimed to determine the prevalence and characteristics of CA patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital in Denpasar, Bali, Indonesia. Methods: A retrospective cross-sectional study was conducted using medical records of CA patients attending the STI and Dermatology Clinic at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, from January 2021 to December 2023. Data collected included patient visit status, age, gender, occupation, education, concomitant STIs, sexual orientation, marital status, and use of protective measures. Data were processed descriptively. Results: Of 284 CA patients, 69.7% were male and 30.3% were female. The mean age was 28.99 ± 11.38 years. Married individuals constituted 41.5% of cases. Private employees were the predominant occupation (34.2%). Fifty percent of patients had no concomitant STIs, while HIV was present in 37.7% of the total sample (75.4% of those with any concomitant STI). A significant proportion (49%) reported not using protective measures during sexual intercourse. Conclusion: The prevalence of CA at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, was 40 per 1000 visits during the study period. CA was predominantly observed in adult males who were married, heterosexual, had completed high school, worked as private employees, and did not use protective measures during sexual intercourse. These findings underscore the need for targeted public health interventions.

The Landscape of Condyloma Acuminata and Concomitant STIs in Denpasar: A Retrospective Analysis with Implications for Public Health Strategies Ni Putu Wina Widyastuti; Ni Made Dwi Puspawati; I Gusti Ayu Agung Elis Indira; Aditya Permana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1345

Background: Condylomata acuminata (CA) is a prevalent sexually transmitted infection (STI). Research into the risk factors and characteristics associated with CA is crucial for developing effective prevention strategies. This study aimed to determine the prevalence and characteristics of CA patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital in Denpasar, Bali, Indonesia. Methods: A retrospective cross-sectional study was conducted using medical records of CA patients attending the STI and Dermatology Clinic at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, from January 2021 to December 2023. Data collected included patient visit status, age, gender, occupation, education, concomitant STIs, sexual orientation, marital status, and use of protective measures. Data were processed descriptively. Results: Of 284 CA patients, 69.7% were male and 30.3% were female. The mean age was 28.99 ± 11.38 years. Married individuals constituted 41.5% of cases. Private employees were the predominant occupation (34.2%). Fifty percent of patients had no concomitant STIs, while HIV was present in 37.7% of the total sample (75.4% of those with any concomitant STI). A significant proportion (49%) reported not using protective measures during sexual intercourse. Conclusion: The prevalence of CA at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, was 40 per 1000 visits during the study period. CA was predominantly observed in adult males who were married, heterosexual, had completed high school, worked as private employees, and did not use protective measures during sexual intercourse. These findings underscore the need for targeted public health interventions.

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

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.

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

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.

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