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"Latar belakang : Angka kejadian infeksi menular seksual (IMS) dengan pengeluaran duh genital di Indonesia didasarkan pada modalitas diagnosis yang masih terbatas. Survey IMS di kota besar pada kelompok resiko tinggi secara periodik memberikan gambaran infeksi klamidia dan gonore yang dominan. Perubahan patogenesis infeksi klamidia dan gonore yang disebabkan karakteristik demografik, perilaku seks dan pengobatan sendiri menyebabkan diagnosis pendekatan sindrom tidak lagi akurat.Tujuan : Mengembangkan sistem deteksi C. trachomatis dan N. gonorrhoeae menggunakan PCR dupleks pada penderita IMS dengan pengeluaran duh genital.Metode : Penelitian dilakukan dalam 3 tahap. Tahap I adalah tahap optimasi terhadap suhu dan waktu annealing, konsentrasi primer, waktu sentrifugasi dan volume elusi akhir. Tahap II merupakan uji spesifisitas pemeriksaan terhadap bakteri lain dan ambang deteksi dupleks PCR dan tahap III adalah aplikasi PCR dupleks terhadap spesimen klinik.Hasil : Hasil optimasi yang didapatkan adalah sebagai berikut: suhu annealing 54°C, waktu annealing 60 detik, konsentrasi baik primer CTR dan CTF masing-masing 0,7μM sedangkan konsentrasi baik primer NGR dan NGF masing-masing 0,5μM, waktu sentrifugasi 10 menit dan volume elusi 60 μl. Ambang deteksi DNA terendah untuk C. trachomatis adalah 0,927 pg/reaksi PCR dan untuk N. gonorrhoeae adalah 1,19 pg/reaksi PCR. PCR dupleks terhadap 23 spesimen endoserviks memberikan hasil pita yang sesuai untuk C. trachomatis sebanyak 10 kasus (43,5%) dan pita yang sesuai untuk N. gonorrhoeae sebanyak 10 kasus (43,5%) dengan 4 kasus koinfeksi. PCR dupleks pada 18 swab uretra laki-laki memberikan hasil pita yang sesuai untuk C. trachomatis sebanyak 1 kasus (0,5%) dan pita yang sesuai untuk N. gonorrhoeae sebanyak 12 kasus (66,7%). Pemeriksaan PCR dupleks terhadap N. gonorrhoeae memiliki sensitivitas, spesifisitas, nilai prediksi positif dan nilai prediksi negatif berturut-turut 100%, 61,9%, 20%, dan 100% pada spesimen endoserviks dan 75%, 40%, 50%, dan 66,67% pada spesimen uretra pria. PCR dupleks terhadap C. trachomatis dibandingkan uji deteksi antigen klamidia memiliki hasil positif lebih banyak baik pada spesimen swab endoserviks maupun uretra pria (10:3 dan 1:0).

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Background : The incidence of sexually transmitted infections (STIs) with discharge in Indonesia is based on limited diagnostic modalities. STIs survey periodically in large cities of Indonesia to high-risk groups provide dominant pattern of C. trachomatis and N. gonorrheae infection. Pathogenesis change of C. trachomatis and N. gonorrheae infection due to demographic characteristic, sexual and self-medication behavior may reflect routine syndromic approach diagnostic is no longer accurate.

Objective : To develop detection system of C. trachomatis and N. gonorrhoeae using duplex PCR assay to genital discharge in patient with sexual transmitted infection.

Methods : Three steps research were done. Firstly was PCR assay optimalization to annealing time and temperature, primer concentration, centrifugation time and elution volume. Secondly, specificity test and thirdly duplex PCR assay application to clinical specimen.

Results : Duplex PCR assay optimalization gave results as follow: annealing temperature was 54°C, annealing time was 60 detik, C. trachomatis primer concentration both reverse and forward were 0,7μM and N. gonorrhoeae primer concentration both reverse and forward were 0,5μM, centrifugation time was 10 minutes and elution volume elusi 60 μl. Detection limit of duplex PCR to C. trachomatis was 0.927 pg / PCR reaction, and N. gonorrhoeae was 1,19 pg / PCR reaction. Duplex PCR application to 23 endocervical swab which corresponds to C. trachomatis were 10 cases (43.5%) and corresponds to N. gonorrhoeae were 10 cases (43.5%), with 4 coinfection cases. Duplex PCR to 18 male urethral swab which corresponds to C. trachomatis was 1 case (0.5%) and that corresponds to N. gonorrhoeae were 12 cases (66.7%). Duplex PCR to detect N. gonorrhoeae had sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.9%, 20%, and 100% in endocervical specimens, respectively and 75%, 40%, 50%, and 66.67%, in male urethral specimens respectively. Duplex PCR to detect C. trachomatis was compared with chlamydial antigen detection test were show positive results higher both in endocervical and male urethral specimens (10:3 and 1:0)."

"ABSTRAKLatar belakang : Gonore masih menjadi masalah kesehatan yang cukup signifikan terutama padalaki-laki dengan perilaku seksual risiko tinggi. Pemeriksaan baku emas untuk diagnosis gonoreadalah biakan dan tes amplifikasi asam nukleat. Namun, kedua tes tersebut sulit dilakukan padatempat dengan keterbatasan fasilitas serta sumber daya manusia. ENCODETM gonorrhea rapidtest (GRT) merupakan salah satu point of care test (POCT) yang relatif mudah untuk digunakandan dapat memberikan hasil dalam waktu singkat. Jenis POCT ini diperkirakan dapat menegakkandiagnosis gonore lebih praktis, cepat, dan akurat di Indonesia.Tujuan : Mengetahui sensitivitas, spesifisitas, nilai prediksi positif, dan nilai prediksi negatif dariGRT dalam diagnosis gonore pada duh tubuh uretra laki-laki risiko tinggi di JakartaMetode : Penelitian ini merupakan studi potong lintang terhadap laki-laki risiko tinggi dengankeluhan duh tubuh uretra yang mengunjungi dua klinik IMS di Jakarta selama Bulan September-November 2018. Jenis POCT gonore yang digunakan adalah ENCODETM GRT untuk mengujisensitivitas, spesifisitas, nilai prediksi negatif dan positifnya. Pemeriksaan baku emas yangdigunakan adalah biakan.Hasil : Telah berhasil diseleksi sebanyak total 54 subyek penelitian. Sensitivitas dan spesifisitasGRT diperoleh sebesar 96,77% (95% IK 83,3-99,92%) dan 82,6% (95% IK 61,22-95,05%).Nilai prediksi positif didapatkan sebesar 88,24% (95% IK 75,43-94,82%) sedangkan nilaiprediksi negatif sebesar 95% (95% IK 73,25-99,25%).Kesimpulan : ENCODETM GRT menunjukkan sensitivitas dan spesifisitas yang cukup baikuntuk diagnosis gonore pada laki-laki risiko tinggi dengan keluhan duh tubuh uretra.Pengunaannya cukup praktis, sehingga dapat disarankan untuk tempat dengan keterbatasanfasilitas.

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ABSTRACTBackground : Gonorrhea still becomes a significant health problem especially in men with highrisksexual activities. The gold standard diagnostic tests are culture and nucleic acid amplificationtest. However, both of the tests were difficult to perform in the setting of limited resources. Othertests require trained analyst to perform, which may also not available in rural areas. ENCODEgonorrhea rapid test (GRT) is a point of care test (POCT) which is relatively easy to use and canprovide result quickly. This POCT may provide more practical, faster, and more accuratediagnosis of gonorrhea in Indonesia.Objective : To know the sensitivity, specificity, positive predictive value, negative predictivevalue of gonorrhea rapid test in diagnosing gonorrhea urethritis on high risk men in Jakarta.Methods : This is a cross-sectional study including men with symptomatic gonococcal urethritiswho visited two STI clinics in Jakarta during September-November 2018. ENCODETM GRT wasperformed to evaluate its sensitivity, specificity, positive and negative predictive value. The goldstandard diagnostic test was culture.Result : There were 54 men recruited in this study. The sensitivity and specificity for ENCODEgonorrhea rapid test are 96.77% (95% CI 83.3-99.92%) and 82.6% (95% CI 61.22-95.05%).Positive and negative predictive values respectively are 88.24% (95% CI 75.43-94.82%) and95% (95% CI 73.25-99.25%).Conclusion : ENCODE GRT has a good sensitivity and specificity rates for diagnosing gonorrheain high risk men with urethral discharge. Its use is recommended especially in rural areas or areaswith limited resources due to its practicality."

"[ABSTRAKDuh tubuh vagina adalah cairan yang keluar dari alat genital perempuan yang tidak berupa darah. World Health Organization (2007) merekomendasikan dalam menegakkan diagnosis duh tubuh vagina dengan menggunakan alur pemeriksaan dengan spekulum. Kementerian Kesehatan Republik Indonesia telah merekomendasikan alur tersebut untuk seluruh puskesmas di Indonesia. Penelitian ini bertujuan untuk mengetahui nilai sensitivitas dan spesifisitas alur pemeriksaan duh tubuh vagina dengan spekulum oleh dokter puskesmas di Kota Pontianak yang dikonfirmasi dengan pemeriksaan laboratorium. Uji diagnostik sensitivitas dan spesifisitas dilakukan terhadap 52 subyek penelitian. Hasil penelitian menunjukkan nilai sensitivitas dan spesifisitas diagnosis vaginitis menggunakan spekulum sebesar 57,1% dan 52%, sedangkan sensitivitas dan spesifisitas untuk diagnosis servisitis sebesar 75% dan 57,7%. Hal tersebut menunjukkan nilai sensitivitas dan spesifisitas yang rendah (≤85%), menunjukkan bahwa pemeriksaan menggunakan spekulum tidak cukup baik untuk digunakan sebagai dasar dalam menegakkan diagnosis duh tubuh vagina.

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ABSTRACTVaginal discharge is the discharge from womens genitals which does not consist of blood. World Health Organization in 2007 provide recommendations for diagnosis vaginal discharge in health care one of them by using a speculum. The Ministry of Health of Indonesia has recommended speculum examination of vaginal discharge to all health centers in Indonesia. This research aim was to study the sensitivity and specificity of vaginal discharge examination using a speculum by doctors in primary health care in Pontianak confirmed by laboratory examination. Sensitivity and specificity of diagnostic testing were conducted on 52 research subjects. The result of the study showed the sensitivity and specificity for the diagnosis of vaginitis using a speculum were 57.1% and 52%, whereas the sensitivity and specificity for the diagnosis of cervicitis were 75% and 57.7%. Low sensitivity and specificity values (≤85%), indicating that the use of a speculum examination is not good enough to be used as a basis in the diagnosis of vaginal discharge., Vaginal discharge is the discharge from womens genitals which does not consist of blood. World Health Organization in 2007 provide recommendations for diagnosis vaginal discharge in health care one of them by using a speculum. The Ministry of Health of Indonesia has recommended speculum examination of vaginal discharge to all health centers in Indonesia. This research aim was to study the sensitivity and specificity of vaginal discharge examination using a speculum by doctors in primary health care in Pontianak confirmed by laboratory examination. Sensitivity and specificity of diagnostic testing were conducted on 52 research subjects. The result of the study showed the sensitivity and specificity for the diagnosis of vaginitis using a speculum were 57.1% and 52%, whereas the sensitivity and specificity for the diagnosis of cervicitis were 75% and 57.7%. Low sensitivity and specificity values (≤85%), indicating that the use of a speculum examination is not good enough to be used as a basis in the diagnosis of vaginal discharge.]"