LITERATURE REVIEW

CLINICAL ASPECTS FLUOR ALBUS OF FEMALE AND

TREATMENT

Monalisa, Abdul Rahman Bubakar, Muhammad Dali Amiruddin

Departement of Dermatovenereology Medical Faculty of Hasanuddin University / Wahidin

Sudirohusodo Hospital Makassar

ABSTRACT
Vaginal discharge is an excessive secretion of fluid from the female
reproductive canal (vagina). Vaginal discharge can be either
physiological or pathological. Physiological vaginal discharge consists of
fluid, that sometimes is mucous with numbers of epithelial cells and few
leukocytes, whereas in pathological conditions, consists of a lot of
leukocytes. Several physiological conditions are newborn, late
menarche, pregnancy, sexual stimulation and chronic diseases.
Vaginal discharge was found ranging from childhood to
adulthood. Discomfort, low self-esteem, anxiety caused by vaginal
discharge lead some women to seek help at the doctor but mostly
soluble in an attempt to self-medication. Most pathologic vaginal
discharge was caused by infection. This paper will discuss clinical
picture of the vaginal discharge and its management.

Keywords : vaginal discharge, clinical manifestation, treatment.

19
IJDV
PREFACE
Fluor albus / leucorrhea / white discharge
is a state of vaginal discharge and/or
cervix in women. Fluor albus can be either
physiological or pathological. Fluor albus
was determined as pathological vaginal
discharge or cervix discharge , if
accompanied by changes in odor and
color as well as the amount that is not
normal. Complaints may be accompanied
by intense itching, genital edema, dysuria,
lower abdominal pain or low back pain. (1)
In normal conditions, the glands in
the cervix produce a clear liquid that
comes out mixed with bacteria, the cells
are separated and vaginal secretions from
bartholin’s gland. In women, vaginal
discharge is a natural thing from the body
to cleanse itself, as a lubricant and the
defense of various infections. Under
normal conditions, it seems clear vaginal
discharge, cloudy white or yellowish when
dry on clothing. This discharge of non-
irritant, not interfere, there is no blood and
has a pH of 3.5 to 4.5. (2, 3)
The most common cause of pathological
fluor albus is infected. Various pathogens
can cause vaginal discharge that is
transmitted through sexual intercourse.
Leucorrhea can be differentiated into
vaginitis and cervicitis. Vaginitis can be
caused by Candida albicans, Gardnerella
vaginalis, Mycoplasma genital and
anaerobic germs and Trichomonas vagi-
nalis.
While cervicitis often caused by Neisseria
gonorrhoeae and Chlamydia trachomatis.
(1)
To established a diagnosis, it takes
some laboratory examinations.
Among others are the direct
microscopic examination with saline so-
lution dripped into the vaginal secretions
(wet preparation), direct microscopic exa-
mination with 10% KOH solution, with
gram staining, culture methods/breeding.
(4)
Components of the management of
sexually transmitted infections (STIs)
among others are covering history,
20
Vol.1 No.1 2012
disease history, physical examination and
investigation to STI etiological diagnosis is
frequently encountered problems. Related
to time constraints, resource availability,
financing and affordability of treatment. (5)
EPIDEMIOLOGY
Bacterial vaginosis (BV) is the
commonest cause of vaginal discharge
and odor, but more than 50% of women
with asymptomatic BV. More often found
in women who check their health another
types of vaginitis. Frequency depends on
socioeconomic level population, we had
mentioned that 50% of sexually active
women infected with Gardnerella
vaginalis, but few cause symptoms. (5)
Candidiasis Vulvovaginalis (CVV) of
mostly women at least once during their
lifetime, most often in the productive age,
with estimated between 70-75%, of which
40-50% will experience recurrence. Most
studies indicate that the KVV is a frequent
diagnosis among young women, are about
as many as 15-30% of symptomatic
women who visit the doctor. (6)
Reports for trichomoniasis pre-
valence varies widely, depending on the
techniques used in the diagnosis and the
population studied. In general, prevalence
estimates ranging from 5% to 74% in
women and 5-29% in men, with the
highest number of both sexes reported
among STD clinic patients and other high-
risk populations. (7)
Chlamydia infection of the genital
organs are distributed worldwide and
prevalent in industrialized countries and
developing countries. World Health
Organization (WHO) estimates that 89
million new cases of genital chlamydia
infections occurred worldwide in 2001. The
number of reported cases occur in
womenmore than men. (8)
The incidence of gonorrhea varies
according to age, 75% of cases reported
in the age 15-29 years, with the highest
rates occurred in the age group 15-19
years. Demographic risk factors for
Monalisa
gonorrhea include low socioeconomic
status, early onset of sexual activity,
without marital status, and past history of
gonorrhea. (9)
ETIOPATHOGENESIS
Fluoralbus can be caused by
manythings, fluor albus physiologically
canbe found in some circumstances
following, newborn babies until approxi-
mately age 10 days because of the
influence of estrogen from the placenta to
the uterus and vagina fetus, before
menarche because of the influence of the
hormone estrogen and canbe lost own,
adult women are aroused by spending
transudation of vaginal wall. (2)
Although many variations of color,
consistency, and amount of vaginal
discharge can be considered a normal, but
the change is are always interpreted as an
infection patients ,especially caused by the
fungus . Some women also have a lot of
vaginal discharge. Under normal con-
ditions, discharge from the vagina
containing vaginal discharge, vaginal cells
are separated and cervical mucous, which
will vary due to age, menstrual cycle,
pregnancy, use of birth control pills.
Normal vaginal environment is charac-
terized by a dynamic relationship between
Lactobacillus acidophilus with other
endogenous flora, estrogen, gly-cogen, pH
of the vagina and the other metabolites.
Lactobacillus acidophilus produces endo-
genous peroxide is toxic to bacterial
pathogens. Because the action of
estrogen on the vaginal epithelium, the
production of glycogen, lactobacillus (Dö-
derlein) and lactic acid production that
produces a low vaginal pH to 3.8 to 4.5
and at this level can inhibit the growth of
other bacteria. (3)
Pathological fluor albus can be
caused by sexually transmitted infections
(Chlamydia trachomatis, Neisseria gonor-
rhoeae, Trichomonas vaginalis), other
infections such vulvovaginalis can-didiasis
(Candida albicans), bacterial vaginosis
(Gardnerella vaginalis), because of foreign
21
Clinical Aspects Fluor Albus of Female and Treatment
objects and the process of malignancy. (10)
The most common cause of pathological
fluor albus is infected. Here the fluid
containing many leukocytes and slightly
yellowish color to green, often more thick
and smelly. (2)
CLINICAL PICTURE
Pathological fluor albus body can be
caused by Trichomonas vaginalis,
Candida albicans and mixed infections of
Gardnerella vaginalis and vaginal
anaerobs. Neisseria gonorrhoeae and
Chlamydia trachomatis cause cervical
discharge and cervicitis. (11)
• Fluor albus caused by Tricho-
moniasis is usually asymptomatic
or appear with a picture of a
vaginal discharge is thick, foul-
smelling, greenish yellow color,
and accompanied by pruritus on
the vulva. In addition there is an
infection also occurs inflammation
of the vagina and cervix, some-
times also found in minor bleeding
with ulceration of the cervix. (4, 12, 13)
• Fluor albus caused by Candida
albicans is white, odorless or smell
sour, the vaginal wall is normally
the picture of a lump of cheese
(cottage cheese), sometimes
accompanied by a sense of
hot/burning, and dysuria and
dispareuni. (6, 10, 14)
• Fluor albus caused by Gardnerella
vaginalis and vaginal anaerobes in
the form snoring discharge, dilute,
homogeneous, white-gray to
yellowish with foul or fishy odor
and attached to the walls of the
vagina, often appear on the labia.
(10, 12, 15)
• Fluor albus caused by Neisseria
gonorrhoeae from endocervicitis is
purulent, thin and somewhat
smelly. In addition vaginal dis-
charge complaints, the infection
IJDV
is some times accompanied by
complaints dysuria, dyspareunia
and lower abdominal pain, fever,
nausea and vomiting. (4, 9, 12)
• Fluor albus caused by Chlamydia
trachomatis is characterized by a
purulent exudate or mukopurulen
seen in endocervical and cervical
fragile and bleed easily be post-
coitus or intermenstrual bleeding.
(12)
• Fluor albus caused by foreign
bodies sometimes accompanied by
blood. Vaginal discharge that
occurs in children, the very
suspicion caused by foreign
objects. If there is infection,
especially by anaerobic bacteria,
purulent discharge may form. (12)
EXAMINATION SUPPORT
To assist in the diagnosis of sexually
transmitted infections, there are several
laboratory tests, namely:
• Wet specimen examination
(0.9% Nacl)
In this examination of the vaginal
discharge swab taken from the
posterior fornix mixed at Nacl
solution droplets on the glass
object. Microscopic examination of
wet preparations to see the
movement of trichomonas, PMN
leukocytes, vaginal epithelium.(16)
Examination of specimens should
not be postponed, since when it
has dried to change the outcome.
For exampleTrichomonas vaginalis
to lose motility when wet has dried
preparations, which is then difficult
to distinguish from leukocytes.
10x magnification for counting
leukocytes, epithelial cells, the
movement of Trichomonas vagi-
nalis and pseudohifa.
Greater magnification to see the
clue cells, Trichomonas vaginalis,
and blastospora. If found≥1
22
Vol.1 No.1 2012
Trichomonasvaginalis with the form
of a kite and move to say(+)
trichomoniasis. (4, 16, 17)
• Examination preparation 10%
KOH
Addition of KOH in wet pre-
parations to dissolve the epithelial
cells and make more visible
hyphae. Blastospora can also be
seen. If found ≥ 1 or blastospora
pseudohifa and said (+) vulvo-
vaginalis candidiasis. (4, 16, 17)
•
GramStaining
To manufacture these pre-
parations taken discharge smear
from the cervix and vagina. On
gram staining that examined the
number of PMN leukocytes and
epithelium, Candida (pseudohifa
and blastospora), diplococcus
intracellular gram negative. In
cervical smear if obtained ≥ 1
PMN-containing gram-negative
diplococcus with typical morpho-
logy, ≥ 5PMN/field of view of
immersion oil is said (+)
gonococcal infection. Vaginal
swabs from the discharge said (+)
if earned pseudohifa candida and
orblastospora, whereas bacterial
vaginosis was found morphotype
for lactobacil. (4, 12, 17)
• Whifftest / Amin test
At the end of the examination in
spekulo, speculum removed care-
fully and then the liquid was poured
speculum10% KOH solution. Are
sought on this exami-nation is fishy
odor or smell of amine were
detected after the addition of10%
KOH to vaginal discharge. (4, 17)
• Examination Vaginal Fluid pH
Vaginal discharge in the lateral part
of the vagina using pH indicator
paper. Checking the pH mustbe
careful to avoid contact with the
mucosal of the cervix have a high
pH.(17)
Monalisa
• Bacterial Culture Inspection
To see the bacterial aerobic and
anaerobic what is the cause of the
infection.
• Polymerase Chain Reaction
(PCR)
PCR is used to identify micro-
organisms that cause infections
with certainty. (4, 17)
COMPLICATION
• In trichomoniasis complications
that can happen is cystitis, skenitis
and Bartholin abscess. In pregnant
women can cause premature birth,
low birth weight. Infertility can
occur in Trichomonas vaginalis that
is transmitted through sexual
intercourse. In the vagina or cervix
in ascending infect the endo-
metrium, fallopian tubes and
adjacent structures causing pelvic
inflammatory disease and almost
always left sequele of scarring or
adhesions and infertility asa result.
(4, 7)
• In VVC most disturbing compli-
cation is recurrent infections,
especially in patients who have a
predisposition to infection. In
pregnant women the complications
that can occur spreading infection
to the upper(ascending infection)
and cause hematogenous dissemi-
nation. Babies born to mothers
who suffer VVC can be infected
through direct contact with
contaminated amniotic fluid or
direct contact through the birth
canal. (4, 6, 14)
• Complications of BV is an
increased risk of urinary tract
infection. High incidence of BV in
women with pelvic inflammatory
disease. Although no studies
showing that treatment of BV
reduce the risk of pelvic inflam-
matory disease later in life. (4, 13, 15)
23
Clinical Aspects Fluor Albus of Female and Treatment
• Complications common in cervisitis
gonorrhea is pelvic inflammatory
disease. It was about10-20% of
acute gonorrhea infection. Another
complication is bartholinitis. (4, 9)
TREATMENT
Management fluor albus depends on
the underlying cause of fluor albus.
• Treatment vaginal discharge
caused by Trichomonas aginalis
(Trichomoniasis).
The recommended therapy
is metronidazole 2 grams orally
single dose or tinidazole 2 g oral
single dose. As for the alternative
regimens can be administered
orally 2 x 500 mg metronidazole
for seven days, or tinidazole 2 x
500 mg for five days. (5,18)
Metronidazole has antiparasitic
and antimicrobial effects, which
are effective against tricho-
moniasis and some other obligate
bacteria. Randomized clinical
trials using metronidazole showed
90-95% cure rate, while the use
of tinidazole provide 86 - 100%
cure rate. Provision of therapy in
patients and sexual partners will
eliminate the symptoms, healing
microbiology and reduced trans-
mission. (5)
Metronidazole gel in the
treatment of trichomoniasis is less
effective than oral preparations.
Application of topical anti-mi-
crobials can not reach thera-
peutic levels in the urethra or
glans perivaginal, therefore the
use of topical preparations are
not recommended. However, in
patients with recurrent trichomo-
niasis with metronidazole therapy,
additional therapy can be given
topical therapy of intra-vaginal
metronidazole 500 mg every night
for 3-7 days. Follow-up after
therapy is not needed
IJDV Vol.1 No.1 2012

anymore when it does not have Recommended regimen :

symptoms. (18) • Miconazole or clotrimazole
Sexual partners of patients 200mg intravaginal /day 3
with trichomoniasis should also days
be treated. Patients are also • Clotrimazole 500 mg
advised to abstain from sexual intravaginal  single dose
relations until cured (treatment • Fluconazole 150 mg oral 
has been completed and the single dose
patient / asymptomatic sexual Alternative regimen :
partner). (18)
• Nystatin 100.000 IU intravaginal
/ day 14 days
Some special considerations that
Canadian Guideline 2008(19)
need to be considered on the following
conditions: • Azole Intravaginal 
Gestation Clotrimazole orMiconazole
• Fluconazole 150 mg oral 
Trichomonas vaginalis may cause single dose
complications in pregnancy such as
premature rupture of membranes, •
Sexually Transmitted Diseases
premature delivery and low birth weight. Treatment Guidelines 2006(5)
Therapy can eliminate symptoms vaginal Intravaginal :
discharge pregnant woman, preventing the
• Butoconazole 2% cream 5 g
infant genital infection. Provision of
intravaginal 3 days
metronidazole is not recommended in the
• Butoconazole 2% cream 5 g
first trimester of pregnancy, but canbe
(Butaconazole1-sustained
used on the second and the third
release), single intravaginal
trimesters. Minimum dose (2gr single oral
application
dose), whereas the incoming tinidazole
preformance category C.(5, 18) • Clotrimazole 1% cream 5 g
Lactating women treated with metro- intravaginal 7–14 days
nidazole, should stop breastfeeding during • Clotrimazole 100 mg vaginal
treatment and 12-24 hours after the last tablet  7 days
dose will reduce exposure to metro- • Clotrimazole 100 mg vaginal
nidazole in infants. While the use of tablet 2 tablet for 3 days
tinidazol breastfeeding cessation is • Miconazole 2% cream 5 g
recommended during therapy and 3 days intravaginal 7 days
after last dose.(5, 18) • Miconazole 100 mg vaginal
suppositoria, 1 suppositoria for
Allergy Or Intolerance 7 days
Metronidazole and tinidazole is a • Miconazole 200 mg vaginal
class of nitroimidazoles. Topical therapy supositoria, one suppositoria for
with drugs other than nitroimidazoles 3 days
group can try, but the cure rate is low • Miconazol 1,200 mg vaginal
(<50%). For example clotrimazole pesari supositoria, one suppositoria for
intravaginal 100mg for 6 days.(18) 1 day
• Fluor albus therapy caused by • Nystatin 100.000-unit vaginal
Candida albicans(Candidiasis tablet, one tablet for 14 days
Vulvovaginalis). • Tioconazole 6.5% ointment 5 g
WHO Guideline 2001(18) intravaginal in a single
application

24
Monalisa
• Terconazole 0.4% cream 5 g
intravaginal for 7 days
• Terconazole 0.8% cream 5 g
intravaginal for 3 days
• Terconazole 80 mg vaginal
suppositoria, 1 suppositoria for
3 hari
Oral :
• Fluconazole 150 mg oral
single dose
Patients are advised to control if the
symptoms persist or recur with in two
months after the initial symptoms. Clinical
signs and symptoms will disappear within
48-72 hours after therapy, and mycological
cure in 4-7 days after therapy.(5)VVC is not
transmitted through sexual contact, so it is
not recommended therapy of sexual
partners, unless the woman is having
recurrent infections. A small percentage of
male sexual partners of patients suffering
from balanitis characterized by ery-
thematous areas on the glans penis due to
pruritus or irritation.Therapy given to
relieve symptoms is a topical antifungal. (5)
Recurrent VVC is said when
symptoms repeated four times or more a
year. The cause of recurrence is still
unclear and most of th ewomen who
experienced it have no predisposing
factors or other factors underlying. Vaginal
culture examination should be performed
to confirm the clinical diagnosis and
identification of unusual species such as
species,especially C.nonalbicans glabrata.
Where these species are founding10-20%
of patients recurrent VVC.(6, 14)
The recommended therapy for
recurrent VVC are topical and oral therapy
azole short term as long as 7-14 days
topical/oral dose of fluconazole100 mg,
150 mg or 200mg every three days to
three doses to get the mycological
remission before starting maintenance
therapy. The first choice is oral
fluconazole(100mg, 150mg, 200mg) every
week for six months. If not available to be
replaced with clotrimazole 200 mg twice a
25
Clinical Aspects Fluor Albus of Female and Treatment
week, clotrimazole (vaginal supp 500 mg
once a week) or other topical therapy is
intermittent. Topical therapy effective for
reducing recurrent VVC.However, about
30-50% of women with recurrence afte
rcompletion of treatment maintenance.(5, 6,
12)
Some special conditions to consider :
Gestation
Vulvovaginal candidias is often occur
during pregnancy. Only topical groups
azole (for 7 days) is recommended for
pregnant women. (5, 14, 18)
Allergy, intolerance and side effects
Topical agents are generally not a
systemic effect, but local burning or
irritation may occur. Oral agents oc-
casionally cause nausea, abdominal pain
and headaches. Azole group of oral
therapy is rarely associated with abnormal
liver enzyme elevations. Clinically
important interactions with other drugs
may occur in astemizole class drugs,
calcium antagonists, cisapride, Coumadin,
cyclosporine A, oral hypoglycemic drugs,
phenytoin, protease inhibitors, tacrolimus,
terfenadine, theophylline, trimetrexate, and
rifampin. (5)
• Vulvovaginal candidiasis Nonalbicans
(19)
Most commonly caused by C. labrata,
hich is 10-100 times less susceptible
to azoles than C. albicans.
First Therapy :
• Boric acid 600 mg intravaginal
capsuleoncea day during 14
days (Efficacy 64-81%)
• Flusitocine crim 5 g
intravaginalonce a day during
14 days(Efficacy 90%)
• Amphotericine B 50 mg
intravaginal suppositoriaonce a
day during 14 days (Efficacy
80%)
IJDV
• Flusitocine 1gr + Ampothericine B
100 grcombination in lubricant
gel intravaginal once a day during
14 days(Efficacy 100%)
If recurrent symptoms:
• Boric acid 600mg intravaginal
capsuleoncea day during 14
days followed administration
boric acid for several weeks
• Nistatin 100.000 unit vaginal
supositoriaonce a day during 3-
6 months.
Immunocompromise patients
Patients with uncontrolled diabetes
mellitus or takingc orticosteroids do not
respond well to short-term therapy, so that
needs to be given conventional anti-fungal
longer(7-14 days). (5, 19)
• Fluor albus treatment caused by Gard-
nerella vaginalis and vaginal ana-
erobes.
Gardner after25 years shows that
only antimicrobial that has activity
against anaerobic bacteria are effective
in the treatment of bacterialvaginosis.
(15)
Indication of therapy on bacterial
vaginosis are :(5, 18)
1. All women are asymptomatic, preg-
nant or not.
2. Pregnant women who are asymp-
tomatic with a highrisk of premature
deliver.
3. Women who are asymptomatic
before a surgical procedure or
curettage.
Recommended regimen :
• Metronidazole 2 x 500 mg oral
 7 days
• Metronidazole gel 0,75%  1
application 5g intravaginal at
nightday 5 days
• Clindamycin krim 2%  1
application 5g intravaginal
nightday 7 days
26
Vol.1 No.1 2012
Alternative regimen :
• Metronidazole 2gr oral  single
dose
• Clindamycin 2 x 300mg oral  7
days
• Clindamycin ovula 100mg
intravaginal, nightday 3 days
The principle of management of bacterial
vaginosis(5, 13, 15, 18)
Clinical trials have shown that
intravaginal metronidazole gel 0.75% once
daily compared with twice daily showed
similar cure rates 1 month after therapy.
Bacterial vaginosis with metronidazole
therapy 2 gr single dose has the lowest
effectiveness for BV and so far no longer
recommended as well as for alternative
therapies. FDA recommends metro-
nidazole 750mg once daily for 7 days and
a single dose of clindamycin intravaginal
cream.
Clindamycine is an antimicrobial
derivative lincomisine, which works to
inhibit the synthesis of proteins with
bacteriostatic effect. Clindamycine and oil-
based cream may weaken condoms and
diaphragms. There was no difference in
cure rates between clindamycin cream
intravaginal with clindamycin ovules.
Several studies evaluating the clinical and
microbiological effectiveness of the use of
Lactobacillus intravaginal to restore
normal vaginal flora and BV treatment.
There are no data supporting the use
douching as a therapy to relieve
symptoms.(5)
Control is not recommended when
no complaints. For recurrent BV
metronidazole 500 mg canbe given orally
for 10-14 days or metronidazole gel 0.75%
one applicator 5 gr once a day
metronidazole intravaginal for 10 days
followed gel twice a week for 4-6
months.Therapy on sexual partners is
recommended and not to prevent
recurrence.(5,19)
Monalisa
Some special conditions to consider:
Gestation
Therapy aims to eliminate BV
symptoms and signs of infection, reduce
the risk of infectious complications in
pregnancy such as preterm labor,
premature rupture of membranes, amniotic
infection, postpartum endometritis. The
recommended therapy is oral metro-
nidazole for 7 days 2 x 500 mg or 3 x 250
mg orally for 7 days or 2 x 300mg oral
clindamycin for 7 days. Provision of
metronidazole in the first trimester is not
recommended. (5, 18, 20) Therapy of BV
should be initiated early in the second
trimester of pregnancy and should be
completed before the age of 16 weeks of
pregnancy. (20)
Allergy or Intolerance
Clindamycin intravaginal cream is
preferred in cases of allergy or tolerance
to metronidazole.
Intravaginal metronidazole gel canbe
considered for patients who do not tolerate
systemic metronidazole, but patients
allergic to oral metronidazole should not
be administered intravaginal metro-
nidazole. (5)
• Fluor albus treatment causedby
Neisseria gonorrhoeae :
Recommended therapy :
• Ciprofloxacin 500 mg oral
single dose
• Azitromycin 2 gr oral single
dose
• Ceftriaxone 125 mg
intramuscular single dose
• Cefixime 400 mg oral single
dose
• Spectinomycin 2 gr
intramuscular single dose
Alternative theraphy :
• Kanamycin 2 gr intramuscular
single dose
• Trimethoprime 80 mg / amoxycillin for 7days. Tetracycline,
sulfametoxazole 400 mg 10
27
Clinical Aspects Fluor Albus of Female and Treatment
tablet oral  single dose for 3
days
Many health centers also provide
therapy advocated for Neisseria gonor-
rhoeae to sexual partners. In this case it is
recommended to provide treatment to all
sexual partners within 60 days before the
diagnosis of gonorrhea. This kind of
therapy even in patients with asym-
ptomatic gonorrhea proven to give better
results.(9)Because all treatment regimens
recommended for gonorrhea have a cure
rate of almost 100%, then the culture
examination test for recovery criteria are
no longer needed. But the test of cure still
be necessary if patient adherence to
therapy is unknown. (9)
• Fluor albus treatment caused by
Chlamydia trachomatis
WHO Guideline :
Recommended therapy :
• Doxycycline 2 x 100mg oral  7
days
• Azithromycine 1gr oral single
dose
Alternative Regimen :
• Amoxycillin 3 x 500mg 7 days
• Erithromycin 4 x 500mg oral 
7 days
• Ofloxacine 2 x 300mg oral  7
days
• Tetracycline 4 x 500mg oral  7
days
Sexual partners should be examined
to assess the presence or absence of
urethritis, because it is often asymp-
tomatic. Failures in sexual partner
treatment can cause recurrence. Com-
pliance therapy in running for 7 days is
veryimportant. Chlamydia trachomatisis
resistant to treatment regimens has not
been found until now.(8, 13, 18)
The drugs recommended for
pregnant women is erythromycin 4 x 500
mg orally for 7 days, or 3 x 500 mg orally
doxycycline and other groups and
IJDV
ofloxacine are contraindicated in pregnant
women. Safety and efficacy of
azithromycin in pregnant and lactating
women is unknown. Erythromycin estolat
contraindicated during pregnancy because
of hepatotoxic, so only erythromycin or
erythromycin etil sucsinat sole that can be
used. (5, 18)
•
Fluor albus treatment caused by
a foreign object is to remove
foreign objects. In addition,
appropriate antibiotics canbe
given. (10)
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1. Wiraguna A, editor. Manajemen Terkini
Keputihan (Fluor albus) dan discar uretra.
Annual Scientific Meeting; 2010;
Yogyakarta. Fakultas Kedokteran
Universitas Gajah Mada.
2. Wiknjosastro H, Saifuddin AB, T R.
Radang dan Beberapa penyakit lain pada
alat genital wanita. Ilmu Kandungan.
Jakarta: Yayasan Bina Pustaka Sarwono
Prawirodihardjo; 1999. p. 271.
3. Dharmawan N, Muchtar SV, MD A. Fluor
Albus. In: Amiruddin MD, editor. Penyakit
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4. Murtiastutik D. Buku Ajar Infeksi Menular
Seksual. Surabaya: FK UNAIR RSU Dr.
Soetomo; 2008.
5. Gerberding JL. Sexually Transmitted
Diseases Treatment Guidelines. Atlanta:
Centers for Disease Control and
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