Genital Herpes Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Genital Herpes. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Genital Herpes Indian Medical PG Question 1: Which type of HSV is most commonly associated with recurrent genital herpes?
- A. HSV-2 (Correct Answer)
- B. HSV-1
- C. VZV (Varicella-Zoster Virus)
- D. CMV (Cytomegalovirus)
Genital Herpes Explanation: ***HSV-2***
- **HSV-2** is the primary cause of **genital herpes** and is significantly more likely to cause recurrent outbreaks than HSV-1 in the genital region.
- The virus establishes **latency in sacral ganglia**, leading to frequent reactivation and subsequent genital lesions.
*HSV-1*
- While **HSV-1** can cause **genital herpes** (often through oral-genital contact), it is more commonly associated with **oral herpes (cold sores)**.
- Genital infections caused by HSV-1 tend to recur less frequently and are generally less severe than those caused by HSV-2.
*VZV (Varicella-Zoster Virus)*
- **VZV** causes **chickenpox** (initial infection) and **shingles** (reactivation), not genital herpes.
- It establishes latency in **dorsal root ganglia** and reactivation presents as a dermatomal rash (shingles).
*CMV (Cytomegalovirus)*
- **CMV** is a common virus that usually causes **asymptomatic infection** in healthy individuals, but can cause severe disease in immunocompromised patients or neonates.
- It is not associated with genital lesions or recurrent genital herpes.
Genital Herpes Indian Medical PG Question 2: What is the characteristic microscopic finding in a Tzanck smear from a herpes lesion?
- A. Multinucleated giant cells (Correct Answer)
- B. Intracellular inclusion bodies
- C. Budding yeast cells
- D. Clue cells
Genital Herpes Explanation: ***Multinucleated giant cells***
- The presence of **multinucleated giant cells** (also called Tzanck cells or multinucleated keratinocytes) is the **most characteristic** cytological finding in a Tzanck smear from herpes simplex virus (HSV) or varicella-zoster virus (VZV) lesions.
- These giant cells with **2-15 nuclei** form due to **viral-induced cell fusion (syncytia formation)** and are readily identified on routine staining.
- This is the hallmark finding that makes Tzanck smear a useful rapid diagnostic test.
*Intracellular inclusion bodies*
- While **intranuclear inclusion bodies** (Cowdry type A inclusions) are indeed present in herpes infections, they are **less prominent** and require careful examination [1].
- These inclusions are **strictly intranuclear** (within the nucleus), appearing as eosinophilic inclusions surrounded by a clear halo [1].
- Although diagnostic when present, multinucleated giant cells are more readily identified and thus considered the characteristic finding on Tzanck smear.
*Budding yeast cells*
- **Budding yeast cells** are characteristic of fungal infections, most commonly *Candida* species.
- They are typically seen in conditions like candidiasis, not viral infections such as herpes.
*Clue cells*
- **Clue cells** are epithelial cells covered with bacteria, specifically *Gardnerella vaginalis*, and are a hallmark of **bacterial vaginosis**.
- They are not associated with viral vesicular lesions or herpes infections.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 366-367.
Genital Herpes Indian Medical PG Question 3: Which of the following statements about nucleic acid amplification tests (NAATs) for STIs is FALSE?
- A. They can be used for test of cure after 3 weeks
- B. They can detect dead organisms after treatment
- C. They can be used for pharyngeal gonorrhea screening
- D. They are less sensitive than culture for rectal chlamydia (Correct Answer)
Genital Herpes Explanation: ***They are less sensitive than culture for rectal chlamydia***
- This statement is **FALSE**. NAATs are generally **more sensitive** than culture methods for detecting *Chlamydia trachomatis* in all anatomical sites, including the rectum.
- The high sensitivity of NAATs allows for the detection of very low bacterial loads, making them the preferred diagnostic method for many STIs.
*They can be used for test of cure after 3 weeks*
- This statement is generally **true**. While a "test of cure" (TOC) is not routinely recommended for uncomplicated *Chlamydia* or *Gonorrhea* infections due to high treatment efficacy, it can be considered in specific circumstances (e.g., persistent symptoms, pregnancy, or use of alternative regimens).
- If a TOC is performed, it should ideally be done **no sooner than 3 weeks post-treatment** to minimize potential false positives from detecting residual nucleic acids from dead organisms.
*They can detect dead organisms after treatment*
- This statement is **true**. NAATs detect the **nucleic acids (DNA or RNA)** of the target organism.
- These nucleic acids can persist in the body for a period even after the organism has been killed by treatment, leading to a positive NAAT result despite successful eradication of the infection.
*They can be used for pharyngeal gonorrhea screening*
- This statement is **true**. NAATs are the **recommended method** for detecting *Neisseria gonorrhoeae* in extragenital sites, including the pharynx.
- Pharyngeal gonorrhea is often **asymptomatic**, making screening of at-risk individuals important for public health.
Genital Herpes Indian Medical PG Question 4: A 25-year-old woman is diagnosed with first-episode genital herpes. Which clinical feature best predicts the likelihood of frequent recurrences?
- A. Severe primary episode
- B. HSV-2 versus HSV-1 etiology (Correct Answer)
- C. Presence of prodromal symptoms
- D. Duration of lesions >10 days
Genital Herpes Explanation: ***HSV-2 versus HSV-1 etiology***
- **HSV-2 infections** are associated with significantly **higher recurrence rates** (typically 4-5 recurrences per year) compared to genital HSV-1 infections (approximately one recurrence every two years) [1].
- The **anatomical site** (genital vs. oral) and the **viral serotype** are key determinants of recurrence frequency [1].
*Severe primary episode*
- While a severe primary episode may indicate a higher viral load or a less robust immune response, it does **not reliably predict the frequency of future recurrences**.
- Its severity is more indicative of the **initial symptomatic presentation** rather than the long-term recurrence pattern [1].
*Presence of prodromal symptoms*
- **Prodromal symptoms** (e.g., tingling, itching) precede a recurrence but **do not predict the likelihood or frequency** of subsequent recurrences.
- They are an important patient cue for an impending outbreak, but not a prognostic factor for recurrence rate.
*Duration of lesions >10 days*
- The **duration of primary lesions** is characteristic of the initial infection's severity and the time taken for healing, but it does **not predict the frequency of future recurrences**.
- Longer lesion duration may reflect a more widespread or intense initial viral shedding, rather than persistent viral activity over time.
Genital Herpes Indian Medical PG Question 5: A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?
- A. Azithromycin 1g orally as single dose
- B. Benzathine penicillin G 2.4 million units IM
- C. Acyclovir 400mg orally TID for 7-10 days (Correct Answer)
- D. Doxycycline 100mg orally BID for 14 days
Genital Herpes Explanation: Acyclovir 400mg orally TID for 7-10 days
- The patient's presentation with painful genital ulcers and vesicles, fever, malaise, and tender inguinal lymphadenopathy is highly suggestive of primary herpes simplex virus (HSV) infection [1].
- Acyclovir is an antiviral medication that effectively reduces the duration and severity of symptoms in primary HSV outbreaks [1].
Azithromycin 1g orally as single dose
- Azithromycin is primarily used to treat bacterial infections, particularly chlamydia and gonorrhea, which typically present with urethritis or cervicitis, not painful vesicles.
- It is ineffective against viral infections such as HSV.
Benzathine penicillin G 2.4 million units IM
- Benzathine penicillin G is the treatment of choice for syphilis, which causes a painless chancre in its primary stage, not painful vesicles.
- This antibiotic has no efficacy against HSV.
Doxycycline 100mg orally BID for 14 days
- Doxycycline is an antibiotic used for various bacterial infections, including chlamydia, lymphogranuloma venereum, and granuloma inguinale [1].
- These conditions typically present with different clinical features (e.g., painless ulcers, buboes) and not the vesicular rash seen in HSV.
Genital Herpes Indian Medical PG Question 6: Which of the following is the MOST CRITICAL indication for Acyclovir use during pregnancy?
- A. Treatment of disseminated herpes (Correct Answer)
- B. Treatment of chickenpox in the first trimester
- C. Prophylaxis for recurrent herpes during pregnancy
- D. Prevention of cytomegalovirus infection in pregnancy
Genital Herpes Explanation: ***Treatment of disseminated herpes***
- **Disseminated herpes** in pregnancy is a severe, life-threatening condition for both the mother and the fetus, making acyclovir use critically indicated.
- This systemic infection can lead to **visceral organ involvement**, **encephalitis**, and significantly increased maternal and fetal morbidity and mortality.
- Immediate treatment with intravenous acyclovir is essential to prevent **multi-organ failure** and death.
*Treatment of chickenpox in the first trimester*
- While chickenpox in the first trimester can be serious, leading to **congenital varicella syndrome**, acyclovir's role here is primarily to mitigate maternal illness, not as critical as disseminated herpes.
- The risk of congenital varicella syndrome for the fetus is relatively low (around 0.4%) after maternal infection in the first trimester.
*Prophylaxis for recurrent herpes during pregnancy*
- **Prophylactic acyclovir** in the third trimester is commonly used to prevent recurrent genital herpes and reduce the risk of **neonatal herpes**, but it is not as acutely critical as treating disseminated disease.
- This intervention aims to prevent transmission during delivery rather than managing an immediate, life-threatening maternal or fetal condition.
*Prevention of cytomegalovirus infection in pregnancy*
- Acyclovir has **minimal activity against CMV** and is not indicated for CMV prevention or treatment.
- **Ganciclovir** or **valganciclovir** are the antivirals used for CMV, not acyclovir.
Genital Herpes Indian Medical PG Question 7: A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?
- A. Wait & watch
- B. Acyclovir & elective cesarean section (C-section) (Correct Answer)
- C. Acyclovir & allow spontaneous progression of labor
- D. Induction of labor
Genital Herpes Explanation: ***Acyclovir & elective cesarean section (C-section)***
- Active **genital herpetic lesions** at the time of delivery pose a significant risk of transmitting **herpes simplex virus (HSV)** to the neonate.
- **Acyclovir** can help suppress viral replication, but a **cesarean section** is necessary to prevent direct contact with the lesions during birth, which could lead to severe neonatal HSV infection.
*Wait & watch*
- This approach is inappropriate due to the high risk of **vertical transmission** of HSV to the neonate if lesions are active during vaginal delivery, potentially causing life-threatening complications.
- **Neonatal HSV** can result in significant morbidity and mortality, including neurological damage and disseminated disease.
*Acyclovir & allow spontaneous progression of labor*
- While **acyclovir** can reduce viral load, it does not completely eliminate the risk of transmission from active lesions during a vaginal birth.
- The primary concern is protecting the neonate from direct contact with the **active lesions** in the birth canal.
*Induction of labor*
- **Induction of labor** does not mitigate the risk of **vertical transmission** from active lesions during a vaginal delivery.
- The focus should be on preventing contact with the lesions, not on expediting vaginal birth once active lesions are present.
Genital Herpes Indian Medical PG Question 8: A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:
- A. Meningococci
- B. Streptococci
- C. HSV I
- D. HSV II (Correct Answer)
Genital Herpes Explanation: ***HSV II***
- **Herpes simplex virus type 2 (HSV-2)** is the most common cause of **neonatal herpes**, presenting with neurological manifestations like encephalitis and characteristic vesicular skin lesions.
- Transmission usually occurs during **vaginal delivery** from a mother with genital herpes, leading to widespread infection in the neonate.
*Meningococci*
- While *Neisseria meningitidis* can cause **meningitis** and **septicemia** in neonates, it does not typically produce vesicular skin lesions.
- Its infections are more commonly associated with a **petechial or purpuric rash**, not vesicles.
*Streptococci*
- **Group B Streptococcus (GBS)** is a leading cause of **neonatal sepsis and meningitis**, but it does not cause vesicular skin lesions.
- GBS typically presents with non-specific signs of sepsis or meningitis in neonates.
*HSV I*
- Although **herpes simplex virus type 1 (HSV-1)** can cause neonatal herpes, **HSV-2 remains the predominant cause** of vertically transmitted neonatal infection with encephalitis and disseminated disease.
- HSV-1 is more commonly associated with **oral herpes (cold sores)** in older children and adults, though its incidence in neonatal infection is increasing.
Genital Herpes Indian Medical PG Question 9: Which of the following genital ulcer diseases is LEAST likely to cause inguinal lymphadenopathy?
- A. Lymphogranuloma venereum
- B. Chancroid
- C. Granuloma inguinale (Correct Answer)
- D. Genital herpes
Genital Herpes Explanation: ***Granuloma inguinale***
- While ulcers are present, **granuloma inguinale** typically causes a **painless, progressive ulcerative lesion** and is notable for a lack of significant **lymphadenopathy** [1].
- Systemic manifestations are rare, and regional lymph node involvement, if present, is usually due to **secondary bacterial infection**.
*Lymphogranuloma venereum*
- Characterized by **painful inguinal lymphadenopathy** (buboes) developing weeks after a transient, often unnoticed, primary ulcer [1].
- The **buboes** can become fluctuant, rupture, and drain, a hallmark feature of the disease.
*Chancroid*
- Causes **painful genital ulcers** and frequently leads to **tender, unilateral inguinal lymphadenopathy** [1].
- The affected lymph nodes (buboes) can also become suppurative and may rupture.
*Genital herpes*
- Often presents with painful vesicular lesions that progress to ulcers, accompanied by **tender bilateral inguinal lymphadenopathy** [1], [2].
- The lymphadenopathy is typically more generalized and less likely to suppurate compared to chancroid or LGV.
Genital Herpes Indian Medical PG Question 10: Treatment of partner is required in all infection except:
- A. Trichomonas
- B. Herpes
- C. Gardnerella (Correct Answer)
- D. Candida
Genital Herpes Explanation: ***Gardnerella***
- **Gardnerella vaginalis** is a common inhabitant of the vaginal flora and its overgrowth causes **bacterial vaginosis**, which is not typically considered a sexually transmitted infection (STI) in the same way others are.
- While it can be transmitted sexually, treating the male partner has not been shown to prevent recurrence in the female; therefore, routine **partner treatment is generally not recommended**.
*Trichomonas*
- **Trichomoniasis** is a sexually transmitted infection caused by the parasite **Trichomonas vaginalis**. [1]
- **Partner treatment is essential** to prevent reinfection and interrupt the cycle of transmission, as asymptomatic infection is common. [1]
*Herpes*
- **Genital herpes** is caused by the **Herpes Simplex Virus (HSV)** and is highly transmissible sexually. [2]
- While treatment often focuses on managing symptoms in the infected individual, open communication and potential treatment or counseling for partners are crucial to prevent transmission and manage outbreaks.
*Candida*
- **Candidiasis** (yeast infection) is typically caused by an overgrowth of **Candida albicans**, a fungus naturally present in the body.
- While it is not strictly an STI, sexual activity can sometimes trigger or exacerbate symptoms, and in recurrent cases, treating a male partner might be considered, but **it's not routinely required** as it is for true STIs like trichomonas or chlamydia. [2]
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