Sexually Transmitted Infections — MCQs
Why is syndromic management of STIs particularly important in resource-limited settings?
A 20-year-old man presents with dysuria, urgency, and urethral discharge. Physical examination shows suppurative urethritis, with redness and swelling at the urethral meatus. Which of the following is the most likely etiology of urethritis in this patient?
Which of the following conditions is not caused by the Herpes simplex virus?
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 30-year-old male, Kallu, with a history of sexual exposure presents with a painless indurated ulcer over the penis with everted margins. The diagnosis is:
A man presents with a history of dysuria and urethral discharge after having unprotected sexual intercourse. What is the treatment of choice for this infection?
Which of the following statements about lymphogranuloma venereum (LGV) is NOT true?
In your STI clinic, standardized treatment kits are available for different conditions based on clinical presentation and likely pathogens. A 22-year-old female comes to the STI clinic with minimal vaginal discharge. On speculum examination, erosions are seen on the cervix. Which of the following treatment kit should be given to this patient?
The use of condoms for protection against sexually transmitted diseases qualifies as
What is the most commonly reported bacterial sexually transmitted infection?
Sexually Transmitted Infections Indian Medical PG Practice Questions and MCQs
Question 1: Why is syndromic management of STIs particularly important in resource-limited settings?
- A. It's more cost-effective than targeted therapy
- B. It prevents emergence of drug resistance
- C. It's more effective than etiologic diagnosis
- D. It allows treatment without waiting for laboratory confirmation (Correct Answer)
Explanation: ***It allows treatment without waiting for laboratory confirmation*** - **Syndromic management** enables immediate treatment based on clinical symptoms, which is crucial in settings where laboratory tests are **unavailable or delayed**. - This approach helps to **interrupt transmission** and prevent complications quickly, even without a definitive diagnosis. *It's more cost-effective than targeted therapy* - While syndromic management can be more cost-effective than extensive laboratory testing, its primary importance in resource-limited settings is not solely about cost but about **accessibility and timeliness of treatment**. - **Over-treatment with multiple drugs** can sometimes increase overall drug costs, but the benefit of prompt treatment often outweighs this. *It prevents emergence of drug resistance* - Syndromic management often involves the use of **broad-spectrum antibiotics** or multiple drugs, which can actually contribute to the **emergence of drug resistance** if not appropriate for the specific pathogen. - Preventing drug resistance is primarily addressed through **appropriate drug selection** and adherence to treatment guidelines, not inherently by the syndromic approach itself. *It's more effective than etiologic diagnosis* - **Etiologic diagnosis** (identifying the specific pathogen) is considered the gold standard for STI management as it allows for **targeted therapy** and better pathogen-specific treatment. - Syndromic management is a pragmatic approach used when etiologic diagnosis is not feasible, making it a **practical alternative**, not necessarily more effective.
Question 2: A 20-year-old man presents with dysuria, urgency, and urethral discharge. Physical examination shows suppurative urethritis, with redness and swelling at the urethral meatus. Which of the following is the most likely etiology of urethritis in this patient?
- A. Haemophilus ducreyi
- B. Chlamydia trachomatis
- C. Ureaplasma urealyticum
- D. Neisseria gonorrhoeae (Correct Answer)
Explanation: ***Neisseria gonorrhoeae*** - The presentation of **dysuria, urgency, urethral discharge**, and **suppurative urethritis** (purulent discharge with redness and swelling) is highly characteristic of **gonococcal urethritis** [1]. - **Gonorrhea** is a common cause of sexually transmitted urethritis, especially with prominent inflammatory signs [1]. *Haemophilus ducreyi* - This bacterium is the causative agent of **chancroid**, which typically presents as painful genital ulcers with regional lymphadenopathy. - It does not cause urethritis with significant urethral discharge as described. *Chlamydia trachomatis* - While *Chlamydia trachomatis* is a common cause of urethritis, it typically causes **non-gonococcal urethritis (NGU)**, which is often less symptomatic and may present with a thinner, mucoid discharge [1]. - The **suppurative (purulent) nature** of the discharge described points more strongly towards gonorrhea [1]. *Ureaplasma urealyticum* - *Ureaplasma urealyticum* is a known cause of **non-chlamydial, non-gonococcal urethritis**, similarly to *Chlamydia* [1]. - However, its presentation is generally milder and less suppurative than that caused by *Neisseria gonorrhoeae* [1].
Question 3: Which of the following conditions is not caused by the Herpes simplex virus?
- A. Gingivostomatitis
- B. Mollaret meningitis
- C. Herpes labialis
- D. Carcinoma of the cervix (Correct Answer)
Explanation: ***Carcinoma of the cervix*** - **Cervical cancer** is primarily caused by **Human Papillomavirus (HPV)**, not the Herpes simplex virus (HSV). - While HSV can cause genital lesions, it is **not oncogenic** for the cervix. *Gingivostomatitis* - **Acute herpetic gingivostomatitis** is a common manifestation of **primary Herpes simplex virus type 1 (HSV-1)** infection, particularly in children. - It causes painful blisters and ulcers in the mouth and gums. *Mollaret meningitis* - **Mollaret's meningitis** is a rare form of **recurrent aseptic meningitis** strongly associated with **Herpes simplex virus type 2 (HSV-2)** infection. - HSV-2 *DNA* can often be detected in the cerebrospinal fluid during episodes. *Herpes labialis* - Commonly known as **cold sores** or **fever blisters**, Herpes labialis is caused by **Herpes simplex virus type 1 (HSV-1)**. - It results in recurrent vesicular lesions on the lips and around the mouth.
Question 4: 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
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.
Question 5: A 30-year-old male, Kallu, with a history of sexual exposure presents with a painless indurated ulcer over the penis with everted margins. The diagnosis is:
- A. Granuloma inguinale
- B. Chancroid
- C. Lymphogranuloma venereum
- D. Syphilis (Correct Answer)
Explanation: ***Syphilis*** - The description of a **painless, indurated ulcer with everted margins** (a **chancre**) is the classic presentation of **primary syphilis** [1]. - **Sexual exposure** is the primary mode of transmission for *Treponema pallidum*, the causative agent. *Granuloma inguinale* - Characterized by **painless, progressive ulcerative lesions** without regional lymphadenopathy, often described as "beefy red." - The lesions caused by *Klebsiella granulomatis* are typically **friable** and do not present with the distinct induration and everted margins of a syphilitic chancre. *Chancroid* - Presents with **tender, painful genital ulcers** with irregular, undermined borders and often associated with **tender inguinal lymphadenopathy** [1]. - This contrasts sharply with the **painless** and **indurated** nature of the ulcer described in the patient. *Lymphogranuloma venereum* - Begins with a transient, **small, painless papule or ulcer** at the site of inoculation, which often goes unnoticed leading to delayed diagnosis. - The prominent feature is later development of **unilateral, painful inguinal lymphadenitis** (buboes) and associated systemic symptoms, which are not mentioned in this presentation.
Question 6: A man presents with a history of dysuria and urethral discharge after having unprotected sexual intercourse. What is the treatment of choice for this infection?
- A. Erythromycin
- B. Azithromycin
- C. Ceftriaxone (Correct Answer)
- D. Penicillin G
Explanation: ***Ceftriaxone*** - The combination of **dysuria** and **urethral discharge** following unprotected sexual intercourse is highly suggestive of **gonorrhea**. - **Ceftriaxone** is the recommended first-line treatment for uncomplicated gonococcal infections due to increasing antibiotic resistance. *Erythromycin* - Erythromycin is primarily used for atypical bacterial infections, such as those caused by *Mycoplasma pneumoniae* or *Chlamydia trachomatis*. - While it can be used for chlamydia, it is not the preferred treatment for suspected gonorrhea. *Azithromycin* - Azithromycin is often used in combination with ceftriaxone for gonorrhea to cover potential co-infection with **Chlamydia trachomatis**. - However, **monotherapy with azithromycin is not recommended for gonorrhea** due to concerns about emerging resistance and suboptimal efficacy. *Penicillin G* - Penicillin G was historically used to treat gonorrhea, but this is no longer the case due to widespread **resistance** of *Neisseria gonorrhoeae* strains. - Its primary use now is for susceptible bacterial infections, such as syphilis and certain streptococcal infections.
Question 7: Which of the following statements about lymphogranuloma venereum (LGV) is NOT true?
- A. Groove sign is characteristic
- B. Caused by C. trachomatis serovars L1, L2, L3
- C. Can lead to proctocolitis
- D. Primary genital ulcer is painful (Correct Answer)
Explanation: ***Primary genital ulcer is painful*** - The primary genital lesion of LGV, known as a **papule or shallow ulcer**, is typically **painless** and often resolves spontaneously without being noticed [1]. - Painful ulcers are more characteristic of other sexually transmitted infections like **herpes simplex virus (HSV)** or **chancroid** [1]. *Groove sign is characteristic* - The **groove sign**, characterized by enlarged inguinal and femoral lymph nodes separated by the inguinal ligament, is a **pathognomonic clinical feature** of LGV, particularly in later stages [1]. - This sign indicates extensive involvement of regional lymphatics. *Caused by C. trachomatis serovars L1, L2, L3* - LGV is indeed caused by specific **invasive serovars** of *Chlamydia trachomatis*, namely **L1, L2, and L3** [1]. - These serovars have a greater capacity for systemic dissemination and lymphatic tissue invasion compared to the serovars causing ocular or urogenital chlamydial infections. *Can lead to proctocolitis* - **Proctocolitis** (inflammation of the rectum and colon) can occur, especially in individuals engaging in **anal-receptive intercourse**, as the infection can directly involve the rectal mucosa [1]. - This can lead to symptoms such as **rectal pain, discharge, tenesmus, and bleeding** [1].
Question 8: In your STI clinic, standardized treatment kits are available for different conditions based on clinical presentation and likely pathogens. A 22-year-old female comes to the STI clinic with minimal vaginal discharge. On speculum examination, erosions are seen on the cervix. Which of the following treatment kit should be given to this patient?
- A. Green
- B. Red
- C. Grey (Correct Answer)
- D. Yellow
Explanation: ***Grey*** - A grey kit is indicated for **vaginal discharge** with associated **cervical erosions**, suggesting a treatable bacterial STI like gonorrhea or chlamydia. This kit typically contains antibiotics effective against these pathogens. - The presence of **minimal vaginal discharge** combined with **cervical erosions** points towards cervicitis, for which the grey kit is specifically designed. *Green* - The green kit is typically for the treatment of **vaginal discharge** without specific signs of cervicitis, often targeting common causes like **bacterial vaginosis** or **trichomoniasis**. - It would not specifically address the **cervical erosions** seen in this patient, which are more indicative of cervicitis. *Red* - The red kit is generally used for the treatment of **genital ulcers**, which are typically caused by **herpes simplex virus** or **syphilis**. - While there are erosions, the primary complaint is discharge, and erosions are not typically the sole indicator for a "genital ulcer" kit. *Yellow* - The yellow kit is often designated for **urethral discharge** in males, addressing conditions like **gonorrhea** or **chlamydia** when presenting as urethritis. - This patient is female and presents with **vaginal discharge** and **cervical erosions**, making the yellow kit inappropriate.
Question 9: The use of condoms for protection against sexually transmitted diseases qualifies as
- A. Primordial prevention
- B. Health promotion
- C. Secondary prevention
- D. Specific protection (Correct Answer)
Explanation: ***Specific protection*** - **Specific protection** involves measures aimed at preventing particular diseases by reducing exposure to their causes or by enhancing resistance against them. - Using condoms directly acts against the transmission of **sexually transmitted infections (STIs)**, thus making it a form of specific protection. *Primordial prevention* - **Primordial prevention** focuses on addressing underlying social and economic conditions that contribute to disease risk. - It targets **root causes** before risk factors for a disease even develop in the population. *Health promotion* - **Health promotion** is a broader concept that includes educational and environmental efforts to support healthy lifestyles and reduce overall disease risk. - While condom use could be part of a health promotion campaign, the act itself is a more targeted intervention. *Secondary prevention* - **Secondary prevention** involves early detection and prompt treatment of existing health problems to prevent their progression or complications. - This would include activities like **STI screening** and starting treatment after diagnosis, not preventing initial transmission.
Question 10: What is the most commonly reported bacterial sexually transmitted infection?
- A. HSV
- B. HIV
- C. Syphilis
- D. Chlamydia (Correct Answer)
Explanation: ***Correct: Chlamydia*** - **Chlamydia trachomatis** is the most frequently reported bacterial STI in many countries, often being **asymptomatic** and thus easily spread - Its high prevalence is due to efficient transmission and the widespread use of sensitive diagnostic tests that detect infections in asymptomatic individuals - Accounts for the majority of reported bacterial STI cases globally *Incorrect: HSV* - **Herpes Simplex Virus (HSV)** is a **viral STI**, not bacterial, and is characterized by recurrent outbreaks of **genital ulcers** or sores - While common, it does not qualify as a bacterial infection and is often not laboratory-confirmed due to mild or subclinical presentations *Incorrect: HIV* - **Human Immunodeficiency Virus (HIV)** is also a **viral STI**, not bacterial, that attacks the immune system leading to AIDS - Although highly impactful, HIV is not a bacterial infection and has lower incidence rates compared to Chlamydia *Incorrect: Syphilis* - **Syphilis**, caused by the bacterium **Treponema pallidum**, is a serious bacterial STI that can have long-term complications if untreated - While its incidence has been increasing in some regions, it is significantly less common than **Chlamydia** in terms of overall reported cases
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