Chancroid and Other Genital Ulcers — MCQs
A truck driver presented with a painless, demarcated ulcer on the penis and inguinal lymphadenopathy. What is the best method to visualize the motility of the most likely causative agent?
Which lymphogranuloma venereum complication is characterized by fusion of inguinal and femoral lymphadenopathy, separated by Poupart's ligament?
A 25-year-old man presents with multiple painful genital ulcers with undermined edges and suppurative lymphadenopathy. Gram stain shows 'school of fish' arrangement. What is the most appropriate initial treatment?
A 24-year-old woman presents with painful genital ulcers and lymphadenopathy. Tzanck smear shows multinucleated giant cells. What is the most appropriate initial treatment?
Which of the following best describes the appearance of a syphilitic chancre?
A patient presents with genital grouped vesicles, as shown in the image. What is the most likely causative organism?
A 25-year-old man presents with multiple painful genital ulcers with erythematous borders for 5 days. Physical examination reveals tender inguinal lymphadenopathy. Gram stain of ulcer exudate shows numerous polymorphonuclear leukocytes but no organisms. What is the most likely diagnosis?
A sex worker presents with purulent urethral discharge. Microscopy reveals gram-negative diplococci. What is the most likely diagnosis?
A 24-year-old man had been treated for gonorrhea 2 months previously. He developed an ulcerative lesion in the glands of the penis that is noted to be condylomata lata. The etiology of condylomata lata is which of the following?
A sex worker presents with a genital ulcer and gram-negative diplococci. What is the most likely diagnosis?
Chancroid and Other Genital Ulcers Indian Medical PG Practice Questions and MCQs
Question 1: A truck driver presented with a painless, demarcated ulcer on the penis and inguinal lymphadenopathy. What is the best method to visualize the motility of the most likely causative agent?
- A. Fluorescent microscopy
- B. Light microscopy
- C. Dark field microscopy (Correct Answer)
- D. Electron microscopy
Explanation: ***Dark field microscopy*** - The symptoms (painless, demarcated penile ulcer and inguinal lymphadenopathy) are highly suggestive of **primary syphilis**, caused by *Treponema pallidum*. - **Dark field microscopy** is the gold standard for visualizing the characteristic **corkscrew motility** of *T. pallidum* directly from lesion exudate. *Fluorescent microscopy* - This technique uses **fluorochromes** to stain structures and is often used in **immunofluorescence** assays to detect antibodies or antigens. - While useful for some microbial identification, it is not the primary method for visualizing the motility of *Treponema pallidum*. *Light microscopy* - Standard light microscopy has **insufficient resolution** to clearly visualize the thin, coiled spirochetes of *Treponema pallidum* or their motility. - The organisms are generally **too small and refractile** to be easily seen without specialized illumination. *Electron microscopy* - Provides extremely **high resolution** and is used for studying viral structures or detailed cellular ultrastructure. - It is **not practical** for routine clinical diagnosis, especially for live, motile bacteria, and is not used to observe motility.
Question 2: Which lymphogranuloma venereum complication is characterized by fusion of inguinal and femoral lymphadenopathy, separated by Poupart's ligament?
- A. Bubo
- B. Pseudobuboes
- C. Phagedenic ulceration
- D. Groove sign (Correct Answer)
Explanation: ***Groove sign*** - The **groove sign** is a classic but rare complication seen in **lymphogranuloma venereum (LGV)**, characterized by separation of enlarged inguinal and femoral lymph node groups by the **inguinal ligament (Poupart's ligament)**. - This pathognomonic sign occurs when matted lymph nodes both above and below the inguinal ligament create a groove-like depression, forming the characteristic "groove of Poupart." - Seen in approximately 10-20% of LGV cases with inguinal syndrome. *Bubo* - A **bubo** is a swollen, inflamed lymph node commonly seen in **lymphogranuloma venereum** during the secondary (inguinal) stage. - While LGV causes buboes, the groove sign specifically refers to the anatomical pattern of lymphadenopathy separated by the inguinal ligament, not just any bubo. *Pseudobuboes* - **Pseudobuboes** are subcutaneous granulomatous lesions that mimic lymph node swelling but are not true lymphadenopathy. - These can occur in LGV but represent extension of infection into subcutaneous tissue rather than the specific pattern of inguinal-femoral node separation. *Phagedenic ulceration* - **Phagedenic ulceration** refers to rapidly spreading, destructive ulceration that can occur as a complication of genital ulcer diseases. - While this can occur in severe LGV, it describes the primary lesion progression, not the characteristic lymphadenopathy pattern of the groove sign.
Question 3: A 25-year-old man presents with multiple painful genital ulcers with undermined edges and suppurative lymphadenopathy. Gram stain shows 'school of fish' arrangement. What is the most appropriate initial treatment?
- A. Erythromycin 500mg QID for 7 days
- B. Azithromycin 1g single dose (Correct Answer)
- C. Ceftriaxone 250mg IM single dose
- D. Doxycycline 100mg BD for 7 days
Explanation: ***Azithromycin 1g single dose*** - This presentation is highly suggestive of **chancroid**, caused by *Haemophilus ducreyi*. **Azithromycin 1g single dose** is a highly effective and convenient treatment as recommended by CDC guidelines. - The **"school of fish"** gram stain appearance and **painful genital ulcers with undermined edges** are classic features of chancroid [1], making azithromycin the most appropriate initial therapy. *Erythromycin 500mg QID for 7 days* - While **erythromycin** is an effective treatment for chancroid, the **multi-day regimen** makes it less convenient and potentially lowers adherence compared to a single-dose option. - This regimen is less preferred as a first-line initial treatment given the availability of single-dose options for chancroid. *Ceftriaxone 250mg IM single dose* - **Ceftriaxone IM** is the preferred treatment for uncomplicated **gonorrhea** and is also used for **syphilis**, but it is **not the primary treatment for chancroid**. - While it has some activity against *Haemophilus ducreyi*, azithromycin or ciprofloxacin are generally more effective and recommended for chancroid. *Doxycycline 100mg BD for 7 days* - **Doxycycline** is the treatment of choice for **chlamydia** and **syphilis**, but it is **not the recommended first-line treatment for chancroid**. - Its efficacy against *Haemophilus ducreyi* is not as reliable as macrolides or fluoroquinolones for chancroid.
Question 4: A 24-year-old woman presents with painful genital ulcers and lymphadenopathy. Tzanck smear shows multinucleated giant cells. What is the most appropriate initial treatment?
- A. Acyclovir 400mg TID for 7-10 days
- B. Acyclovir 200mg 5 times daily for 7-10 days
- C. Famciclovir 250mg TID for 7-10 days
- D. Valacyclovir 1g BD for 7-10 days (Correct Answer)
Explanation: ***Valacyclovir 1g BD for 7-10 days*** - This is the recommended initial treatment for **genital herpes simplex virus (HSV)** infections, especially for the **first clinical episode**. [1] - Valacyclovir offers a more convenient twice-daily dosing compared to acyclovir due to its **better bioavailability**. *Acyclovir 400mg TID for 7-10 days* - This regimen is often used for **suppressive therapy** or less severe recurrent outbreaks of genital herpes, not typically for initial severe presentations. - While acyclovir is effective, higher doses or more frequent dosing are usually recommended for the initial episode's acute treatment. *Acyclovir 200mg 5 times daily for 7-10 days* - This is an appropriate initial treatment regimen for the **first clinical episode of genital herpes**. [1] - However, valacyclovir offers better patient adherence due to less frequent dosing without compromising efficacy. *Famciclovir 250mg TID for 7-10 days* - Famciclovir is an effective antiviral for genital herpes, but the recommended dose for an initial episode is typically higher (e.g., 250 mg three times a day for 7-10 days or 500 mg twice a day for 7 days). [1] - Like valacyclovir, it's a prodrug of penciclovir, but valacyclovir generally has a more preferred dosing schedule for convenience.
Question 5: Which of the following best describes the appearance of a syphilitic chancre?
- A. Painful, purulent ulcer with ragged edges
- B. Painless, clean-based ulcer with indurated edges (Correct Answer)
- C. Vesicular lesions in clusters
- D. Papular lesions with central umbilication
Explanation: ***Painless, clean-based ulcer with indurated edges*** - A **syphilitic chancre** is typically a **painless ulcer**, which is a key diagnostic feature distinguishing it from other genital lesions. - It has a characteristic **clean base** and **firm, raised (indurated) edges** due to the inflammatory infiltrate. *Painful, purulent ulcer with ragged edges* - This description is more indicative of a **chancroid**, caused by *Haemophilus ducreyi*, which presents with **painful, ragged-edged ulcers** that often have a purulent base. - Chancroids typically cause **tender inguinal lymphadenopathy**, unlike the firm, non-tender lymphadenopathy associated with primary syphilis. *Vesicular lesions in clusters* - This appearance is characteristic of **genital herpes**, caused by the **herpes simplex virus (HSV)**. - Herpes lesions begin as painful vesicles that rupture to form ulcers, often recurring in the same area. *Papular lesions with central umbilication* - These lesions are typical of **molluscum contagiosum**, a viral infection. - Molluscum lesions are flesh-colored, dome-shaped papules with a distinctive **central umbilication** or dimple.
Question 6: A patient presents with genital grouped vesicles, as shown in the image. What is the most likely causative organism?
- A. Herpes simplex virus (Correct Answer)
- B. Haemophilus
- C. Klebsiella
- D. Treponema
Explanation: ***Herpes*** - The image shows **grouped vesicles** on an erythematous base, which is the classic presentation of **genital herpes** caused by the **Herpes simplex virus (HSV)**. - These lesions are typically painful and can recur, indicating a viral etiology. *Haemophilus* - *Haemophilus ducreyi* causes **chancroid**, which presents as **painful genital ulcers** with ragged borders and often associated with inguinal lymphadenopathy. - It does not present as grouped vesicles. *Klebsiella* - *Klebsiella granulomatis* causes **donovanosis (granuloma inguinale)**, characterized by progressive, **painless ulcerative lesions** that are highly vascular and bleed easily. - This organism does not cause vesicular lesions. *Treponema* - *Treponema pallidum* causes **syphilis**, which in its primary stage presents as a **painless chancre** (a solitary ulcer) or in secondary stage as a diffuse rash. - It does not cause grouped vesicles.
Question 7: A 25-year-old man presents with multiple painful genital ulcers with erythematous borders for 5 days. Physical examination reveals tender inguinal lymphadenopathy. Gram stain of ulcer exudate shows numerous polymorphonuclear leukocytes but no organisms. What is the most likely diagnosis?
- A. Chancroid (Correct Answer)
- B. Primary syphilis
- C. Genital herpes
- D. Lymphogranuloma venereum
Explanation: ***Chancroid*** - Presents with **multiple, painful genital ulcers** with **erythematous borders** and **tender inguinal lymphadenopathy**. - **Gram stain showing numerous polymorphonuclear leukocytes** without identifiable organisms is characteristic, as *Haemophilus ducreyi* is difficult to visualize on Gram stain but causes an intense inflammatory response. *Primary syphilis* - Characterized by a **single, painless ulcer (chancre)**, in contrast to the painful multiple ulcers described. - While lymphadenopathy can be present, it is typically **non-tender and rubbery**, unlike the tender nodes in this case. *Genital herpes* - Typically presents as **multiple, painful vesicles that rupture to form shallow ulcers**, often preceded by prodromal symptoms like tingling. - While it can cause painful ulcers and lymphadenopathy, the presence of numerous PMNs without viral cytopathic effects on Gram stain makes it less likely. *Lymphogranuloma venereum* - Initially presents as a **painless, transient papule or ulcer** that often goes unnoticed, followed by significant, often unilateral, **inguinal lymphadenopathy (buboes)**. - The ulcers described here are multiple and painful from the outset, which is inconsistent with the typical presentation of LGV.
Question 8: A sex worker presents with purulent urethral discharge. Microscopy reveals gram-negative diplococci. What is the most likely diagnosis?
- A. Gonorrhea (Correct Answer)
- B. Syphilis
- C. Chancroid
- D. Lymphogranuloma venereum
Explanation: ***Gonorrhea*** - The presence of **purulent urethral discharge** and **Gram-negative diplococci** on microscopy is pathognomonic for Neisseria gonorrhoeae infection [1]. - This clinical presentation in a **sex worker** further increases the likelihood of a sexually transmitted infection like gonorrhea [1]. *Syphilis* - Caused by *Treponema pallidum*, it typically presents with a **painless chancre** in the primary stage, not urethral discharge. - Diagnosis is usually made by **serological tests** or darkfield microscopy, not Gram stain of discharge. *Chancroid* - Caused by *Haemophilus ducreyi*, it presents with **painful genital ulcers** and often **inguinal lymphadenopathy**. - Microscopy would show Gram-negative rods in a "school of fish" arrangement, not diplococci. *Lymphogranuloma venereum* - Caused by specific serovars of *Chlamydia trachomatis*, it initially presents with a **transient, often unnoticed, genital lesion**, followed by painful **inguinal lymphadenopathy (buboes)**. - Diagnosis is typically by nucleic acid amplification tests (NAAT) from bubo aspirate, not Gram stain of urethral discharge.
Question 9: A 24-year-old man had been treated for gonorrhea 2 months previously. He developed an ulcerative lesion in the glands of the penis that is noted to be condylomata lata. The etiology of condylomata lata is which of the following?
- A. Herpesvirus hominis, type II
- B. Hemophilus ducreyi
- C. Mixture of organisms
- D. Treponema pallidum (Correct Answer)
Explanation: ***Treponema pallidum*** - **Condylomata lata** are characteristic lesions of **secondary syphilis**, caused by *Treponema pallidum* [1]. - They are typically broad, flat, moist, wart-like lesions that occur in warm, moist areas such as the anogenital region [1]. *Herpesvirus hominis, type II* - Herpesvirus hominis, type II (HSV-2) causes **genital herpes**, which manifests as painful vesicles that ulcerate [1]. - The lesions caused by HSV-2 are typically clustered, vesicular, and very painful, which is distinct from the hypertrophic, non-painful nature of condylomata lata [1]. *Hemophilus ducreyi* - *Hemophilus ducreyi* is the causative agent of **chancroid**, which presents as painful, soft ulcers with ragged, undermined borders, often accompanied by painful inguinal lymphadenopathy. - Chancroid lesions are typically destructive and highly painful, contrasting with the proliferative and less painful nature of condylomata lata. *Mixture of organisms* - While some sexually transmitted infections can involve coinfection, **condylomata lata** specifically point to a single etiological agent: *Treponema pallidum* [1]. - Attributing condylomata lata to a "mixture of organisms" is too vague and inaccurate given the specific morphology and strong association with syphilis [1].
Question 10: A sex worker presents with a genital ulcer and gram-negative diplococci. What is the most likely diagnosis?
- A. H. ducreyi
- B. N. gonorrhoeae (Correct Answer)
- C. C. trachomatis
- D. T. pallidum
Explanation: N. gonorrhoeae - The presence of **gram-negative diplococci** from a genital ulcer is highly characteristic of *Neisseria gonorrhoeae* infection [1]. - While more commonly associated with urethritis [1] or cervicitis, *N. gonorrhoeae* can also present with **genital ulcers**, particularly if there is co-infection or atypical presentation. *H. ducreyi* - *Haemophilus ducreyi* causes **chancroid**, which presents with **painful genital ulcers** and often tender inguinal lymphadenopathy. - However, *H. ducreyi* is a **gram-negative coccobacillus**, not a diplococcus, and typically forms "school of fish" arrangements on Gram stain. *C. trachomatis* - *Chlamydia trachomatis* can cause **genital ulcers** (e.g., lymphogranuloma venereum serovars L1-L3), but it is an **obligate intracellular bacterium** and cannot be visualized on Gram stain as diplococci [1]. - Gram staining for *Chlamydia* would not show distinct bacterial morphology [1]. *T. pallidum* - *Treponema pallidum* causes **syphilis**, which presents with a **painless chancre** (genital ulcer) in its primary stage. - *Treponema pallidum* is a **spirochete** and is too thin to be seen on Gram stain; it is typically identified via **dark-field microscopy** or serological tests.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free