Venerology — MCQs
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What is the most common genital lesion observed in patients with HIV?
What is the drug of choice for secondary syphilis in pregnant women?
Condylomata lata are seen in which stage of syphilis?
A 28-year-old female presented with a syphilitic chancre and was treated with Inj. Benzathine penicillin G, 2.4 million units intramuscularly as a single dose. After initial treatment, she was screened at 6-month intervals and was found to be still seropositive. Which of the following treatment regimens would you recommend?
A 45-year-old male with a history of unprotected sexual intercourse 15 years ago presents with what pupillary condition?
What is the drug of choice for Lymphogranuloma venereum (LGV)?
Which of the following is not a sexually transmitted disease?
What is the dosage of benzyl penicillin in the treatment of primary syphilis?
Chancroid is caused by?
Genital herpes is caused by which virus?
Venerology Indian Medical PG Practice Questions and MCQs
Question 91: What is the most common genital lesion observed in patients with HIV?
- A. Chlamydia
- B. Herpes (Correct Answer)
- C. Syphilis
- D. Candida
Explanation: **Explanation:** The correct answer is **Herpes (HSV-2)**. In patients living with HIV, **Herpes Simplex Virus (HSV)** is the most common cause of genital ulcer disease (GUD) worldwide [1]. There is a synergistic relationship between the two viruses: HIV-induced immunosuppression leads to more frequent, severe, and persistent herpetic outbreaks, while the open ulcers caused by HSV provide a portal of entry that increases the risk of HIV transmission and acquisition. **Analysis of Options:** * **B. Herpes (Correct):** Studies consistently show that HSV-2 is the most prevalent co-infection and the leading cause of genital lesions in HIV-positive individuals [1]. In advanced HIV, these lesions may become "chronic" (lasting >1 month), which is an AIDS-defining illness. * **A. Chlamydia:** While common as a cause of urethritis or cervicitis, it typically presents as a discharge rather than a visible external "genital lesion" (except for the rare Lymphogranuloma Venereum strain). * **C. Syphilis:** *Treponema pallidum* causes genital ulcers (chancre), and while its incidence is rising among HIV-positive populations, it remains less common than HSV [1]. * **D. Candida:** Candidiasis is a very common opportunistic fungal infection in HIV (especially oral thrush), and while it can cause balanitis or vulvovaginitis, it is not the most common cause of a primary genital lesion compared to HSV. **High-Yield Clinical Pearls for NEET-PG:** * **AIDS-Defining Condition:** A chronic herpetic ulcer (mucocutaneous) persisting for more than **1 month** is an AIDS-defining illness. * **Atypical Presentation:** In HIV patients, HSV may present as large, deep, "punched-out" necrotic ulcers or even hypertrophic/verrucous lesions that mimic malignancy. * **Treatment:** Acyclovir is the drug of choice, but higher doses or longer durations are often required. Be aware of **Acyclovir-resistant HSV** in non-responsive cases (treated with Foscarnet).
Question 92: What is the drug of choice for secondary syphilis in pregnant women?
- A. Doxycycline
- B. Benzathine Penicillin (Correct Answer)
- C. Ceftriaxone
- D. Cotrimoxazole
Explanation: **Explanation:** **1. Why Benzathine Penicillin is Correct:** Benzathine Penicillin G (BPG) is the gold standard and the **only** recommended treatment for syphilis during pregnancy. It is highly effective at treating maternal infection and, crucially, it crosses the placenta to prevent or treat congenital syphilis in the fetus. For secondary syphilis (which falls under early syphilis), a single intramuscular dose of **2.4 million units** is the standard regimen. **2. Why the Other Options are Incorrect:** * **Doxycycline:** While used as an alternative in non-pregnant patients allergic to penicillin, it is **contraindicated in pregnancy** due to the risk of fetal tooth discoloration and bone growth inhibition (Tetracycline group). * **Ceftriaxone:** Although it has some anti-treponemal activity, it is not the first line. There is insufficient data regarding its efficacy in preventing congenital syphilis compared to penicillin. * **Cotrimoxazole:** This drug has no activity against *Treponema pallidum* and is used for conditions like UTI or PCP prophylaxis. **3. Clinical Pearls for NEET-PG:** * **Penicillin Allergy in Pregnancy:** If a pregnant woman with syphilis is allergic to penicillin, the mandatory next step is **Skin Testing and Desensitization**, followed by treatment with Benzathine Penicillin. No other drug is an acceptable substitute in pregnancy. * **Jarisch-Herxheimer Reaction:** Warn patients about this acute febrile reaction occurring within 24 hours of treatment. In pregnancy, it can trigger preterm labor or fetal distress, necessitating fetal monitoring. * **Staging:** Early syphilis (Primary, Secondary, Early Latent) requires **one dose** of BPG. Late Latent or syphilis of unknown duration requires **three doses** at weekly intervals [1].
Question 93: Condylomata lata are seen in which stage of syphilis?
- A. Congenital syphilis
- B. Primary syphilis
- C. Secondary syphilis (Correct Answer)
- D. Tertiary syphilis
Explanation: **Explanation:** **Condylomata lata** are highly infectious, moist, flat-topped, wart-like papules found in intertriginous areas (like the anogenital region or axilla) [1]. They are a hallmark clinical feature of **Secondary Syphilis** [1]. 1. **Why Secondary Syphilis is correct:** Secondary syphilis represents the hematogenous dissemination of *Treponema pallidum*. It typically occurs 4–10 weeks after the initial infection. This stage is characterized by systemic symptoms, generalized lymphadenopathy, and mucocutaneous lesions [1]. Condylomata lata develop due to the accumulation of treponemes in warm, moist skin folds, leading to local inflammatory hypertrophy [1]. 2. **Why other options are incorrect:** * **Primary Syphilis:** Characterized by the **chancre**, a painless, indurated ulcer at the site of inoculation [1]. * **Tertiary Syphilis:** Characterized by **gummas** (granulomatous lesions), cardiovascular syphilis (aortitis), and neurosyphilis (tabes dorsalis) [1]. * **Congenital Syphilis:** Presents with features like snuffles, Hutchinson’s teeth, Mulberry molars, and Sabre shin. While skin lesions occur, condylomata lata are specifically associated with the acquired secondary stage. **High-Yield Clinical Pearls for NEET-PG:** * **Condyloma Lata vs. Condyloma Acuminata:** Do not confuse them. Lata is seen in **Syphilis** (flat/broad); Acuminata is caused by **HPV 6 and 11** (pedunculated/cauliflower-like). * **Serology:** Secondary syphilis is the stage where non-treponemal tests (VDRL/RPR) reach their highest titers. * **Other Secondary features:** Maculopapular rash (involving palms and soles) [1],
Question 94: A 28-year-old female presented with a syphilitic chancre and was treated with Inj. Benzathine penicillin G, 2.4 million units intramuscularly as a single dose. After initial treatment, she was screened at 6-month intervals and was found to be still seropositive. Which of the following treatment regimens would you recommend?
- A. Inj. Benzathine penicillin G, 2.4 million units intramuscularly, single dose
- B. Inj. Benzathine penicillin G, 2.4 million units intramuscularly, twice daily for 1 week
- C. Inj. Benzathine penicillin G, 2.4 million units intramuscularly, twice weekly for 3 weeks
- D. Inj. Benzathine penicillin G, 2.4 million units intramuscularly, weekly for 3 weeks (Correct Answer)
Explanation: ### Explanation **1. Understanding the Correct Answer (Option D)** The patient in the scenario is experiencing **Serofast State** or a potential treatment failure. According to the CDC and WHO guidelines, for primary syphilis (chancre), the initial treatment is a single dose of Benzathine Penicillin G (2.4 MU). Patients are monitored using non-treponemal tests (RPR/VDRL). [1] If the titers fail to decline fourfold (2 dilutions) within 6–12 months, or if the patient remains seropositive at a high titer, it is classified as a "treatment failure" or "seroresistance." In such cases, if neurosyphilis is ruled out, the recommended management is to **re-treat** the patient using the regimen for **Late Latent Syphilis**: **Benzathine Penicillin G, 2.4 million units IM, once weekly for 3 consecutive weeks.** **2. Why Other Options are Incorrect** * **Option A:** This is the standard treatment for *primary, secondary, or early latent* syphilis. Since the patient remained seropositive after this regimen, repeating the same single dose is insufficient for a suspected treatment failure. * **Option B:** Benzathine Penicillin is a long-acting depot preparation. Giving it twice daily is pharmacologically incorrect and would lead to toxicity without therapeutic benefit. * **Option C:** The standard interval for syphilis treatment is **weekly**, not twice weekly. Deviating from the 7-day interval disrupts the required continuous treponemicidal levels of penicillin in the blood. **3. High-Yield Clinical Pearls for NEET-PG** * **Jarisch-Herxheimer Reaction:** An acute febrile reaction occurring within 24 hours of starting syphilis treatment (most common in secondary syphilis) [1]. It is managed with antipyretics, not by stopping penicillin. * **Treatment of Choice:** Penicillin G remains the gold standard for all stages of syphilis. * **Neurosyphilis:** Requires **Aqueous Crystalline Penicillin G** (18–24 million units IV daily) for 10–14 days. * **Penicillin Allergy in Pregnancy:** Desensitization is mandatory; Doxycycline is contraindicated.
Question 95: A 45-year-old male with a history of unprotected sexual intercourse 15 years ago presents with what pupillary condition?
- A. Accommodation reflex negative, and pupillary reaction positive
- B. Accommodation reflex positive, and pupillary reaction negative (Correct Answer)
- C. Accommodation reflex positive, and pupillary reaction positive
- D. Accommodation reflex negative, and pupillary reaction negative
Explanation: ***Accommodation reflex positive, and pupillary reaction negative*** - This describes **Argyll Robertson pupil**, a classic sign of **tertiary neurosyphilis** in patients with long-standing untreated syphilis infection. - The **accommodation reflex remains intact** (pupil constricts for near vision) while the **pupillary light reflex is lost** (no response to light). *Accommodation reflex negative, and pupillary reaction positive* - This pattern is **not characteristic** of any specific neurological condition and does not match **tertiary syphilis**. - **Accommodation dysfunction** with intact light reflex is uncommon and would suggest different pathology. *Accommodation reflex positive, and pupillary reaction positive* - This describes **normal pupillary function** with both reflexes intact, ruling out neurosyphilis. - A patient with **15-year untreated syphilis** would be expected to have neurological complications, not normal findings. *Accommodation reflex negative, and pupillary reaction negative* - This represents **complete pupillary denervation** seen in severe **third cranial nerve palsy** or **pharmacological blockade**. - Does not match the specific pattern of **Argyll Robertson pupil** characteristic of tertiary syphilis.
Question 96: What is the drug of choice for Lymphogranuloma venereum (LGV)?
- A. Doxycycline (Correct Answer)
- B. Ampicillin
- C. Erythromycin
- D. Ceftriaxone
Explanation: **Lymphogranuloma venereum (LGV)** is a sexually transmitted infection caused by the **L1, L2, and L3 serovars of *Chlamydia trachomatis***. It typically presents in three stages: a painless primary lesion, a painful secondary stage characterized by regional lymphadenopathy (the "Groove sign"), and a tertiary stage involving chronic inflammation and proctocolitis [1]. 1. **Why Doxycycline is correct:** **Doxycycline (100 mg orally twice daily for 21 days)** is the established **drug of choice** for LGV. Tetracyclines are highly effective against intracellular organisms like *Chlamydia* [1]. The extended 3-week duration is necessary to ensure complete eradication and prevent the late-stage complications of lymphatic destruction and fibrosis. 2. **Why the other options are incorrect:** * **Ampicillin:** This is a beta-lactam antibiotic. *Chlamydia* lacks a traditional peptidoglycan cell wall, making cell-wall synthesis inhibitors like Ampicillin ineffective. * **Erythromycin:** While Erythromycin (500 mg four times daily for 21 days) is an effective alternative for patients who cannot tolerate tetracyclines (e.g., pregnant women), it is not the first-line treatment due to gastrointestinal side effects and a more frequent dosing schedule. * **Ceftriaxone:** This is the drug of choice for *Neisseria gonorrhoeae* and Chancroid, but it has no clinical activity against *C. trachomatis* [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Groove Sign:** Pathognomonic for LGV; it refers to the inguinal ligament dividing matted, enlarged matted lymph nodes (inguinal and femoral). * **Alternative in Pregnancy:** Erythromycin base is the preferred treatment for LGV in pregnant and lactating women. * **Azithromycin:** While a single dose of Azithromycin (1g) treats uncomplicated urethritis/cervicitis (*Serovars D-K*), it is **not** the first-line recommendation for LGV; Doxycycline remains superior for the L-serovars.
Question 97: Which of the following is not a sexually transmitted disease?
- A. Hepatitis A virus (Correct Answer)
- B. Human Papillomavirus (HPV)
- C. Human Immunodeficiency Virus (HIV)
- D. Hepatitis B virus
Explanation: The classification of a Sexually Transmitted Disease (STD) depends on the primary mode of transmission. [1] **1. Why Hepatitis A Virus (HAV) is the correct answer:** Hepatitis A is primarily transmitted via the **fecal-oral route**, usually through contaminated food or water. While it can occasionally be transmitted during sexual activity (specifically through oro-anal contact), it is clinically classified as an **enteric pathogen** rather than a classic STD. Unlike the other options, sexual contact is not its primary or defining mode of spread. **2. Analysis of Incorrect Options:** * **Human Papillomavirus (HPV):** This is the most common viral STD worldwide. It is transmitted through direct skin-to-skin contact during vaginal, anal, or oral sex. It is the primary causative agent for genital warts and cervical cancer. [2] * **Human Immunodeficiency Virus (HIV):** HIV is a classic STD transmitted through infected blood, semen, and vaginal fluids. [1] Sexual intercourse remains the most frequent mode of transmission globally. * **Hepatitis B Virus (HBV):** Unlike HAV, Hepatitis B is highly concentrated in blood and genital secretions. It is considered a major STD, as sexual transmission accounts for a significant percentage of new infections in adults. [2] **Clinical Pearls for NEET-PG:** * **Hepatitis Viruses:** Remember the mnemonic **"Vowels (A & E) hit the Bowel"** (Fecal-oral), while **B, C, and D** are parenteral/sexual. * **Hepatitis B** is 50–100 times more infectious than HIV. * **Ulcerative STDs:** Syphilis (painless), Chancroid (painful), and Herpes (painful vesicles). [2] * **Non-ulcerative STDs:** Chlamydia, Gonorrhea, and Trichomoniasis. [2]
Question 98: What is the dosage of benzyl penicillin in the treatment of primary syphilis?
- A. 1.2 MU single i.m.
- B. 1.2 MU single i.v.
- C. 2.4 MU single i.m. (Correct Answer)
- D. 4.8 MU single i.m.
Explanation: The treatment of choice for **Primary Syphilis** (as well as Secondary and Early Latent Syphilis) is a single dose of **Benzathine Penicillin G**. [1] **Why Option C is Correct:** The standard recommended dose is **2.4 million units (MU)** administered as a **single intramuscular (i.m.) injection**. Because *Treponema pallidum* has a slow replication cycle (30–33 hours), it requires sustained treponemicidal levels of antibiotics. Benzathine penicillin is a long-acting repository formulation that provides these low but effective blood levels for up to 2–3 weeks following a single injection. **Why Other Options are Incorrect:** * **Option A (1.2 MU i.m.):** This dose is sub-therapeutic for syphilis. While 1.2 MU is used for rheumatic fever prophylaxis, it is insufficient to eradicate *T. pallidum*. * **Option B (1.2 MU i.v.):** Benzathine penicillin must **never** be given intravenously as it can cause fatal cardio-respiratory arrest or embolic events (Nicolau syndrome). Crystalline penicillin is the only form used intravenously (specifically for Neurosyphilis). * **Option D (4.8 MU i.m.):** This is an excessive dose for a single session. However, for **Late Latent Syphilis** or syphilis of unknown duration, the total dose is 7.2 MU (given as 2.4 MU weekly for 3 weeks). **High-Yield Clinical Pearls for NEET-PG:** 1. **Jarisch-Herxheimer Reaction:** An acute febrile reaction occurring within 24 hours of starting treatment (most common in Secondary Syphilis). It is managed with NSAIDs, not by stopping penicillin. 2. **Penicillin Allergy:** In non-pregnant patients allergic to penicillin, **Doxycycline (100 mg BID for 14 days)** is the preferred alternative. 3. **Neurosyphilis:** Treated with **Aqueous Crystalline Penicillin G** (18–24 MU daily, administered as 3–4 MU IV every 4 hours) for 10–14 days. 4. **Pregnancy:** Penicillin is the only recommended treatment. If the mother is allergic, she must undergo **desensitization** and then be treated with penicillin.
Question 99: Chancroid is caused by?
- A. Haemophilus ducreyi (Correct Answer)
- B. Treponema pallidum
- C. Neisseria gonorrhoeae
- D. Herpes simplex virus
Explanation: **Explanation:** **Chancroid** is a sexually transmitted infection characterized by painful genital ulcers and regional lymphadenopathy. It is caused by **Haemophilus ducreyi**, a fastidious, Gram-negative coccobacillus [1]. The organism typically requires X-factor (hemin) for growth and presents classically on microscopy as a **"school of fish"** or "railroad track" appearance. **Analysis of Options:** * **A. Haemophilus ducreyi (Correct):** It is the definitive causative agent of Chancroid [1]. The ulcers are typically "soft," ragged, and exquisitely painful, unlike the painless ulcers of syphilis. * **B. Treponema pallidum:** This spirochete causes **Syphilis**. The primary lesion (Chancre) is typically a single, painless, indurated (hard) ulcer with clean bases [2]. * **C. Neisseria gonorrhoeae:** This Gram-negative diplococcus causes **Gonorrhea**, which primarily manifests as urethritis, cervicitis, or pelvic inflammatory disease (PID), rather than genital ulcers. * **D. Herpes simplex virus (HSV):** HSV-2 (and sometimes HSV-1) causes **Genital Herpes** [2]. While these ulcers are painful, they typically begin as grouped vesicles on an erythematous base, unlike the deep, purulent ulcers of Chancroid. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic:** "It’s so painful, you **do cry** (**ducreyi**)." * **Buboes:** Painful, fluctuant inguinal lymphadenopathy is common in Chancroid and may rupture spontaneously [1]. * **Diagnosis:** Often a diagnosis of exclusion. Culture requires special media (Mueller-Hinton agar). * **Treatment:** Single dose of **Azithromycin (1g)** or Ceftriaxone (250mg IM). * **Key Distinction:** Chancroid = Painful/Soft ulcer; Syphilis = Painless/Hard ulcer.
Question 100: Genital herpes is caused by which virus?
- A. Herpes Simplex Virus type 1 (HSV-1)
- B. Herpes Simplex Virus type 2 (HSV-2) (Correct Answer)
- C. Varicella-Zoster Virus (VZV)
- D. None of the above
Explanation: **Explanation:** Genital herpes is a common sexually transmitted infection (STI) primarily caused by the **Herpes Simplex Virus type 2 (HSV-2)** [1]. While both HSV-1 and HSV-2 can cause genital lesions, HSV-2 is historically and epidemiologically the most common cause of recurrent genital ulcer disease worldwide [1]. * **Why Option B is correct:** HSV-2 has a predilection for the sacral ganglia, where it establishes latency after the initial infection [1]. It is almost exclusively transmitted through sexual contact, making it the classic causative agent of genital herpes [3]. * **Why Option A is incorrect:** HSV-1 is traditionally associated with oropharyngeal disease ("above the waist"), causing gingivostomatitis and herpes labialis [1]. While HSV-1 is increasingly responsible for primary genital herpes in developed nations due to changing sexual practices, HSV-2 remains the definitive answer for the general etiology of the condition. * **Why Option C is incorrect:** Varicella-Zoster Virus (VZV) causes chickenpox (primary infection) and herpes zoster/shingles (reactivation). It does not cause genital herpes. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Characterized by painful, fluid-filled vesicles on an erythematous base ("dewdrops on a rose petal" appearance) that rupture to form shallow ulcers [3]. * **Diagnosis:** The gold standard is PCR [2]. However, for exams, remember the **Tzanck Smear**, which shows **multinucleated giant cells** and **Cowdry Type A** intranuclear inclusion bodies. * **Management:** Acyclovir, Valacyclovir, or Famciclovir are the drugs of choice [2]. They reduce viral shedding and symptom duration but do not cure the latent infection. * **Neonatal Herpes:** Usually acquired during delivery; if active lesions are present in the mother, a Cesarean section is indicated to prevent transmission.
Practice by Chapter
Syphilis
Practice Questions
Gonorrhea
Practice Questions
Chlamydial Infections
Practice Questions
Chancroid and Other Genital Ulcers
Practice Questions
Genital Herpes
Practice Questions
Human Papillomavirus Infections
Practice Questions
HIV and STIs
Practice Questions
Pelvic Inflammatory Disease
Practice Questions
STI Screening and Prevention
Practice Questions
Partner Notification and Treatment
Practice Questions
Sexually Transmitted Enteric Infections
Practice Questions
Special Populations Management
Practice Questions
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