Venerology Practice Questions

Q: What is the most common genital lesion observed in patients with HIV?

Herpes. **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).

Q: What is the drug of choice for secondary syphilis in pregnant women?

Benzathine Penicillin. **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].

Q: Condylomata lata are seen in which stage of syphilis?

Secondary syphilis. **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],

Q: What is the drug of choice for Lymphogranuloma venereum (LGV)?

Doxycycline. **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.

Q: Which of the following is not a sexually transmitted disease?

Hepatitis A virus. 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]

Q: Chancroid is caused by?

Haemophilus ducreyi. **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.

Q: Genital herpes is caused by which virus?

Herpes Simplex Virus type 2 (HSV-2). **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.

Question 1

What is the most common genital lesion observed in patients with HIV?

Accepted Answer

Herpes

Answer

Chlamydia

Answer

Syphilis

Answer

Candida

Question 2

What is the drug of choice for secondary syphilis in pregnant women?

Accepted Answer

Benzathine Penicillin

Answer

Doxycycline

Answer

Ceftriaxone

Answer

Cotrimoxazole

Question 3

Condylomata lata are seen in which stage of syphilis?

Accepted Answer

Secondary syphilis

Answer

Congenital syphilis

Answer

Primary syphilis

Answer

Tertiary syphilis

Question 4

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?

Accepted Answer

Inj. Benzathine penicillin G, 2.4 million units intramuscularly, weekly for 3 weeks

Answer

Inj. Benzathine penicillin G, 2.4 million units intramuscularly, single dose

Answer

Inj. Benzathine penicillin G, 2.4 million units intramuscularly, twice daily for 1 week

Answer

Inj. Benzathine penicillin G, 2.4 million units intramuscularly, twice weekly for 3 weeks

Question 5

A 45-year-old male with a history of unprotected sexual intercourse 15 years ago presents with what pupillary condition?

Accepted Answer

Accommodation reflex positive, and pupillary reaction negative

Answer

Accommodation reflex negative, and pupillary reaction positive

Answer

Accommodation reflex positive, and pupillary reaction positive

Answer

Accommodation reflex negative, and pupillary reaction negative

Question 6

What is the drug of choice for Lymphogranuloma venereum (LGV)?

Accepted Answer

Doxycycline

Answer

Ampicillin

Answer

Erythromycin

Answer

Ceftriaxone

Question 7

Which of the following is not a sexually transmitted disease?

Accepted Answer

Hepatitis A virus

Answer

Human Papillomavirus (HPV)

Answer

Human Immunodeficiency Virus (HIV)

Answer

Hepatitis B virus

Question 8

What is the dosage of benzyl penicillin in the treatment of primary syphilis?

Accepted Answer

2.4 MU single i.m.

Answer

1.2 MU single i.m.

Answer

1.2 MU single i.v.

Answer

4.8 MU single i.m.

Question 9

Chancroid is caused by?

Accepted Answer

Haemophilus ducreyi

Answer

Treponema pallidum

Answer

Neisseria gonorrhoeae

Answer

Herpes simplex virus

Question 10

Genital herpes is caused by which virus?

Accepted Answer

Herpes Simplex Virus type 2 (HSV-2)

Answer

Herpes Simplex Virus type 1 (HSV-1)

Answer

Varicella-Zoster Virus (VZV)

Answer

None of the above

Venerology — MCQs

Venerology — MCQs

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