Venerology — MCQs

Venerology Indian Medical PG Practice Questions and MCQs

Question 111: A female presents with a 3 cm painless ulcer with raised edges on the labia majora. What is the most common cause?

A. Syphilis (Correct Answer)
B. Gonorrhea
C. Herpes
D. Chlamydia trachomatis

Explanation: **Explanation:** The clinical presentation of a **painless, indurated ulcer with raised edges** (often described as a "button-like" consistency) is the classic hallmark of a **Chancre**, which is the primary lesion of **Syphilis**, caused by *Treponema pallidum*. **Why Syphilis is correct:** Primary syphilis typically manifests as a single, firm, painless ulcer at the site of inoculation. The "raised edges" and lack of tenderness are key diagnostic features [1]. In females, these are often found on the labia majora, labia minora, or cervix. **Why the other options are incorrect:** * **Gonorrhea:** Typically presents as a purulent vaginal or urethral discharge (cervicitis/urethritis) rather than a discrete ulcer [2]. * **Herpes (HSV-2):** Characterized by **painful**, multiple, shallow, vesicular or ulcerative lesions on an erythematous base [1]. They are rarely painless or indurated. * **Chlamydia trachomatis:** While Serotypes L1-L3 cause *Lymphogranuloma Venereum (LGV)*, the initial ulcer is usually small, transient, and often goes unnoticed. The dominant feature of LGV is painful inguinal lymphadenopathy (Buboes) [3]. **NEET-PG High-Yield Pearls:** * **Painful vs. Painless Ulcers:** Remember the mnemonic **"H is for Hurt"** (Herpes and Hemophilus ducreyi/Chancroid are painful). Syphilis and LGV are generally painless. * **Donovanosis (Granuloma Inguinale):** Caused by *Klebsiella granulomatis*; presents as a painless, beefy-red, velvety ulcer that bleeds on touch (Donovan bodies on biopsy) [3]. * **Investigation of Choice:** Dark-field microscopy is the gold standard for primary syphilis; VDRL/RPR are screening tests (may be negative in early primary stage). * **Treatment:** Benzathine Penicillin G (2.4 million units IM) remains the drug of choice.

Question 112: Which of the following is characteristic of Granuloma inguinale?

A. Is caused by Gardnerella vaginalis
B. Beefy red ulcers that bleed easily (Correct Answer)
C. Painful inflammatory nodules
D. Short incubation period of 3 days

Explanation: **Granuloma Inguinale (Donovanosis)** is a chronic, progressive bacterial infection caused by the Gram-negative intracellular bacterium ***Klebsiella granulomatis*** (formerly *Calymmatobacterium granulomatis*). ### **Explanation of Options** * **Correct Answer (B):** The hallmark of Donovanosis is the presence of **beefy red, velvety, painless ulcers**. These lesions are highly vascular due to extensive granulation tissue, which causes them to **bleed easily on contact**. Despite the extensive tissue destruction, the ulcers remain painless unless secondarily infected. * **Option A:** *Gardnerella vaginalis* is the causative agent of Bacterial Vaginosis (associated with Clue cells and a fishy odor), not Granuloma inguinale. * **Option C:** Painful inflammatory nodules are characteristic of **Chancroid** (*Haemophilus ducreyi*) or **Lymphogranuloma Venereum (LGV)** during the bubo stage. Donovanosis typically presents with "pseudobuboes"—firm, painless swellings in the groin that are actually subcutaneous granulomas rather than true lymphadenopathy. * **Option D:** Donovanosis has a relatively **long and variable incubation period**, typically ranging from **1 to 12 weeks** (average 50 days). A short incubation period of 1–3 days is more characteristic of Chancroid. ### **High-Yield Clinical Pearls for NEET-PG** * **Pathognomonic Sign:** **Donovan Bodies** (safety-pin appearance) seen within large mononuclear cells (macrophages) on Giemsa or Wright stain. * **Clinical Presentation:** Painless, beefy red ulcers; **absence of true inguinal lymphadenopathy** (Pseudobuboes). * **Treatment of Choice:** **Azithromycin** (1g orally once weekly or 500mg daily) for at least 3 weeks or until lesions have completely healed. * **Differential Diagnosis:** Must be distinguished from Syphilis (painless but clean-based ulcer) and Chancroid (painful, dirty-based ulcer).

Question 113: A 34-year-old HIV-positive male, a truck driver, presented with small painless nodules and a sexual history 15 days prior. Subsequently, the nodules ruptured, forming open, fleshy, oozing lesions that developed into beefy red ulcers in the genital region. What is the most likely diagnosis?

A. Klebsiella granulomatis (Correct Answer)
B. Chlamydia trachomatis
C. Neisseria gonorrhea
D. Haemophilus ducreyi

Explanation: **Explanation:** The clinical presentation of **beefy red, painless, fleshy ulcers** in the genital region is the hallmark of **Granuloma Inguinale (Donovanosis)**, caused by **Klebsiella granulomatis** (formerly *Calymmatobacterium granulomatis*). [1] **Why Option A is correct:** The incubation period (typically 1–4 weeks) and the progression from painless nodules to highly vascular, "beefy red" ulcers that bleed easily on contact (friable) are classic features. [1] Unlike many other STIs, Donovanosis is characterized by the **absence of significant inguinal lymphadenopathy** (though "pseudobuboes"—subcutaneous granulation tissue—may occur). [1] **Why other options are incorrect:** * **B. Chlamydia trachomatis (L1-L3):** Causes Lymphogranuloma Venereum (LGV). It typically presents with a transient, small, painless papule followed by painful, massive inguinal lymphadenopathy (the "Groove sign"). [1] * **C. Neisseria gonorrhea:** Primarily causes urethritis (purulent discharge) rather than genital ulcers. [2] * **D. Haemophilus ducreyi:** Causes Chancroid. These ulcers are characteristically **painful**, soft, and often associated with painful inflammatory inguinal buboes. [1] **NEET-PG High-Yield Pearls:** * **Pathognomonic Finding:** Presence of **Donovan Bodies** (safety-pin appearance) within macrophages on Giemsa or Wright stain. * **Clinical Appearance:** Often described as "velvety" or "serpiginous" ulcers. * **Treatment of Choice:** Azithromycin (1g once weekly or 500mg daily) for at least 3 weeks or until lesions heal. * **Risk Group:** Frequently seen in tropical regions and among individuals with high-risk sexual behavior (e.g., long-distance truck drivers).

Question 114: What is the recommended treatment for penicillin-resistant gonorrhea?

A. Ciprofloxacin
B. Ceftriaxone (Correct Answer)
C. Streptomycin
D. Erythromycin

Explanation: **Explanation:** The correct answer is **Ceftriaxone**. **Why Ceftriaxone is correct:** *Neisseria gonorrhoeae* has developed widespread resistance to penicillin due to the production of **plasmid-mediated beta-lactamase (PPNG)** and chromosomal mutations. Consequently, third-generation cephalosporins, specifically **Ceftriaxone**, have become the first-line treatment [1]. Ceftriaxone is highly bactericidal, has a long half-life, and provides high cure rates for mucosal gonorrhea (urethral, cervical, and pharyngeal) [1]. **Why the other options are incorrect:** * **Ciprofloxacin:** Once a standard treatment, fluoroquinolone resistance (QRNG) is now globally prevalent, making it unreliable for empirical therapy [1]. * **Streptomycin:** This aminoglycoside is not effective against *N. gonorrhoeae* and is primarily used in the treatment of tuberculosis or plague. * **Erythromycin:** While used for neonatal prophylaxis (ophthalmia neonatorum), it is not the drug of choice for adult gonorrhea due to poor efficacy and gastrointestinal side effects. **High-Yield Clinical Pearls for NEET-PG:** 1. **Dual Therapy Concept:** To cover potential co-infection with *Chlamydia trachomatis*, the current CDC/WHO guidelines often recommend combining Ceftriaxone with **Azithromycin** (though some recent guidelines suggest Ceftriaxone monotherapy at higher doses, e.g., 500mg IM, if Chlamydia is ruled out) [1]. 2. **Disseminated Gonococcal Infection (DGI):** Ceftriaxone remains the drug of choice for systemic manifestations like arthritis-dermatitis syndrome. 3. **Spectinomycin:** This is an alternative for patients who are allergic to cephalosporins. 4. **Culture Media:** Remember **Thayer-Martin medium** (VPN: Vancomycin, Polymyxin, Nystatin) is the selective medium for *N. gonorrhoeae*.

Question 115: Schirmer test is done for?

A. Oculomotor nerve
B. Optic nerve
C. Facial nerve (Correct Answer)
D. All

Explanation: Explanation: The **Schirmer test** is a clinical diagnostic tool used to measure tear production (lacrimation). It is primarily used to evaluate dry eye syndrome or conditions like Sjögren’s syndrome. **Why Facial Nerve is the Correct Answer:** The **Facial nerve (CN VII)** provides parasympathetic innervation to the **lacrimal gland** via the Greater Petrosal Nerve. In cases of proximal facial nerve palsy (e.g., Bell’s palsy or lesions at the geniculate ganglion), tear production is significantly reduced. The Schirmer test is used topographically to determine the level of the facial nerve lesion; if lacrimation is absent, the lesion is at or proximal to the geniculate ganglion. **Why Other Options are Incorrect:** * **Oculomotor Nerve (CN III):** This nerve controls most extraocular muscles, the levator palpebrae superioris (eyelid elevation), and pupillary constriction. It does not control lacrimation. * **Optic Nerve (CN II):** This is a purely sensory nerve responsible for vision and the afferent limb of the pupillary light reflex. It has no motor or secretomotor function. **High-Yield Clinical Pearls for NEET-PG:** * **Procedure:** A filter paper (Whatman No. 41) is placed in the lower conjunctival fornix for 5 minutes. * **Interpretation:** Normal wetting is >15 mm. Wetting <5 mm is diagnostic of **Keratoconjunctivitis Sicca (Dry Eye)**. * **Topographic Diagnosis:** In Facial Nerve palsy, the Schirmer test helps differentiate a lesion in the Internal Auditory Meatus/Geniculate ganglion (abnormal test) from a lesion in the Stylomastoid foramen (normal test). * **Sjögren’s Syndrome:** Often presents with a positive Schirmer test along with xerostomia (dry mouth).

Question 116: A young man presents with asymptomatic macules and erythematous painless lesions over the glans with generalized lymphadenopathy. What is the treatment of choice in this condition?

A. Ceftriaxone
B. Benzathine penicillin (Correct Answer)
C. Acyclovir
D. Fluconazole

Explanation: ### Explanation The clinical presentation of **painless lesions (chancres)** on the glans, accompanied by **generalized lymphadenopathy**, is a classic hallmark of **Syphilis**, caused by the spirochete *Treponema pallidum* [2]. **1. Why Benzathine Penicillin is the Correct Answer:** Benzathine Penicillin G is the gold standard and drug of choice for all stages of syphilis [2]. For primary, secondary, or early latent syphilis, a **single intramuscular dose of 2.4 million units** is curative. Its long-acting nature ensures sustained treponemicidal levels in the blood, which is essential because *T. pallidum* divides slowly. **2. Analysis of Incorrect Options:** * **Ceftriaxone (Option A):** While it has anti-treponemal activity and can be used as an alternative in penicillin-allergic patients, it is not the first-line "treatment of choice." * **Acyclovir (Option B):** This is an antiviral used for Herpes Simplex Virus (HSV) [1]. Genital herpes typically presents with **painful** vesicles or ulcers, unlike the painless lesions described here [1]. * **Fluconazole (Option D):** This is an antifungal used for conditions like Candidal balanitis, which usually presents with itchy, erythematous patches and a cheesy discharge, not generalized lymphadenopathy [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Primary Syphilis:** Characterized by the "Hard Chancre" (painless, indurated, clean base) [2]. * **Secondary Syphilis:** Presents with a generalized maculopapular rash (including palms and soles), condyloma lata, and generalized lymphadenopathy [2]. * **Jarisch-Herxheimer Reaction:** A common systemic reaction (fever, headache) occurring within 24 hours of starting penicillin due to the release of endotoxins from dying spirochetes. * **Diagnosis:** Screening is done via **VDRL/RPR** (non-specific); confirmation is via **TPHA/FTA-ABS** (specific). * **Drug of choice in Penicillin Allergy:** Doxycycline (100 mg BID for 14 days).

Question 117: Which of the following features is NOT associated with Chancroid?

A. Painful ulcer
B. Painless lymphadenopathy (Correct Answer)
C. School of fish appearance on staining
D. Azithromycin is useful in treatment

Explanation: Everything is painful in Chancroid, a sexually transmitted infection caused by **_Haemophilus ducreyi_** [1]. 1. **Why Option B is correct:** In Chancroid, the inguinal lymphadenopathy (buboes) is characteristically **exceedingly painful**, inflammatory, and often unilateral [1]. These buboes may become fluctuant and spontaneously rupture. Painless lymphadenopathy is instead a feature of Primary Syphilis or Lymphogranuloma Venereum. 2. **Analysis of other options:** * **Option A (Painful ulcer):** Unlike the painless chancre of syphilis, the ulcer in Chancroid is soft, friable, and very painful [1]. * **Option C (School of fish appearance):** On Gram stain of the discharge, the organisms arrange themselves in parallel rows or chains, described as a "school of fish" appearance. * **Option D (Azithromycin):** According to CDC guidelines, a single 1g oral dose of Azithromycin is a first-line treatment for Chancroid. **Clinical Pearls for NEET-PG:** * **The "H" Rule:** _**H**. ducreyi_ causes a **H**eavy (large), **H**orrible (painful) ulcer that makes you **"cry"** (ducreyi). * **Syphilis vs. Chancroid:** Syphilis (Chancre) is painless with painless nodes; Chancroid is painful with painful nodes [1]. * **Autoinoculation:** Chancroid ulcers often show "kissing lesions" on opposing skin surfaces due to autoinoculation [1].

Question 118: What is the most common cause of nongonococcal urethritis?

A. Chlamydia (Correct Answer)
B. Mycoplasma
C. Trichomonas
D. Gram negative rod

Explanation: **Explanation:** **Nongonococcal Urethritis (NGU)** refers to inflammation of the urethra not caused by *Neisseria gonorrhoeae*. It is the most common sexually transmitted syndrome in men [1]. **Why Chlamydia is Correct:** * **Chlamydia trachomatis** (Serovars D-K) is the most common cause of NGU worldwide, accounting for approximately **30% to 50%** of cases [1]. It is an obligate intracellular bacterium. Clinically, NGU typically presents with a longer incubation period (7–14 days) and a more mucoid, scant discharge compared to the purulent discharge of gonorrhea [1]. **Analysis of Incorrect Options:** * **B. Mycoplasma:** *Mycoplasma genitalium* is the second most common cause of NGU (approx. 15–25%). It is increasingly recognized due to its association with persistent or recurrent urethritis and its resistance to azithromycin [1]. * **C. Trichomonas:** *Trichomonas vaginalis* is a protozoan cause of NGU. While significant in certain populations, it is much less common than Chlamydia [1]. * **D. Gram-negative rod:** While *E. coli* can cause urinary tract infections (UTIs), it is an uncommon cause of primary urethritis in sexually active young men unless associated with insertive anal intercourse. **High-Yield Clinical Pearls for NEET-PG:** 1. **Dual Infection:** Up to 30% of patients with gonorrhea are co-infected with *C. trachomatis*. Therefore, treatment usually covers both (e.g., Ceftriaxone + Azithromycin/Doxycycline). 2. **Diagnosis:** The gold standard for diagnosing Chlamydia is **Nucleic Acid Amplification Testing (NAAT)** using a first-void urine sample or urethral swab. 3. **Complications:** Untreated NGU can lead to epididymitis in men and Pelvic Inflammatory Disease (PID) or infertility in women. 4. **Reiter’s Syndrome:** NGU is a classic trigger for Reactive Arthritis (triad of urethritis, conjunctivitis, and arthritis).

Question 119: Which of the following infections is not sexually transmitted?

A. Lymphogranuloma venereum
B. Genital herpes
C. Bacterial vaginosis (Correct Answer)
D. Syphilis

Explanation: **Explanation:** The correct answer is **Bacterial Vaginosis (BV)**. While BV is associated with sexual activity and is more common in sexually active individuals, it is not classified as a **Sexually Transmitted Infection (STI)** [1]. **1. Why Bacterial Vaginosis is the correct answer:** BV is a **dysbiosis** (imbalance) of the normal vaginal flora, characterized by a reduction in hydrogen peroxide-producing *Lactobacillus* and an overgrowth of anaerobic bacteria like *Gardnerella vaginalis*, *Mobiluncus*, and *Atopobium vaginae*. It is considered a "sexually associated" condition rather than an infection transmitted from person to person via coitus. Treatment of the male partner does not prevent recurrence, further confirming it is not a traditional STI. **2. Why the other options are incorrect:** * **Lymphogranuloma venereum (LGV):** Caused by *Chlamydia trachomatis* (serovars L1, L2, L3). It is a classic STI presenting with painless ulcers followed by painful inguinal lymphadenopathy (Buboes) [2]. * **Genital Herpes:** Caused by Herpes Simplex Virus (HSV-2 > HSV-1). It is one of the most common STIs worldwide, characterized by painful, fluid-filled vesicles [3]. * **Syphilis:** Caused by the spirochete *Treponema pallidum*. It is a systemic STI transmitted through direct contact with an infectious lesion (chancre). **Clinical Pearls for NEET-PG:** * **Amsel’s Criteria for BV (3 out of 4 required):** 1. Homogeneous white-grey discharge. 2. Vaginal pH > 4.5. 3. Positive **Whiff test** (fishy odor with 10% KOH). 4. Presence of **Clue cells** on saline microscopy (Gold Standard). * **Nugent Scoring:** The diagnostic gold standard for BV based on Gram stain. * **Drug of Choice:** Oral or topical **Metronidazole**. [4] * **Note:** BV increases the risk of acquiring other STIs (like HIV) due to the loss of protective lactobacilli.

Question 120: Tertiary syphilis most frequently involves which of the following structures?

A. Central nervous system (CNS) (Correct Answer)
B. Liver
C. Testes
D. Aorta

Explanation: ### Explanation **Correct Answer: A. Central Nervous System (CNS)** Tertiary syphilis (late syphilis) occurs years after the initial infection in untreated patients [1]. While it is a multisystem disease, the **Central Nervous System (CNS)** is the most frequently involved structure in the tertiary stage. Neurosyphilis can manifest as asymptomatic neurosyphilis, meningovascular syphilis, or parenchymatous syphilis (Tabes dorsalis and General Paresis of the Insane). Although cardiovascular involvement is serious, statistically, neurological involvement (especially asymptomatic or symptomatic neurosyphilis) is more common in the clinical progression of late-stage disease [1]. **Analysis of Incorrect Options:** * **B. Liver:** Hepatic involvement in tertiary syphilis presents as "Hepar Lobatum" due to the healing of gummas. While characteristic, it is significantly less common than CNS or cardiovascular involvement. * **C. Testes:** Gummas can occur in the testes (painless swelling), but this is a rare site compared to the nervous or vascular systems. * **D. Aorta:** Cardiovascular syphilis (primarily syphilitic aortitis) is the second most common manifestation of tertiary syphilis [1]. It typically involves the ascending aorta, leading to aneurysms or aortic regurgitation, but its incidence is lower than neurosyphilis. **High-Yield Clinical Pearls for NEET-PG:** * **Argyll Robertson Pupil:** A classic sign of neurosyphilis where the pupil accommodates but does not react to light ("Prostitute's Pupil"). * **Tabes Dorsalis:** Involves the posterior columns of the spinal cord, leading to loss of vibration/position sense and "lightning pains." * **Jarisch-Herxheimer Reaction:** An acute febrile reaction occurring within 24 hours of starting penicillin treatment for syphilis. * **Screening vs. Confirmatory:** VDRL/RPR are used for screening (and monitoring treatment response), while FTA-ABS or TPHA are specific treponemal tests used for confirmation.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Venerology — MCQs

Venerology — MCQs

On this page

Practice by Chapter

Want unlimited practice?