Venerology Practice Questions

Q: An adult male presented 4 weeks after intercourse with fever, a rubbery ulcer, and inguinal lymphadenopathy. What is the causative organism?

Lymphogranuloma venereum (LGV). ### Explanation The clinical presentation of a **rubbery ulcer** (primary lesion) followed by **inguinal lymphadenopathy** and systemic symptoms like **fever** approximately 3–6 weeks after exposure is characteristic of **Lymphogranuloma venereum (LGV)** [1]. **1. Why LGV is the Correct Answer:** LGV is caused by **Chlamydia trachomatis (serotypes L1, L2, L3)**. It progresses through three stages [1]: * **Primary stage:** A small, painless, often transient "rubbery" papule or ulcer at the site of inoculation. * **Secondary stage (Inguinal syndrome):** Occurs 2–6 weeks later, characterized by painful, firm inguinal lymphadenopathy (buboes) [1]. The "Groove sign" (enlargement of nodes above and below the inguinal ligament) is a classic pathognomonic finding. * **Systemic symptoms:** Fever, chills, and malaise are common during the lymphatic spread [1]. **2. Why the Other Options are Incorrect:** * **Syphilis (*Treponema pallidum*):** Presents with a **painless, indurated (hard)** chancre. While it causes regional lymphadenopathy, the nodes are typically non-tender and rubbery, and the primary ulcer usually heals before systemic symptoms (Secondary Syphilis) appear weeks later. * **Chancroid (*Haemophilus ducreyi*):** Presents with a **painful, soft, ragged ulcer** (non-rubbery) and painful, suppurative inguinal lymphadenopathy [1]. The incubation period is very short (3–7 days). * **HIV:** While acute retroviral syndrome causes fever and lymphadenopathy, it does not typically present with a localized genital ulcer as the primary manifestation. **3. NEET-PG Clinical Pearls:** * **Drug of Choice for LGV:** Doxycycline (100 mg BID for 21 days). * **Groove Sign:** Produced by the inguinal ligament dividing the matted superficial and deep inguinal nodes. * **Esthiomene:** A late-stage complication of LGV involving chronic lymphatic obstruction leading to elephantiasis of the external genitalia.

Q: What is the incubation period of syphilis?

9-90 days. **Explanation:** Syphilis is a chronic systemic infection caused by the spirochete *Treponema pallidum*. The correct incubation period is **9 to 90 days**, with an average of **3 weeks (21 days)**. This period represents the time from initial inoculation through micro-abrasions in the skin or mucous membranes to the appearance of the primary chancre. * **Why Option C is correct:** The wide range (9–90 days) reflects the variability in host immune response and the size of the initial inoculum. After the spirochetes enter the body, they replicate locally and disseminate systemically via lymphatics and the bloodstream even before the primary lesion appears. * **Why Options A, B, and D are incorrect:** * **10-14 days:** This is too narrow and represents the incubation period for other STIs like Chancroid (usually 3–7 days) or Lymphogranuloma Venereum (3–30 days). * **30-60 days:** While this falls within the range, it misses the common earlier presentations. * **3-6 months:** This is significantly longer than the typical incubation for primary syphilis; however, secondary syphilis usually develops 2–8 weeks after the appearance of the chancre. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Syphilis:** Characterized by a **painless, indurated ulcer (Hard Chancre)** with painless regional lymphadenopathy. * **Diagnosis:** The investigation of choice for a primary chancre is **Dark Ground Microscopy (DGM)**, as serological tests (VDRL/RPR) may still be negative in the first 1–2 weeks of the lesion. * **Treatment:** The drug of choice for primary, secondary, and early latent syphilis is a single dose of **Benzathine Penicillin G (2.4 million units IM)**. * **Jarisch-Herxheimer Reaction:** An acute febrile reaction occurring within 24 hours of starting treatment, caused by the release of endotoxins from dying spirochetes.

Question 1

A 43-year-old businessman presents with a purulent penile discharge, reporting unprotected sexual contact one week prior. Gram stain of the discharge does not show any organisms. What is the most likely cause of the discharge?

Accepted Answer

Chlamydia trachomatis

Answer

Bowen disease

Answer

Herpes simplex virus

Answer

Treponema pallidum

Question 2

A patient presents with a painless penile ulcer of 2 weeks duration. A VDRL test is reactive at a dilution of 1:4. The patient also reports a recent diagnosis of hepatitis A. Which one of the following actions would be most appropriate?

Accepted Answer

Order a confirmatory test such as FTA-ABS test

Answer

Order a rapid plasma reagin (RPR) test

Answer

Perform a spinal tap to rule out neurosyphilis

Answer

Repeat the VDRL test

Question 3

Which of the following drugs are included in the 'Green STD kit'?

Accepted Answer

Secnidazole, Fluconazole

Answer

Azithromycin, Cefixime

Answer

Acyclovir

Answer

Azithromycin, Doxycycline

Question 4

An adult male presented 4 weeks after intercourse with fever, a rubbery ulcer, and inguinal lymphadenopathy. What is the causative organism?

Accepted Answer

Lymphogranuloma venereum (LGV)

Answer

Syphilis

Answer

Chancroid

Answer

Human Immunodeficiency Virus (HIV)

Question 5

Regarding syphilis, all of the following statements are true, except?

Accepted Answer

VDRL titre decreases or becomes absent after treatment

Answer

VDRL becomes positive 10-14 days after infection

Answer

The earliest serological test to become positive in untreated primary syphilis is TPHA

Answer

Yaws and Pinta cannot be differentiated from syphilis serologically

Question 6

What is the incubation period of syphilis?

Accepted Answer

9-90 days

Answer

10-14 days

Answer

30-60 days

Answer

3-6 months

Question 7

What is true about chancroid?

Accepted Answer

Painful ulcer with irregular erythematous non-indurated margins.

Answer

Incubation period is 3 to 10 weeks.

Answer

Characterised typically by prodromal symptoms and systemic reaction.

Answer

Ulcer base is hard and indurated.

Question 8

What is the most common cause of genital herpes?

Accepted Answer

Herpes Simplex Virus type 2 (HSV-2)

Answer

Herpes Simplex Virus type 1 (HSV-1)

Answer

Varicella-Zoster Virus (HSV-3)

Answer

Epstein-Barr Virus (HSV-4)

Question 9

Non-gonococcal urethritis is caused by which of the following?

Accepted Answer

Chlamydia

Answer

Lymphogranuloma venereum (LGV)

Answer

Syphilis

Answer

Gardnella vaginalis

Question 10

A patient presents with mental confusion, visual and auditory hallucinations, perceived changes of body shape, swelling of the tongue, and a fear of impending death after being treated for primary chancre of syphilis with an intramuscular injection. What is the likely diagnosis?

Accepted Answer

Hoigne Syndrome

Answer

Jarisch-Herxheimer Reaction

Answer

Undiagnosed Psychosis

Answer

Schizophrenia

Venerology — MCQs

Venerology — MCQs

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