Venerology — MCQs
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Fitz‐Hugh‐Curtis syndrome involving perihepatitis is present in the following:
A 32-year-old woman presents with recurrent genital ulcers. She was previously diagnosed with genital herpes based on clinical appearance, but current PCR testing for HSV is negative. She also reports occasional painful mouth sores. Serological tests for syphilis are negative. What is the most likely diagnosis?
A 30-year-old woman is diagnosed with gonorrhea and reports a penicillin allergy (rash). Which alternative treatment regimen is most appropriate?
A 25-year-old man presents with penile ulcers for 10 days. Initial VDRL and dark field microscopy are negative. Two weeks later, repeat VDRL is 1:32. What is the most appropriate interpretation?
A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?
Which of the following is NOT characteristic of lymphogranuloma venereum proctitis?
Which of the following clinical manifestations is LEAST likely in secondary syphilis?
A 32-year-old HIV-positive man (CD4 count 320/μL) presents with painless perianal ulcer for 3 weeks. Dark field microscopy shows spirochetes. What is the appropriate treatment?
What is the underlying pathophysiology of post-gonococcal urethritis?
Which screening test has the highest sensitivity for detecting early primary syphilis?
Venerology Indian Medical PG Practice Questions and MCQs
Question 141: Fitz‐Hugh‐Curtis syndrome involving perihepatitis is present in the following:
- A. Syphilis
- B. Tuberculosis
- C. Moniliasis
- D. Gonorrhoea (Correct Answer)
Explanation: **Gonorrhoea** - **Fitz-Hugh-Curtis syndrome** is a complication of **pelvic inflammatory disease (PID)**, which is predominantly caused by sexually transmitted infections like *Neisseria gonorrhoeae* and *Chlamydia trachomatis*. - Perihepatitis, or inflammation of the liver capsule, occurs when bacteria from the pelvic infection spread to the liver surface. *Syphilis* - **Syphilis** primarily presents with chancres, rashes, and neurological or cardiovascular complications in later stages. - It does not typically cause **perihepatitis** as a direct complication of the infection itself. *Tuberculosis* - **Tuberculosis** is caused by *Mycobacterium tuberculosis* and usually affects the lungs, but can spread to other organs. - While it can cause peritonitis, it is not associated with **perihepatitis** in the context of **Fitz-Hugh-Curtis syndrome**. *Moniliasis* - **Moniliasis** (candidiasis) is a fungal infection caused by *Candida* species. - It is commonly associated with vaginal yeast infections or thrush but does not cause **Fitz-Hugh-Curtis syndrome** or perihepatitis.
Question 142: A 32-year-old woman presents with recurrent genital ulcers. She was previously diagnosed with genital herpes based on clinical appearance, but current PCR testing for HSV is negative. She also reports occasional painful mouth sores. Serological tests for syphilis are negative. What is the most likely diagnosis?
- A. Fixed drug eruption
- B. Crohn's disease
- C. Behçet's syndrome (Correct Answer)
- D. Aphthous ulcers
Explanation: Behçet's syndrome - Recurrent genital ulcers that are often painful and heal with scarring, in the absence of HSV or other STIs, are characteristic of Behçet's syndrome. - While other systemic symptoms such as oral ulcers, uveitis, and skin lesions (e.g., erythema nodosum) are common, the diagnosis can be made based on recurrent genital ulcers and the exclusion of other causes. Fixed drug eruption - A fixed drug eruption typically produces a solitary or a few localized skin or mucosal lesions que recur at the same site, usually within hours of drug re-exposure. - While it can cause genital ulcers, it's less likely to present with recurrent ulcers without a clear history of drug exposure or at multiple sites. Crohn's disease - Genital ulcers can occur in Crohn's disease, often as a manifestation of perianal disease or metastatic Crohn's, but they are typically associated with prominent gastrointestinal symptoms (e.g., chronic diarrhea, abdominal pain, weight loss). - The absence of other symptoms makes Crohn's disease less likely in this isolated presentation. Aphthous ulcers - Aphthous ulcers primarily affect the oral mucosa and are not typically found on the genitals [1]. - While Behçet's syndrome does include recurrent oral aphthous ulcers in its diagnostic criteria, genital aphthous ulcers as a solitary finding are not common without other associated symptoms or conditions [1].
Question 143: A 30-year-old woman is diagnosed with gonorrhea and reports a penicillin allergy (rash). Which alternative treatment regimen is most appropriate?
- A. Azithromycin 2g orally single dose
- B. Cefixime 400mg orally single dose
- C. Ciprofloxacin 500mg orally single dose
- D. Spectinomycin 2g IM single dose (Correct Answer)
Explanation: ***Spectinomycin 2g IM single dose*** - **Spectinomycin** is a safe and effective alternative for treating uncomplicated gonorrhea in patients with a history of severe penicillin or cephalosporin allergy. - It provides bactericidal activity against *Neisseria gonorrhoeae* and is administered as a **single intramuscular injection**. *Azithromycin 2g orally single dose* - While azithromycin is part of the dual therapy for gonorrhea (with ceftriaxone), using it as a **monotherapy** is not recommended due to increasing rates of resistance. - The CDC no longer recommends 2g azithromycin monotherapy for gonorrhea due to concerns about **macrolide resistance**. *Cefixime 400mg orally single dose* - **Cefixime** is a third-generation cephalosporin, and a penicillin allergy (especially a rash) may indicate a risk of **cross-reactivity** with cephalosporins. - While it's an alternative, it's generally avoided in significant penicillin allergy due to the potential for hypersensitivity reactions [1] and may have **lower efficacy** than ceftriaxone [2]. *Ciprofloxacin 500mg orally single dose* - **Ciprofloxacin** is a fluoroquinolone, and its use for gonorrhea is no longer recommended due to widespread and increasing **quinolone resistance** of *Neisseria gonorrhoeae* [2]. - Treatment with ciprofloxacin is associated with unacceptably high rates of **treatment failure** in many regions.
Question 144: A 25-year-old man presents with penile ulcers for 10 days. Initial VDRL and dark field microscopy are negative. Two weeks later, repeat VDRL is 1:32. What is the most appropriate interpretation?
- A. The second test is a false positive due to cross-reactivity
- B. The first test was a false negative due to lab error
- C. The initial presentation was in early primary syphilis before seroconversion (Correct Answer)
- D. The patient acquired syphilis between the two tests
Explanation: ***The initial presentation was in early primary syphilis before seroconversion*** - The initial **VDRL** and **dark field microscopy** were negative, indicating that the patient was likely in the very early stage of primary syphilis, when the **immune response** has not yet produced detectable **antibodies** [1]. - The positive VDRL (1:32) two weeks later signifies **seroconversion**, meaning the immune system has now produced enough antibodies to be detected, confirming **syphilis** [1]. *The second test is a false positive due to cross-reactivity* - While cross-reactivity can occur with non-treponemal tests like VDRL, a titer of 1:32 is generally considered significant and unlikely to be a **false positive** without other contributing factors or a low-risk clinical context [1]. - The presence of **penile ulcers** is highly suggestive of primary syphilis, making a false positive less probable [2]. *The first test was a false negative due to lab error* - While lab errors can occur, the scenario of early primary syphilis with **seroconversion** is a more common and clinically appropriate explanation for an initial negative result followed by a positive one [1]. - **False negatives** in early syphilis are due to the **window period** before antibody production, not typically a lab error if the test was performed correctly [1]. *The patient acquired syphilis between the two tests* - The development of **penile ulcers** typically takes 10 to 90 days after exposure, making it unlikely for new acquisition and ulcer formation to occur within a mere two-week interval between tests. - The initial ulcers were present for 10 days before the first test, further contradicting recent infection coinciding with the negative results.
Question 145: A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?
- A. Azithromycin 1g orally as single dose
- B. Benzathine penicillin G 2.4 million units IM
- C. Acyclovir 400mg orally TID for 7-10 days (Correct Answer)
- D. Doxycycline 100mg orally BID for 14 days
Explanation: Acyclovir 400mg orally TID for 7-10 days - The patient's presentation with painful genital ulcers and vesicles, fever, malaise, and tender inguinal lymphadenopathy is highly suggestive of primary herpes simplex virus (HSV) infection [1]. - Acyclovir is an antiviral medication that effectively reduces the duration and severity of symptoms in primary HSV outbreaks [1]. Azithromycin 1g orally as single dose - Azithromycin is primarily used to treat bacterial infections, particularly chlamydia and gonorrhea, which typically present with urethritis or cervicitis, not painful vesicles. - It is ineffective against viral infections such as HSV. Benzathine penicillin G 2.4 million units IM - Benzathine penicillin G is the treatment of choice for syphilis, which causes a painless chancre in its primary stage, not painful vesicles. - This antibiotic has no efficacy against HSV. Doxycycline 100mg orally BID for 14 days - Doxycycline is an antibiotic used for various bacterial infections, including chlamydia, lymphogranuloma venereum, and granuloma inguinale [1]. - These conditions typically present with different clinical features (e.g., painless ulcers, buboes) and not the vesicular rash seen in HSV.
Question 146: Which of the following is NOT characteristic of lymphogranuloma venereum proctitis?
- A. Painful defecation
- B. Constipation alternating with diarrhea
- C. Rectal discharge and bleeding
- D. Absence of inguinal lymphadenopathy (Correct Answer)
Explanation: Absence of inguinal lymphadenopathy - **Lymphogranuloma venereum (LGV)** characteristically causes **inguinal lymphadenopathy** (buboes) due to its systemic nature and potential concurrent genital involvement, even in cases of isolated rectal infection [1]. - While the rectum drains primarily to **internal iliac and sacral lymph nodes**, LGV's systemic spread and inflammatory response typically result in inguinal lymph node involvement, making its absence atypical [1]. *Painful defecation* - **LGV proctitis** commonly causes **painful defecation** and **tenesmus** due to severe inflammation and ulceration of the rectal mucosa [1]. - The inflammatory process affects **nerve endings** in the rectal wall, leading to significant discomfort during bowel movements [1]. *Constipation alternating with diarrhea* - **Rectal inflammation** from LGV disrupts normal bowel function, causing **altered bowel habits** including constipation alternating with diarrhea. - **Rectal strictures** may develop in chronic cases, further contributing to irregular bowel patterns and incomplete evacuation. *Rectal discharge and bleeding* - **LGV proctitis** typically presents with **mucopurulent rectal discharge** due to extensive mucosal inflammation and secondary bacterial infection [1]. - **Rectal bleeding** occurs from **mucosal ulceration** and increased vascular fragility caused by the inflammatory process.
Question 147: Which of the following clinical manifestations is LEAST likely in secondary syphilis?
- A. Chancre (Correct Answer)
- B. Condylomata lata
- C. Mucous patches
- D. Palmar and plantar rash
Explanation: ***Chancre*** - A **chancre** is the characteristic lesion of **primary syphilis**, appearing at the site of inoculation [1]. - By the time **secondary syphilis** develops (typically weeks to months later), the chancre of primary syphilis has usually healed spontaneously [1]. *Condylomata lata* - **Condylomata lata** are highly infectious, moist, wart-like lesions that occur in intertriginous areas and mucous membranes during **secondary syphilis** [1]. - They are a common manifestation due to the widespread dissemination of **Treponema pallidum** [1]. *Mucous patches* - **Mucous patches** are painless, white to gray lesions found on mucous membranes (e.g., mouth, pharynx, vagina, anus) during **secondary syphilis**. - These are highly infectious and result from the systemic spread of the spirochete. *Palmar and plantar rash* - A diffuse, non-pruritic, maculopapular rash, often involving the **palms and soles**, is a classic and highly characteristic sign of **secondary syphilis** [1]. - This rash indicates the systemic nature of the infection and can vary widely in appearance [1].
Question 148: A 32-year-old HIV-positive man (CD4 count 320/μL) presents with painless perianal ulcer for 3 weeks. Dark field microscopy shows spirochetes. What is the appropriate treatment?
- A. Benzathine penicillin G 2.4 million units IM weekly for 3 weeks
- B. Azithromycin 2g orally single dose
- C. Benzathine penicillin G 2.4 million units IM single dose (Correct Answer)
- D. Doxycycline 100mg orally twice daily for 14 days
Explanation: ***Benzathine penicillin G 2.4 million units IM single dose*** - The presence of a painless perianal ulcer and **spirochetes on dark field microscopy** is highly suggestive of **primary syphilis**. - For primary syphilis, the recommended treatment is a **single intramuscular dose of benzathine penicillin G 2.4 million units**, regardless of HIV status unless there's evidence of neurosyphilis. *Benzathine penicillin G 2.4 million units IM weekly for 3 weeks* - This regimen is typically reserved for **late latent syphilis** or syphilis of unknown duration. - It is not indicated for primary syphilis, which can be cured with a single dose. *Azithromycin 2g orally single dose* - **Azithromycin** is a potential alternative for syphilis in some cases, particularly for penicillin-allergic patients, but it is not the first-line treatment due to increasing rates of macrolide resistance. - The recommended dosage for early syphilis (including primary) is typically **2g orally as a single dose**, but penicillin remains superior. *Doxycycline 100mg orally twice daily for 14 days* - **Doxycycline** is an alternative treatment for early syphilis (primary, secondary, or early latent) in **penicillin-allergic patients**. - The standard duration for early syphilis is **14 days**, but it is not the preferred treatment for patients without penicillin allergy.
Question 149: What is the underlying pathophysiology of post-gonococcal urethritis?
- A. Development of antibiotic resistance
- B. Immunological reaction to gonococcal antigens
- C. Concurrent chlamydial infection unaffected by gonococcal treatment (Correct Answer)
- D. Incomplete treatment of gonorrhea
Explanation: ***Concurrent chlamydial infection unaffected by gonococcal treatment*** - Post-gonococcal urethritis often occurs because many individuals co-infected with **gonorrhea** also have a **chlamydial infection** [1]. - Standard **gonorrhea treatment** (e.g., ceftriaxone) does not effectively treat chlamydia, leading to persistent urethritis symptoms caused by the untreated *Chlamydia trachomatis* [1]. *Development of antibiotic resistance* - While **antibiotic resistance** in *Neisseria gonorrhoeae* is a concern, post-gonococcal urethritis typically refers to persistent symptoms after *successful* treatment of gonorrhea [1]. - If initial treatment fails due to resistance, it would be considered **unresolved gonorrhea**, not post-gonococcal urethritis in the context of co-infection. *Immunological reaction to gonococcal antigens* - An **immunological reaction** to gonococcal antigens can occur, but it is not the primary cause of persistent urethritis after *successful* gonococcal eradication. - Such reactions are more characteristic of conditions like **reactive arthritis** following certain infections, which is distinct from persistent urethral inflammation. *Incomplete treatment of gonorrhea* - **Incomplete treatment** implies that the initial *Neisseria gonorrhoeae* infection was not fully eradicated, which would result in persistent gonococcal urethritis [1]. - Post-gonococcal urethritis, by definition, suggests the *gonorrhea* has been effectively treated, and the persistent symptoms are due to another cause, most commonly **co-infection** [1].
Question 150: Which screening test has the highest sensitivity for detecting early primary syphilis?
- A. Dark field microscopy
- B. VDRL
- C. PCR
- D. TPHA (Correct Answer)
Explanation: ***TPHA*** - This **treponemal-specific test** (Treponema pallidum hemagglutination assay) becomes positive early in the infection and remains positive for life, making it highly sensitive for detecting antibodies specific to *Treponema pallidum* in primary syphilis [1]. - While other treponemal tests like FTA-ABS are also highly sensitive, TPHA is a commonly available and reliable option for early detection [1]. *Dark field microscopy* - This method directly visualizes the **spirochetes** from a chancre lesion. Although highly specific, its sensitivity is limited by the need for an active lesion and experienced personnel. - It may be negative if the lesion was treated with topical agents or if the number of spirochetes is low. *VDRL* - The **Venereal Disease Research Laboratory (VDRL)** test is a non-treponemal test that detects antibodies to cardiolipin. It becomes reactive 4-6 weeks after infection [1]. - Its sensitivity is lower than treponemal tests in early primary syphilis, as antibodies may not have developed yet or may be present at very low levels [1]. *PCR* - **Polymerase Chain Reaction (PCR)** can detect *Treponema pallidum* DNA directly from lesions or bodily fluids. While highly specific, its sensitivity for routine screening of early primary syphilis is not superior to treponemal antibody tests due to issues with specimen collection and varying bacterial loads. - PCR is more often used for atypical presentations or for clarifying indeterminate serological results.
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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