Venerology Practice Questions

Q: Which of the following is true about secondary herpes simplex?

All of the options. **All of the options** - **Secondary herpes simplex**, also known as recurrent herpes, often presents with visible symptoms like **painful ulcers**, typically on the **lips, hard palate, and gingiva** [1]. - **Acyclovir** is a primary antiviral treatment used to manage and reduce the severity and duration of secondary herpes simplex outbreaks. *Treatment – Acyclovir* - While acyclovir is indeed a standard treatment for herpes simplex, this option alone does not encompass all accurate statements regarding secondary herpes. - Acyclovir works by inhibiting viral DNA synthesis, helping to alleviate symptoms and prevent further viral replication. *Symptoms- Painful ulcers* - **Painful ulcers** are a characteristic symptom of secondary herpes simplex, particularly during outbreaks [2]. - These lesions are crucial for clinical diagnosis and patient discomfort. *Location – Lips, Hard palate and gingival* - The **lips (herpes labialis)**, **hard palate**, and **gingiva (herpetic gingivostomatitis)** are common sites for recurrent herpes simplex virus (HSV) infections due to viral latency in associated neural ganglia [1]. - Localization is a key diagnostic feature distinguishing it from other oral lesions.

Q: Secondary syphilis occurs after:

6 weeks. 6 weeks - **Secondary syphilis** typically manifests about **6 to 8 weeks** after the appearance of the primary chancre, making 6 weeks a common presentation window [1]. - This stage is characterized by systemic symptoms such as a **rash**, **lymphadenopathy**, and **constitutional symptoms**, indicating dissemination of the bacteria [1]. *13 weeks* - While secondary syphilis can *persist* for several weeks, its onset is usually earlier than **13 weeks**. Without treatment, the rash may last for up to 12 weeks [1]. - A duration of **13 weeks** might encompass the later phases of secondary syphilis or the transition to latent syphilis. *9 weeks* - **9 weeks** falls within the typical timeframe for secondary syphilis, but **6 weeks** is a more precise and common initial presentation. - The range for secondary syphilis onset is usually **6 weeks to 6 months** after primary infection. *1 week* - **One week** after initial infection is too early for the development of secondary syphilis; this period is usually when the primary chancre might just be appearing or in its early stages of development [1]. - Secondary syphilis is a systemic stage, requiring more time for bacterial multiplication and dissemination.

Q: Pseudo bubo is caused by:

Donovanosis. ***Donovanosis*** - **Donovanosis**, caused by *Klebsiella granulomatis*, leads to **subcutaneous granulation tissue** that mimics a true bubo but is not an inflamed lymph node, hence the term **pseudo bubo** [1]. - This condition is characterized by **chronic, progressive ulcerative lesions** primarily affecting the genital and perianal areas [1]. *Syphilis* - **Syphilis**, caused by *Treponema pallidum*, typically presents with a **painless chancre** in its primary stage and can lead to systemic symptoms. - It does not cause pseudo buboes; lymphadenopathy, if present, is usually **generalized and non-suppurative**. *Chancroid* - **Chancroid**, caused by *Haemophilus ducreyi*, results in **painful genital ulcers** and often leads to **true, painful, suppurative inguinal lymphadenopathy** (buboes) [1]. - These buboes can rupture and drain pus, which is distinct from the granulomatous lesions of pseudo buboes. *LGV* - **Lymphogranuloma venereum (LGV)**, caused by specific serotypes of *Chlamydia trachomatis*, is characterized by painful and often **suppurative inguinal lymphadenopathy** (buboes) [1]. - These are true buboes that can become fluctuant and drain, unlike the pseudo bubo of donovanosis.

Q: A 28-year-old sexually active male presents with burning micturition. On clinical examination, there is no ulcer in the genitals. Urine examination shows 50 WBCs/HPF, no RBCs, leucocyte esterase positive, gonococcal culture negative. What could be the most probable causative organism

Chlamydia trachomatis. ***Chlamydia trachomatis*** - This patient presents with **urethritis symptoms** (burning micturition, numerous WBCs in urine, positive leukocyte esterase) but a **negative gonococcal culture**. This clinical picture is classic for **non-gonococcal urethritis**, with *Chlamydia trachomatis* being the most common cause [1]. - The absence of genital ulcers further supports a diagnosis of complicated urethritis rather than other STIs that typically cause ulcers. *Treponema pallidum* - *Treponema pallidum* is the causative agent of **syphilis**, which typically presents with **genital ulcers (chancres)** in its primary stage. - While it is a sexually transmitted infection, the patient's symptoms of burning micturition and WBCs in urine are not characteristic of primary syphilis. *Neisseria* - *Neisseria gonorrhoeae* causes **gonococcal urethritis**, which would present with similar symptoms of burning micturition and pyuria [1]. - However, the question states that the **gonococcal culture was negative**, effectively ruling out *Neisseria gonorrhoeae* as the causative agent. *Hemophilus ducreyi* - *Hemophilus ducreyi* is the bacterium responsible for **chancroid**, a sexually transmitted infection characterized by the formation of **painful genital ulcers**. - The patient's presentation does not include genital ulcers, making chancroid an unlikely diagnosis.

Q: Hutchinson's syphilitic triad includes all except

Cardiovascular anomalies . ***Cardiovascular anomalies*** - **Hutchinson's syphilitic triad** specifically includes **interstitial keratitis**, **nerve deafness**, and **Hutchinson's teeth (notched incisors)** [1]. - **Cardiovascular anomalies** like **aortic regurgitation** or **aneurysm** are manifestations of **tertiary syphilis** and not part of the distinct triad affecting congenital syphilis. *Interstitial keratitis* - This is a key component of **Hutchinson's triad**, representing inflammation of the cornea without primary involvement of the epithelium or endothelium. - It is a common ocular manifestation of **congenital syphilis**, often leading to significant vision impairment if untreated [1]. *Nerve deafness* - This refers to **sensorineural hearing loss** and is another characteristic feature of **Hutchinson's triad**. - It results from damage to the **vestibulocochlear nerve** or inner ear structures due to syphilitic infection. *Notched incisor teeth* - Also known as **Hutchinson's teeth**, these are specifically malformed upper central incisors with characteristic notches [1]. - This dental anomaly is a classic sign of **congenital syphilis** and part of the triad.

Q: A 20-year-old man presents with dysuria, urgency, and urethral discharge. Physical examination shows suppurative urethritis, with redness and swelling at the urethral meatus. Which of the following is the most likely etiology of urethritis in this patient?

Neisseria gonorrhoeae. ***Neisseria gonorrhoeae*** - The presentation of **dysuria, urgency, urethral discharge**, and **suppurative urethritis** (purulent discharge with redness and swelling) is highly characteristic of **gonococcal urethritis** [1]. - **Gonorrhea** is a common cause of sexually transmitted urethritis, especially with prominent inflammatory signs [1]. *Haemophilus ducreyi* - This bacterium is the causative agent of **chancroid**, which typically presents as painful genital ulcers with regional lymphadenopathy. - It does not cause urethritis with significant urethral discharge as described. *Chlamydia trachomatis* - While *Chlamydia trachomatis* is a common cause of urethritis, it typically causes **non-gonococcal urethritis (NGU)**, which is often less symptomatic and may present with a thinner, mucoid discharge [1]. - The **suppurative (purulent) nature** of the discharge described points more strongly towards gonorrhea [1]. *Ureaplasma urealyticum* - *Ureaplasma urealyticum* is a known cause of **non-chlamydial, non-gonococcal urethritis**, similarly to *Chlamydia* [1]. - However, its presentation is generally milder and less suppurative than that caused by *Neisseria gonorrhoeae* [1].

Q: Which one of the following statements best characterizes lympho-granuloma venereum (LGV)?

The causative agent is C. trachomatis. **The causative agent is *C. trachomatis*** - **Lymphogranuloma venereum (LGV)** is a sexually transmitted infection caused by specific serovars (**L1, L2, L2a, L2b, L3**) of *Chlamydia trachomatis*. [1] - These serovars are **invasive** and replicate in **mononuclear phagocytes** of lymphatic tissue, leading to the characteristic lymphadenopathy. [1] *It is most common in temperate regions* - LGV is **most common in tropical and subtropical regions**, particularly in parts of Africa, Southeast Asia, South America, and the Caribbean. - Its prevalence is much lower in temperate regions, though outbreaks can occur, especially in specific *high-risk populations*. *In the United States, it is more common among women* - In developed countries like the United States, LGV primarily affects **men who have sex with men (MSM)**, particularly those who are HIV-positive. [1] - While it can occur in women, its incidence is **significantly lower** in this population. *Penicillin is effective in early treatment* - LGV is caused by *Chlamydia trachomatis*, which is a **bacterium that lacks a peptidoglycan cell wall**, making it inherently resistant to penicillin. - The recommended treatments for LGV are **doxycycline** or **erythromycin**, not penicillin.

Q: In secondary syphilis all are seen except -

Interstitial keratitis. ***Interstitial keratitis*** - **Interstitial keratitis** is a hallmark manifestation of **congenital syphilis**, not secondary syphilis. - It involves non-ulcerative inflammation of the cornea, leading to scarring and vision loss. *Arthritis* - **Arthritis** can occur in secondary syphilis, typically presenting as a **non-inflammatory polyarthritis** affecting large joints. - This is due to the systemic effects of widespread spirochete dissemination. *Proteinuria* - **Proteinuria** can be a feature of **syphilitic glomerulonephritis**, which can occur during the secondary stage. - This renal involvement is a less common but recognized complication. *Condyloma lata* - **Condyloma lata** are highly infectious, raised, grayish-white lesions found in moist areas, such as the anogenital region and oral mucosa [1]. - They are a classic and highly characteristic skin manifestation of **secondary syphilis** [1].

Q: Testicular involvement without epididymitis is a feature of -

Syphilis. ***Syphilis*** - Testicular involvement in syphilis, known as **gumma of the testis**, typically occurs in the **tertiary stage** and can present as a painless, firm mass **without epididymitis** [1]. - This is due to the spirochete *Treponema pallidum* directly invading the testicular parenchyma, leading to **granulomatous inflammation**. *Tuberculosis* - **Tuberculous epididymo-orchitis** is the characteristic presentation, where the **epididymis is almost always involved first**, often with a beaded or nodular feel. - Isolated testicular tuberculosis without epididymal involvement is **rare** and usually accompanies systemic disease. *Granuloma inguinale* - This sexually transmitted infection is caused by *Klebsiella granulomatis* and primarily causes **painless, progressive ulcerative lesions** of the genitourinary and perineal skin. - It does **not typically involve the testis** or epididymis; the lesions are superficial. *Gonorrhoea* - **Gonococcal epididymitis** is the most common manifestation of gonococcal infection in the male genitourinary tract, often associated with urethritis. - **Orchitis without epididymitis is extremely rare** in gonorrhoea and usually only occurs in severe, untreated cases where the infection has ascended.

Q: A man who has a penile chancre appears in a hospital's emergency service. The VDRL test is negative. The most appropriate course of action for the physician in charge would be to

Perform dark-field microscopy for treponemes. Perform dark-field microscopy for treponemes - A penile chancre is highly suggestive of primary syphilis, even with a negative VDRL, as the VDRL test can be negative early in the infection due to an insufficient antibody response. - Dark-field microscopy directly visualizes the spirochetes (Treponema pallidum) from the chancre and is the gold standard for diagnosing primary syphilis. Repeat the VDRL test in 10 days - While the VDRL test might become positive later due to seroconversion, waiting 10 days delays diagnosis and treatment, allowing the infection to progress. - Direct visualization methods like dark-field microscopy offer an immediate and definitive diagnosis for primary syphilis. Send the patient home untreated - This is an unacceptable course of action as the patient presents with a chancre, a classic sign of syphilis, which requires prompt diagnosis and treatment to prevent disease progression and transmission. - Untreated syphilis can lead to severe complications, including neurological and cardiovascular damage. Swab the chancre and culture on Thayer-Martin agar - Thayer-Martin agar is used to culture Neisseria gonorrhoeae, the causative agent of gonorrhea. - Treponema pallidum, the bacterium causing syphilis, cannot be cultured on artificial media, making this option inappropriate for diagnosing syphilis.

Question 1

Which of the following is true about secondary herpes simplex?

Accepted Answer

All of the options

Answer

Treatment – Acyclovir

Answer

Symptoms- Painful ulcers

Answer

Location – Lips, Hard palate and gingival

Question 2

Secondary syphilis occurs after:

Accepted Answer

6 weeks

Answer

9 weeks

Answer

13 weeks

Answer

1 week

Question 3

Pseudo bubo is caused by:

Accepted Answer

Donovanosis

Answer

Syphilis

Answer

Chancroid

Answer

LGV

Question 4

A 28-year-old sexually active male presents with burning micturition. On clinical examination, there is no ulcer in the genitals. Urine examination shows 50 WBCs/HPF, no RBCs, leucocyte esterase positive, gonococcal culture negative. What could be the most probable causative organism

Accepted Answer

Chlamydia trachomatis

Answer

Treponema pallidum

Answer

Neisseria

Answer

Hemophilus ducreyi

Question 5

Hutchinson's syphilitic triad includes all except

Accepted Answer

Cardiovascular anomalies

Answer

Interstitial keratitis

Answer

Nerve deafness

Answer

Notched incisor teeth

Question 6

A 20-year-old man presents with dysuria, urgency, and urethral discharge. Physical examination shows suppurative urethritis, with redness and swelling at the urethral meatus. Which of the following is the most likely etiology of urethritis in this patient?

Accepted Answer

Neisseria gonorrhoeae

Answer

Haemophilus ducreyi

Answer

Chlamydia trachomatis

Answer

Ureaplasma urealyticum

Question 7

Which one of the following statements best characterizes lympho-granuloma venereum (LGV)?

Accepted Answer

The causative agent is C. trachomatis

Answer

It is most common in temperate regions

Answer

In the United States, it is more common among women

Answer

Penicillin is effective in early treatment

Question 8

In secondary syphilis all are seen except -

Accepted Answer

Interstitial keratitis

Answer

Arthritis

Answer

Proteinuria

Answer

Condyloma lata

Question 9

Testicular involvement without epididymitis is a feature of -

Accepted Answer

Syphilis

Answer

Tuberculosis

Answer

Granuloma inguinale

Answer

Gonorrhoea

Question 10

A man who has a penile chancre appears in a hospital's emergency service. The VDRL test is negative. The most appropriate course of action for the physician in charge would be to

Accepted Answer

Perform dark-field microscopy for treponemes

Answer

Repeat the VDRL test in 10 days

Answer

Send the patient home untreated

Answer

Swab the chancre and culture on Thayer-Martin agar

Venerology — MCQs

Venerology — MCQs

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