Venerology — MCQs

A 25 year old male presents to the clinic with a lesion on his penis. On examination he was noted to have a beefy red ulcer on the glans which bled when touched. Smear taken from the ulcer showed gram-negative intracytoplasmic cysts filled with deeply staining bodies that had a safety-pin appearance. What is he most likely suffering from?

Venerology Indian Medical PG Practice Questions and MCQs

Question 201: Genital ulcer followed by painful lymphadenopathy is seen in -

A. LGV (Correct Answer)
B. Granuloma inguinale
C. Chancroid
D. Syphilis

Explanation: ***LGV*** - Lymphogranuloma venereum (LGV) is caused by specific serovars of *Chlamydia trachomatis* and classically presents with a **small, often transient and painless genital ulcer**, followed by **tender, suppurative inguinal lymphadenopathy** (buboes) [1]. - The inguinal lymph nodes can become greatly enlarged and may rupture, leading to **fistula formation**. *Granuloma inguinale* - This condition, also known as donovanosis, is characterized by **painless, progressive ulcerative lesions** without regional lymphadenopathy [1]. - The ulcers have a **beefy red, velvety appearance** due to abundant granulation tissue, distinguishing them from LGV. *Chancroid* - Chancroid is characterized by **painful genital ulcers with ragged borders** and an erythematous base, caused by *Haemophilus ducreyi* [1]. - While it can cause **painful inguinal lymphadenopathy**, the primary ulcer is typically much more prominent and painful than the transient lesion of LGV [1]. *Syphilis* - Primary syphilis presents as a **painless chancre** (genital ulcer) with **painless, firm regional lymphadenopathy**. - The classic firm, clean-based chancre and non-tender lymph nodes are key differentiating features from the painful buboes of LGV.

Question 202: Painless ulcer along with painless lymphadenopathy is characteristic of which STD:

A. Chancroid
B. Donovanosis
C. LGV
D. Syphilis (Correct Answer)

Explanation: ***Syphilis*** - The primary stage of syphilis is characterized by a **painless chancre**, which is a firm, round, and painless ulcer, along with painless regional **lymphadenopathy**. - This presentation is highly suggestive of infection with **Treponema pallidum**. *Chancroid* - Chancroid typically presents with **multiple, painful ulcers** that have ragged, undermined borders. - The associated lymphadenopathy is usually **painful** and may suppurate, forming a **bubo**. *Donovanosis* - Donovanosis (granuloma inguinale) is characterized by **painless, progressive ulcerative lesions** that are often beefy red and bleed easily. - While it causes ulceration, prominent and discreet **painless lymphadenopathy** is not a classic initial feature; rather, it can present with pseudobuboes or subcutaneous granulomas. *LGV* - Lymphogranuloma venereum (LGV) initially presents with a **small, often unnoticed, painless ulcer or papule**. - Its hallmark is pronounced, **painful inguinal lymphadenopathy** (buboes), which can rupture and drain, contrasting with the painless lymphadenopathy described.

Question 203: Which stage of LGV infection is associated with bubos?

A. Third stage
B. First stage
C. Throughout all stages
D. Second stage (Correct Answer)

Explanation: **Second stage** - The **second stage** of LGV (lymphogranuloma venereum) is characterized by the development of **buboes**, which are swollen, painful lymph nodes, most commonly in the inguinal region [1]. - These buboes result from the **lymphatic spread** of the *Chlamydia trachomatis* infection [1]. *Third stage* - The **third stage** of LGV involves chronic complications such as **genital elephantiasis**, **strictures**, and **fistulas** due to persistent inflammation and scarring. - While it follows the bubo formation, buboes themselves are not the primary feature of this later, chronic stage. *First stage* - The **first stage** of LGV is marked by the appearance of a **painless papule, vesicle, or ulcer** at the site of inoculation, which often goes unnoticed because it is transient and resolves quickly. - This stage does not typically involve the development of buboes, as lymphatic spread to regional lymph nodes has not yet become clinically evident. *Throughout all stages* - Buboes are a **distinctive feature** of the second stage of LGV, not a consistent finding across all stages. - The initial stage is a transient lesion, and the third stage involves chronic, destructive changes, making the presence of buboes ubiquitous across all stages inaccurate.

Question 204: Most common genital infection in HIV infected patient

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

Explanation: ***Herpes*** - **Herpes simplex virus (HSV)** infections, particularly HSV-2, are highly prevalent and often more severe and recurrent in HIV-infected individuals due to compromised immunity. - HIV coinfection can lead to atypical presentations of herpes, including chronic, non-healing ulcers and extensive mucocutaneous lesions. *Syphilis* - While syphilis is common among HIV-infected individuals, its prevalence is generally lower than that of herpes. - Syphilis often progresses more rapidly and can have more severe neurological complications in HIV-positive patients, but it is not the *most common* genital infection. *Chlamydia* - **Chlamydia trachomatis** infections are common sexually transmitted infections, but they typically present with less severe symptoms than herpes and are not generally cited as the *most common* genital infection in this population. - While Chlamydia can increase HIV transmission risk, it does not have the same increased severity or prevalence in HIV-infected patients as herpes. *Candida* - **Candida** infections (e.g., candidiasis) are very common in HIV-infected patients, especially oral and esophageal candidiasis, indicating a decline in immune function. - While genital candidiasis (vulvovaginal candidiasis or balanitis) can occur, it is generally considered an opportunistic infection rather than the *most common* primary sexually transmitted genital infection.

Question 205: Incubation period of syphilis is:

A. 10-14 days
B. 9-90 days (Correct Answer)
C. 3-6 months
D. 30-60 days

Explanation: ***9-90 days*** - The incubation period for primary syphilis, from exposure to the appearance of a **chancre**, typically ranges from **9 to 90 days**, with an average of 21 days [1]. - This variability depends on the **inoculum size** and the host's immune response [1]. *10-14 days* - This period is generally **too short** for the typical development of a primary syphilitic lesion, the chancre. - Incubation periods for other infections, such as **gonorrhea**, might fall within this range. *3-6 months* - This duration is usually **too long** for the incubation period of primary syphilis, as chancres typically appear much sooner. - Syphilis may progress to secondary or latent stages within this timeframe if untreated [1]. *30-60 days* - While this period falls within the broader range, it is **not the complete or most accurate representation** of the full incubation period for syphilis. - It captures a common average but omits the earlier and later ends of the known range.

Question 206: Symptoms of secondary syphilis are all except:

A. Localized or diffuse mucocutaneous lesion
B. Condyloma lata is seen
C. Generalized and tender lymphadenopathy (Correct Answer)
D. Self resolving

Explanation: **Generalized and tender lymphadenopathy** - Secondary syphilis typically presents with **generalized, non-tender lymphadenopathy** [1]. - **Tender lymphadenopathy** is more characteristic of acute infections or inflammatory conditions rather than the chronic inflammation seen in syphilis. *Localized or diffuse mucocutaneous lesion* - **Mucocutaneous lesions**, including **rashes on palms and soles**, are very common and characteristic manifestations of secondary syphilis [1]. - These lesions can be maculopapular, pustular, or ulcerative and are often widespread [1]. *Condyloma lata is seen* - **Condyloma lata** are moist, wart-like lesions that occur in intertriginous areas (e.g., groin, perianal region) [1]. - They are highly infectious and a classic sign of secondary syphilis, resulting from a proliferation of spirochetes [1]. *Self resolving* - The symptoms of secondary syphilis, if left untreated, typically **resolve spontaneously** within a few weeks to months [1]. - However, the disease then progresses to a latent stage, and without treatment, can lead to tertiary syphilis [1].

Question 207: Treatment of partner is required in all infection except:

A. Trichomonas
B. Herpes
C. Gardnerella (Correct Answer)
D. Candida

Explanation: ***Gardnerella*** - **Gardnerella vaginalis** is a common inhabitant of the vaginal flora and its overgrowth causes **bacterial vaginosis**, which is not typically considered a sexually transmitted infection (STI) in the same way others are. - While it can be transmitted sexually, treating the male partner has not been shown to prevent recurrence in the female; therefore, routine **partner treatment is generally not recommended**. *Trichomonas* - **Trichomoniasis** is a sexually transmitted infection caused by the parasite **Trichomonas vaginalis**. [1] - **Partner treatment is essential** to prevent reinfection and interrupt the cycle of transmission, as asymptomatic infection is common. [1] *Herpes* - **Genital herpes** is caused by the **Herpes Simplex Virus (HSV)** and is highly transmissible sexually. [2] - While treatment often focuses on managing symptoms in the infected individual, open communication and potential treatment or counseling for partners are crucial to prevent transmission and manage outbreaks. *Candida* - **Candidiasis** (yeast infection) is typically caused by an overgrowth of **Candida albicans**, a fungus naturally present in the body. - While it is not strictly an STI, sexual activity can sometimes trigger or exacerbate symptoms, and in recurrent cases, treating a male partner might be considered, but **it's not routinely required** as it is for true STIs like trichomonas or chlamydia. [2]

Question 208: A 24-year-old man had been treated for gonorrhea 2 months previously. He developed an ulcerative lesion in the glands of the penis that is noted to be condylomata lata. The etiology of condylomata lata is which of the following?

A. Herpesvirus hominis, type II
B. Hemophilus ducreyi
C. Mixture of organisms
D. Treponema pallidum (Correct Answer)

Explanation: ***Treponema pallidum*** - **Condylomata lata** are characteristic lesions of **secondary syphilis**, caused by *Treponema pallidum* [1]. - They are typically broad, flat, moist, wart-like lesions that occur in warm, moist areas such as the anogenital region [1]. *Herpesvirus hominis, type II* - Herpesvirus hominis, type II (HSV-2) causes **genital herpes**, which manifests as painful vesicles that ulcerate [1]. - The lesions caused by HSV-2 are typically clustered, vesicular, and very painful, which is distinct from the hypertrophic, non-painful nature of condylomata lata [1]. *Hemophilus ducreyi* - *Hemophilus ducreyi* is the causative agent of **chancroid**, which presents as painful, soft ulcers with ragged, undermined borders, often accompanied by painful inguinal lymphadenopathy. - Chancroid lesions are typically destructive and highly painful, contrasting with the proliferative and less painful nature of condylomata lata. *Mixture of organisms* - While some sexually transmitted infections can involve coinfection, **condylomata lata** specifically point to a single etiological agent: *Treponema pallidum* [1]. - Attributing condylomata lata to a "mixture of organisms" is too vague and inaccurate given the specific morphology and strong association with syphilis [1].

Question 209: Features of secondary syphilis are: a) Condyloma accuminata b) Condyloma lata c) Mulberry/Moon's molars d) Lesions over palms/soles

A. ad
B. ac
C. bc
D. bd (Correct Answer)

Explanation: ***bd*** - **Condyloma lata** are moist, wart-like lesions that appear in intertriginous areas (e.g., anogenital region, axillae) and are highly infectious manifestations of secondary syphilis [1]. - **Lesions over palms/soles** are classic mucocutaneous manifestations of secondary syphilis, characterized by a non-pruritic, maculopapular rash [1]. *ad* - **Condyloma accuminata** are genital warts caused by the **Human Papillomavirus (HPV)**, not syphilis. - While lesions over palms/soles are a feature of secondary syphilis, the inclusion of condyloma acuminata makes this option incorrect. *ac* - **Condyloma accuminata** are caused by **HPV**, making this option incorrect for syphilis. - **Mulberry/Moon's molars** are a feature of **congenital syphilis**, not secondary syphilis [1]. *bc* - While **condyloma lata** are characteristic of secondary syphilis, **Mulberry/Moon's molars** are a stigmata of **congenital syphilis** [1]. - This option incorrectly combines features of secondary and congenital syphilis.

Question 210: A 25 year old male presents to the clinic with a lesion on his penis. On examination he was noted to have a beefy red ulcer on the glans which bled when touched. Smear taken from the ulcer showed gram-negative intracytoplasmic cysts filled with deeply staining bodies that had a safety-pin appearance. What is he most likely suffering from?

A. Chancroid
B. Syphilis
C. HSV infection
D. Granuloma inguinale (Correct Answer)

Explanation: **Granuloma inguinale** - The characteristic features of a **beefy red ulcer** that bleeds easily on touch, along with the presence of **Gram-negative intracytoplasmic cysts** (Donovan bodies) with deeply staining bodies described as having a **safety-pin appearance**, are pathognomonic for granuloma inguinale, caused by *Klebsiella granulomatis* (formerly *Calymmatobacterium granulomatis*) [1]. - This infection causes progressive, destructive lesions in the genital and perianal areas without significant regional lymphadenopathy, differentiating it from other causes of genital ulcers [1]. *Chancroid* - Caused by *Haemophilus ducreyi*, chancroid typically presents as **painful, soft chancres** with a ragged border and purulent base, often accompanied by **tender inguinal lymphadenopathy** (buboes) [1]. - Microscopic examination of chancroid smears would show **Gram-negative coccobacilli** in "school of fish" arrangements, not intracytoplasmic cysts with safety-pin morphology [1]. *Syphilis* - Primary syphilis manifests as a **painless chancre**, which is a firm, indurated ulcer with a clean base, and typically **does not bleed easily** on touch. - Diagnosis relies on direct visualization of **spirochetes** via darkfield microscopy or serological tests (VDRL, RPR, FTA-ABS), not the "safety-pin" forms seen in granuloma inguinale. *HSV infection* - Genital herpes simplex virus (HSV) infection typically causes **painful vesicles** that quickly rupture to form **superficial, tender ulcers** on an erythematous base, often with a prodromal tingling sensation [1]. - Microscopic findings in HSV infection (Tzanck smear) would show **multinucleated giant cells** and **intranuclear inclusions**, not the distinctive Donovan bodies of granuloma inguinale.

Practice by Chapter

Syphilis

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Gonorrhea

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Chlamydial Infections

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Chancroid and Other Genital Ulcers

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Genital Herpes

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Human Papillomavirus Infections

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HIV and STIs

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Pelvic Inflammatory Disease

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STI Screening and Prevention

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Partner Notification and Treatment

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Sexually Transmitted Enteric Infections

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Special Populations Management

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Venerology — MCQs

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