Venerology Practice Questions

Q: Chancre redux is a clinical feature of

Early relapsing syphilis. ***Early relapsing syphilis*** - **Chancre redux** refers to the reappearance of a chancre-like lesion at the site of the original primary chancre during the **early relapsing phase of syphilis**. - This phenomenon indicates a **failure of treatment** or an **immune system response** that allows the *Treponema pallidum* bacteria to reactivate locally. *Recurrent herpes simplex infection* - Recurrent herpes simplex presents as **vesicular lesions** that evolve into ulcers, typically not referred to as chancre redux [1]. - Herpes lesions are characterized by **painful grouped vesicles** on an erythematous base [1]. *Chancroid* - Chancroid is characterized by **painful, soft chancres** caused by *Haemophilus ducreyi*, which are distinct from the indurated chancre of syphilis. - While it can recur, its recurrence is not termed chancre redux and it is not a treponemal infection. *Late syphilis* - **Late syphilis** is characterized by conditions such as **gummas, cardiovascular syphilis, or neurosyphilis**, not by a recurrence of the primary chancre. - The primary chancre is a feature of **primary syphilis**, and its recurrence suggests an issue during the early stages of disease progression or treatment.

Q: A young female with asymptomatic macules and papules over trunk and reddish patch over palate with a flat, moist lesion on vulva. Patient has generalized lymphadenopathy. What is the line of management?

Benzathine penicillin. ***Benzathine penicillin*** - This clinical presentation, including **asymptomatic macules and papules** on the trunk, a **reddish palatal patch**, a **flat, moist vulval lesion (condyloma lata)**, and **generalized lymphadenopathy**, is highly suggestive of **secondary syphilis** [1]. - **Benzathine penicillin G** is the *drug of choice* for treating all stages of syphilis, particularly effective for early syphilis like this manifestation. *Fluconazole* - **Fluconazole** is an **antifungal medication** primarily used to treat *candidiasis* and other fungal infections [1]. - The symptoms described are *not characteristic* of a fungal infection. *Ceftriaxone* - **Ceftriaxone** is a *beta-lactam antibiotic* used to treat a wide range of bacterial infections, especially *gonorrhea*, *meningitis*, and *respiratory tract infections*. - While a potent antibiotic, it is *not the primary treatment* for syphilis, which requires penicillin. *Acyclovir* - **Acyclovir** is an *antiviral drug* used to treat *herpes simplex virus* infections (e.g., genital herpes, cold sores) and *varicella-zoster virus* [1]. - The lesions described, particularly the *flat, moist condyloma lata* and *generalized maculopapular rash*, are *not typical manifestations of herpes* [1].

Q: The incubation period of LGV is?

10-30 days. ***10-30 days*** - The incubation period for **Lymphogranuloma Venereum (LGV)**, which is caused by specific serovars of *Chlamydia trachomatis*, typically ranges from 10 to 30 days [1]. - This period reflects the time from exposure to the appearance of initial lesions, such as a **small, painless papule** or ulcer at the site of inoculation [1]. *30-90 days* - This period is generally too long for the primary incubation phase of LGV. - While later stages of LGV can manifest much later, the initial incubation before the appearance of primary lesions or regional lymphadenopathy is shorter. *7-10 days* - This period is generally too short for LGV; many other STIs, like **genital herpes**, may have an incubation period in this range. - LGV's characteristic spread to regional lymph nodes and its presentation generally require a slightly longer incubation. *3-7 days* - This incubation period is more characteristic of conditions like **gonorrhea** or **chancroid**, not LGV. - LGV's distinct pathogenesis, involving deeper tissue penetration and lymphatic spread, necessitates a longer initial period.

Q: Urethritis in males is not caused by:

H. ducreyi. ***H. ducreyi*** - *Haemophilus ducreyi* is the causative agent of **chancroid**, a sexually transmitted infection characterized by **genital ulcers** [1] with painful regional lymphadenopathy. - It does not typically cause urethritis as its primary site of infection is the **skin and mucous membranes** of the external genitalia, forming ulcers rather than urethral inflammation. *Chlamydia* - **Chlamydia trachomatis** is a common cause of **non-gonococcal urethritis** in males [1]. - It often presents with **dysuria**, **urethral discharge**, and sometimes can be asymptomatic [1]. *Gonococcus* - **Neisseria gonorrhoeae** (gonococcus) is a well-known cause of urethritis, often referred to as **gonococcal urethritis** [1]. - It typically causes a **purulent urethral discharge** and **dysuria** [1]. *Trichomonas* - **Trichomonas vaginalis** can cause **urethritis** in males [1], although it is less common than in females. - Males may experience **dysuria**, **urethral discharge**, or can be asymptomatic carriers.

Q: Regarding Jarisch-Herxheimer reaction in syphilis treatment, which statement is FALSE?

Requires stopping antibiotic therapy. Regarding Jarisch-Herxheimer reaction in syphilis treatment, which statement is FALSE? ***Requires stopping antibiotic therapy*** - The **Jarisch-Herxheimer reaction (JHR)** is a transient immune-mediated response to endotoxins released by dying spirochetes after initiation of syphilis treatment. It is a sign that the treatment is working, and **antibiotic therapy should not be stopped**. - While supportive care (e.g., antipyretics, analgesics) may be necessary to manage symptoms like fever, chills, myalgia, and headache, stopping the antibiotic would interrupt appropriate syphilis treatment. *More common in secondary syphilis* - The **Jarisch-Herxheimer reaction** is indeed most common and severe in **secondary syphilis** due to the high spirochetemia and widespread dissemination of bacteria, leading to a greater antigen load and subsequent immune response. - Symptoms tend to be milder or absent in primary or latent syphilis. *Can cause fetal distress in pregnancy* - In pregnant women, the **Jarisch-Herxheimer reaction** can potentially induce **uterine contractions** and **fetal distress**, especially if it causes significant maternal fever or systemic inflammation. - Although treatment for syphilis is critical during pregnancy, careful monitoring and management of JHR symptoms are important to mitigate risks to the fetus. *Usually occurs within 24 hours of treatment* - The **Jarisch-Herxheimer reaction** typically has a rapid onset, manifesting within **4 to 12 hours** after the first dose of antisyphilitic medication and usually resolving spontaneously within **24 hours** [1]. - This acute, self-limiting nature is characteristic of the reaction.

Q: A patient presents with painful genital ulcers and vesicles. Which of the following findings best differentiates HSV-1 from HSV-2 infection?

Rate of recurrence. ***Rate of recurrence*** - **HSV-2** infections typically have a **higher rate and greater frequency of recurrence** compared to HSV-1 genital infections. - This difference in recurrence patterns is a key clinical indicator for differentiating between the two types. *Severity of symptoms* - While initial HSV-2 outbreaks are often more severe than HSV-1, the **severity can vary greatly** between individuals and is not a definitive differentiating factor. - Both types can cause mild or severe symptoms depending on host factors and viral load. *Appearance of lesions* - The **lesions of both HSV-1 and HSV-2 are clinically indistinguishable**, typically presenting as painful vesicles that ulcerate. - Microscopic examination or visual inspection alone cannot reliably differentiate the viral types. *None of the above* - The rate of recurrence is a significant differentiating factor, making this option incorrect. - While other factors might contribute to a diagnosis, recurrence frequency provides a stronger clinical clue.

Q: Which of the following statements about non-gonococcal urethritis is INCORRECT?

Trichomonas vaginalis never causes urethritis in males. ***Trichomonas vaginalis never causes urethritis in males*** - This statement is incorrect because **Trichomonas vaginalis** can indeed cause **urethritis** in males, though it is often asymptomatic [1]. - While more commonly associated with vaginitis in women, it can lead to symptoms like dysuria and urethral discharge in men. *Mycoplasma genitalium requires extended azithromycin therapy* - This statement is generally correct, as **Mycoplasma genitalium** is known for developing **macrolide resistance**, often necessitating extended or alternative antibiotic regimens. - Standard single-dose azithromycin regimens are often insufficient, and longer courses (e.g., 5-day azithromycin) or moxifloxacin may be required. *Chlamydia trachomatis is the most common cause* - This is a correct statement, as **Chlamydia trachomatis** is the most frequently identified pathogen responsible for **non-gonococcal urethritis (NGU)** [1]. - It accounts for a significant proportion of NGU cases, making it a primary target for screening and treatment. *Incubation period is typically longer than gonococcal urethritis* - This statement is also correct; the **incubation period for NGU** (often caused by Chlamydia) is generally **7-14 days**, which is longer than that for gonococcal urethritis (2-7 days) [1]. - This difference can be a clue in clinical diagnosis, though definitive diagnosis relies on specific testing [2].

Q: A patient presents with genital ulcer disease. Which of the following combinations correctly matches the pain characteristics with the causative organism?

Multiple painful - HSV. ***Multiple painful - HSV*** - **Herpes Simplex Virus (HSV)** typically causes a constellation of **multiple, superficial, painful ulcers**, often preceded by tingling or burning sensations [1]. - These lesions evolve from vesicles to pustules and then to ulcers, making them highly characteristic of HSV infection [1]. *Painless - H. ducreyi* - **_Haemophilus ducreyi_** is the causative agent of **chancroid**, which classically presents as **painful, ragged, undermined ulcers** with erythematous bases, not painless ones [1]. - The descriptor "painless" is characteristic of the chancre of syphilis caused by _Treponema pallidum_. *Single painful - C. trachomatis* - **_Chlamydia trachomatis_** (specifically serovars L1-L3) causes **lymphogranuloma venereum (LGV)**, which initially presents with a **small, often painless, transient ulcer or papule** that can go unnoticed, followed by painful inguinal lymphadenopathy [1]. - A single painful ulcer is not the typical presentation for _Chlamydia trachomatis_ in the context of genital ulcer disease. *Painful - T. pallidum* - **_Treponema pallidum_**, the bacterium responsible for **syphilis**, causes a primary lesion known as a **chancre**, which is typically a **single, firm, painless ulcer** with raised, indurated borders [1]. - Painful ulcers are uncharacteristic of primary syphilis.

Q: Choose the INCORRECT statement about lymphogranuloma venereum (LGV):

Doxycycline is contraindicated. ***Doxycycline is contraindicated*** - This statement is **incorrect** because **doxycycline** is the **first-line treatment** for lymphogranuloma venereum (LGV), typically administered for a 21-day course. - It is highly effective against *Chlamydia trachomatis* serovars L1, L2, and L3, which cause LGV. *Fistulas are common in late stage* - This statement is **correct**. If left untreated, LGV can progress to a late stage characterized by **chronic inflammation**, **strictures**, and the formation of **fistulas** involving the rectum, vagina, or perineum. - These complications result from extensive tissue damage and scarring, often following the rupture of inflamed lymph nodes. *Primary lesion may be painless* - This statement is **correct**. The primary lesion of LGV is often a **small, painless papule, vesicle, or ulcer** (chancre) that appears at the site of inoculation. - It often goes unnoticed because of its transient and asymptomatic nature, preceding the more prominent lymphadenopathy. *Caused by L1, L2, L3 serovars* - This statement is **correct**. Lymphogranuloma venereum is specifically caused by the **L1, L2, and L3 serovars** of *Chlamydia trachomatis* [1]. - These serovars have a greater invasive capacity compared to other *Chlamydia trachomatis* serovars, leading to systemic infection and severe lymphadenopathy.

Q: A 20-year-old presents with painful inguinal lymphadenopathy and genital ulcer. Gram stain shows streptobacilli in 'school of fish' arrangement. Most likely diagnosis is:

Chancroid. Chancroid - The combination of **painful inguinal lymphadenopathy** and a **painful genital ulcer** is highly suggestive of chancroid [1]. - The Gram stain finding of **streptobacilli** arranged in a "**school of fish**" pattern is a classic diagnostic feature of *Haemophilus ducreyi*, the causative agent of chancroid. *Primary syphilis* - Primary syphilis presents with a **painless chancre** and typically **painless lymphadenopathy** [1]. - Gram stain would show **spirochetes**, not streptobacilli, and requires darkfield microscopy for visualization. *Lymphogranuloma venereum* - Caused by *Chlamydia trachomatis* serovars L1, L2, or L3, which would not be visible on a Gram stain as streptobacilli. - Presents initially with a **transient, often unnoticed, painless lesion**, followed by **painful, often suppurative, inguinal lymphadenopathy** (buboes). *Donovanosis* - Characterized by **painless, progressive ulcerative lesions** that bleed easily, often without significant regional lymphadenopathy. - Diagnosis involves identifying **Donovan bodies** (intracellular Gram-negative bacteria) within macrophages, which are different from streptobacilli in a "school of fish" arrangement.

Question 1

Chancre redux is a clinical feature of

Accepted Answer

Early relapsing syphilis

Answer

Recurrent herpes simplex infection

Answer

Chancroid

Answer

Late syphilis

Question 2

A young female with asymptomatic macules and papules over trunk and reddish patch over palate with a flat, moist lesion on vulva. Patient has generalized lymphadenopathy. What is the line of management?

Accepted Answer

Benzathine penicillin

Answer

Fluconazole

Answer

Ceftriaxone

Answer

Acyclovir

Question 3

The incubation period of LGV is?

Accepted Answer

10-30 days

Answer

30-90 days

Answer

7-10 days

Answer

3-7 days

Question 4

Urethritis in males is not caused by:

Accepted Answer

H. ducreyi

Answer

Chlamydia

Answer

Gonococcus

Answer

Trichomonas

Question 5

Regarding Jarisch-Herxheimer reaction in syphilis treatment, which statement is FALSE?

Accepted Answer

Requires stopping antibiotic therapy

Answer

More common in secondary syphilis

Answer

Can cause fetal distress in pregnancy

Answer

Usually occurs within 24 hours of treatment

Question 6

A patient presents with painful genital ulcers and vesicles. Which of the following findings best differentiates HSV-1 from HSV-2 infection?

Accepted Answer

Rate of recurrence

Answer

Severity of symptoms

Answer

Appearance of lesions

Answer

None of the above

Question 7

Which of the following statements about non-gonococcal urethritis is INCORRECT?

Accepted Answer

Trichomonas vaginalis never causes urethritis in males

Answer

Mycoplasma genitalium requires extended azithromycin therapy

Answer

Chlamydia trachomatis is the most common cause

Answer

Incubation period is typically longer than gonococcal urethritis

Question 8

A patient presents with genital ulcer disease. Which of the following combinations correctly matches the pain characteristics with the causative organism?

Accepted Answer

Multiple painful - HSV

Answer

Painless - H. ducreyi

Answer

Single painful - C. trachomatis

Answer

Painful - T. pallidum

Question 9

Choose the INCORRECT statement about lymphogranuloma venereum (LGV):

Accepted Answer

Doxycycline is contraindicated

Answer

Fistulas are common in late stage

Answer

Primary lesion may be painless

Answer

Caused by L1, L2, L3 serovars

Question 10

A 20-year-old presents with painful inguinal lymphadenopathy and genital ulcer. Gram stain shows streptobacilli in 'school of fish' arrangement. Most likely diagnosis is:

Accepted Answer

Chancroid

Answer

Primary syphilis

Answer

Lymphogranuloma venereum

Answer

Donovanosis

Venerology — MCQs

Venerology — MCQs

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