Venerology — MCQs
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Which of the following conditions can present as a painless genital ulcer?
A 31-year-old male presents with dysuria and urethral discharge. NAAT confirms gonorrhea. Which additional infection should be treated empirically?
A 40-year-old male presents with multiple vesicles on his penis that later ulcerate. Which test is most likely to confirm the diagnosis?
A 42-year-old female presents with a painless, indurated ulcer on her labia that has been present for 3 weeks. She has bilateral non-tender inguinal lymphadenopathy. Darkfield microscopy of the ulcer is positive for spirochetes. Analyze and determine the best treatment approach.
Which sexually transmitted infection is associated with a painless, indurated ulcer?
A 60-year-old male with a history of diabetes presents with painful urination and white patches on the glans penis. Which condition is most likely responsible?
A patient presents with flu-like symptoms and a maculopapular rash on the palms and soles. What is the most likely diagnosis?
A 29-year-old male presents with a painless ulcer on his genitalia and a maculopapular rash on his palms and soles. What is the causative organism?
A patient presents with a painless ulcer and a positive RPR test. What is the most likely diagnosis?
A 50-year-old male presents with a painless genital ulcer and non-tender inguinal lymphadenopathy. The initial RPR is negative, but there is a high suspicion for syphilis. What is the next best diagnostic test?
Venerology Indian Medical PG Practice Questions and MCQs
Question 231: Which of the following conditions can present as a painless genital ulcer?
- A. Genital herpes
- B. Chancroid
- C. Primary syphilis (Correct Answer)
- D. Lymphogranuloma venereum
Explanation: ***Primary syphilis*** - A **chancre**, the hallmark lesion of primary syphilis, is typically a **painless, indurated ulcer** with a clean base. - This characteristic makes it a common cause of painless genital ulcers. *Genital herpes* - Genital herpes typically presents with **multiple, painful vesicular lesions** [1] that can rupture and form shallow ulcers. - Pain is a distinguishing feature, making it less likely to be a painless ulcer [1]. *Chancroid* - Chancroid is caused by *Haemophilus ducreyi* and produces **painful, ragged-edged ulcers** with a grayish base [2]. - The ulcers are usually accompanied by **tender, suppurative lymphadenopathy** [2]. *Lymphogranuloma venereum* - The primary lesion of LGV can be a **small, painless vesicle or ulcer**, but it is often fleeting and unnoticed [2]. - The more prominent and characteristic presentation involves **painful, often suppurative inguinal lymphadenopathy** (buboes) [2].
Question 232: A 31-year-old male presents with dysuria and urethral discharge. NAAT confirms gonorrhea. Which additional infection should be treated empirically?
- A. Chlamydia trachomatis (Correct Answer)
- B. Treponema pallidum
- C. Herpes simplex virus
- D. Trichomonas vaginalis
Explanation: ***Chlamydia trachomatis*** - Due to the high rate of **coinfection** with *Neisseria gonorrhoeae*, empirical treatment for *Chlamydia trachomatis* is recommended when gonorrhea is diagnosed. - This approach ensures comprehensive treatment for common sexually transmitted infections, even if NAAT results for Chlamydia are pending. *Treponema pallidum* - This bacterium causes **syphilis**, which typically presents with a **chancre** in its primary stage or a rash in its secondary stage. - While syphilis is also an STI, its presentation is distinct from the patient's symptoms of dysuria and urethral discharge, and routine empirical treatment alongside gonorrhea is not standard unless there's clinical suspicion. *Herpes simplex virus* - This virus causes **genital herpes**, characterized by **painful genital ulcers or vesicles**. - The patient's symptoms of dysuria and urethral discharge are not typical for a primary HSV infection, and empirical treatment is not indicated in this scenario. *Trichomonas vaginalis* - This protozoan causes **trichomoniasis**, which can present with dysuria and discharge, often described as frothy and odorous. - While it causes similar symptoms, it is less frequently co-infected with gonorrhea compared to Chlamydia, and current guidelines prioritize empirical treatment for Chlamydia.
Question 233: A 40-year-old male presents with multiple vesicles on his penis that later ulcerate. Which test is most likely to confirm the diagnosis?
- A. Tzanck smear
- B. PCR for HSV (Correct Answer)
- C. Viral culture
- D. Serology for HSV antibodies
Explanation: PCR for HSV - PCR (Polymerase Chain Reaction) for herpes simplex virus (HSV) is the most sensitive and specific test for confirming an active HSV infection, especially in the presence of vesicular or ulcerative lesions [1]. - It detects the viral DNA directly from the lesion fluid, providing a definitive diagnosis of genital herpes [2]. Tzanck smear - A Tzanck smear can reveal multinucleated giant cells and acantholytic cells, which are characteristic of herpes simplex virus (HSV) or varicella-zoster virus (VZV) infections. - However, it has lower sensitivity and specificity compared to PCR, as it does not distinguish between HSV and VZV and can produce false negatives. Viral culture - Viral culture was historically the gold standard for HSV diagnosis and can confirm the presence of live virus [1]. - However, it has lower sensitivity than PCR, especially in later stages of lesion evolution or with crusted lesions, and can take longer to yield results [2]. Serology for HSV antibodies - Serology for HSV antibodies detects the presence of IgG or IgM antibodies to HSV, indicating past exposure or primary infection [3]. - While useful for diagnosing recurrent or past infections and differentiating between HSV-1 and HSV-2, it does not confirm an acute, active infection causing current lesions, as antibodies may take weeks to appear after initial infection [2].
Question 234: A 42-year-old female presents with a painless, indurated ulcer on her labia that has been present for 3 weeks. She has bilateral non-tender inguinal lymphadenopathy. Darkfield microscopy of the ulcer is positive for spirochetes. Analyze and determine the best treatment approach.
- A. Single dose of intramuscular penicillin G (Correct Answer)
- B. Oral doxycycline for 14 days
- C. Ceftriaxone 250mg IM once
- D. Azithromycin 2g orally once
Explanation: ***Single dose of intramuscular penicillin G*** - The clinical presentation of a **painless, indurated labial ulcer** (chancre) with **inguinal lymphadenopathy**, along with **positive darkfield microscopy for spirochetes**, is characteristic of **primary syphilis** [1]. - **Penicillin G benzathine** is the **first-line and most effective treatment** for all stages of syphilis, particularly effective as a single intramuscular dose for primary syphilis. *Oral doxycycline for 14 days* - **Doxycycline** is an alternative treatment for primary syphilis, especially in patients with a **penicillin allergy**. - However, it requires a **14-day course of oral therapy**, which may lead to compliance issues, making it less ideal than a single-dose injection if penicillin is tolerated. *Ceftriaxone 250mg IM once* - **Ceftriaxone** is typically used for the treatment of **gonorrhea** and is not considered a first-line agent for syphilis [2]. - While it has some efficacy against *Treponema pallidum*, **penicillin** remains the superior and recommended treatment. *Azithromycin 2g orally once* - **Azithromycin** is used to treat various bacterial infections, including **chlamydia** and some cases of **gonorrhea and chancroid**. - It is **not effective** against syphilis due to widespread resistance and is therefore not recommended for its treatment.
Question 235: Which sexually transmitted infection is associated with a painless, indurated ulcer?
- A. Genital herpes
- B. Chancroid
- C. Primary syphilis (Correct Answer)
- D. Lymphogranuloma venereum
Explanation: Primary syphilis - **Primary syphilis** is classically characterized by a **chancre**, which is a **painless, indurated ulcer** that develops at the site of infection [1]. - The chancre typically appears 10 to 90 days after exposure and usually resolves spontaneously within 3 to 6 weeks, even without treatment. *Genital herpes* - Genital herpes typically presents with **painful, vesicular lesions** that often rupture to form shallow ulcers, which is distinct from a painless, indurated ulcer [1]. - The vesicles are usually preceded by itching or tingling and can recur. *Chancroid* - Chancroid is characterized by **painful, ragged-edged ulcers** with a gray or yellow exudate, often accompanied by tender inguinal lymphadenopathy. - Unlike syphilis, the ulcers of chancroid are noticeably painful and often **purulent**. *Lymphogranuloma venereum* - **Lymphogranuloma venereum (LGV)** often begins with a small, **painless ulcer or papule** that might go unnoticed, but its hallmark is severe, often unilateral, **inguinal lymphadenopathy** (buboes) that can rupture. - The initial lesion is typically transient and not the primary defining feature of the disease's progression.
Question 236: A 60-year-old male with a history of diabetes presents with painful urination and white patches on the glans penis. Which condition is most likely responsible?
- A. Herpes simplex virus
- B. Candidiasis (Correct Answer)
- C. Human papillomavirus
- D. Syphilis
Explanation: ***Candidiasis*** - **Painful urination** and **white patches on the glans penis** in a diabetic patient are classic symptoms of **candidal balanitis**. - Patients with **diabetes mellitus** are at higher risk for fungal infections due to immunocompromise and elevated glucose levels. *Herpes simplex virus* - Characterized by **painful vesicles** that rupture to form ulcers, not typically white patches [1]. - While it can cause painful urination due to urethritis, the appearance of the lesions is different [1]. *Human papillomavirus* - Causes **genital warts**, which are typically flesh-colored, cauliflower-like growths, not white patches or painful urination. - These warts are usually asymptomatic or cause mild itching. *Syphilis* - Presents initially as a **painless chancre** (a firm, round, solitary ulcer) at the site of infection [1]. - Later stages involve rash, fever, and other systemic symptoms, which do not match this presentation.
Question 237: A patient presents with flu-like symptoms and a maculopapular rash on the palms and soles. What is the most likely diagnosis?
- A. Rocky Mountain spotted fever
- B. Secondary syphilis (Correct Answer)
- C. Measles
- D. Hand, foot, and mouth disease
Explanation: ### Secondary syphilis - **Maculopapular rash on the palms and soles** is a classic and highly characteristic feature of secondary syphilis [1]. - **Flu-like symptoms** (fever, malaise, headache) frequently precede or accompany the rash in secondary syphilis [1]. *Rocky Mountain spotted fever* - While it causes a **maculopapular rash**, it typically starts on the ankles and wrists and spreads centrally, not initially on the palms and soles. - The rash can become **petechial**, a feature not mentioned, and patients often have a history of **tick bite**. *Measles* - The characteristic rash of measles is **maculopapular** but typically starts on the **face** and behind the ears, spreading downwards, not on the palms and soles. - It's usually associated with **Koplik spots** (small white spots with red halos on the buccal mucosa) and **cough, coryza, and conjunctivitis**. *Hand, foot, and mouth disease* - Caused by **coxsackievirus**, it primarily affects young children and causes tender, papulovesicular lesions [2]. - The rash involves the **hands, feet, and oral cavity**, but is typically vesicular, not primarily maculopapular, and less commonly affects the palms and soles as a sole presentation without other characteristic findings [2].
Question 238: A 29-year-old male presents with a painless ulcer on his genitalia and a maculopapular rash on his palms and soles. What is the causative organism?
- A. Chlamydia trachomatis
- B. Treponema pallidum (Correct Answer)
- C. Haemophilus ducreyi
- D. Herpes simplex virus
Explanation: ***Treponema pallidum*** - The presentation of a **painless genital ulcer (chancre)** followed by a **maculopapular rash on the palms and soles** is highly characteristic of **secondary syphilis**, caused by *Treponema pallidum* [1]. - *Treponema pallidum* is a **spirochete** that causes syphilis, which progresses through distinct stages with varied clinical manifestations [1]. *Chlamydia trachomatis* - **Chlamydia trachomatis** is a common cause of **urethritis**, **cervicitis**, and **lymphogranuloma venereum**, but it does not typically cause a painless chancre followed by a widespread maculopapular rash on palms and soles. - Genital ulcers caused by *Chlamydia trachomatis* in **lymphogranuloma venereum** are usually transient and small, followed by significant **lymphadenopathy**. *Haemophilus ducreyi* - *Haemophilus ducreyi* causes **chancroid**, which is characterized by **painful genital ulcers** with irregular, undermined borders and frequently associated with **inguinal lymphadenopathy**. - The ulcers are typically **painful**, which contrasts with the patient's painless ulcer. *Herpes simplex virus* - **Herpes simplex virus (HSV)** causes **genital herpes**, which presents as painful, vesicular lesions that ulcerate, often accompanied by **flu-like symptoms** during the primary infection [2]. - The lesions are typically **painful vesicles** and ulcers, not a painless, indurated ulcer (chancre), and the maculopapular rash on palms and soles is not a typical manifestation of HSV infection [2].
Question 239: A patient presents with a painless ulcer and a positive RPR test. What is the most likely diagnosis?
- A. Chancroid
- B. Lymphogranuloma venereum
- C. Primary syphilis (Correct Answer)
- D. Genital herpes
Explanation: **Primary syphilis** - The presence of a **painless ulcer**, known as a **chancre**, is the classic hallmark of primary syphilis [1]. - A **positive RPR test** (Rapid Plasma Reagin) indicates active syphilis infection [1]. *Chancroid* - Caused by **Haemophilus ducreyi**, chancroid typically presents with **multiple, painful, and tender ulcers**. - The RPR test would be **negative**, as it is not a test for chancroid. *Lymphogranuloma venereum* - Initial lesion is often a **transient, painless papule or vesicle** that may go unnoticed, followed by painful **inguinal lymphadenopathy (buboes)**. - While it can be associated with genital ulcers, they are usually not the primary diagnostic feature, and the RPR test would be negative. *Genital herpes* - Characterized by **multiple, painful vesicular or ulcerative lesions** on an erythematous base [1]. - The RPR test would be **negative** as it is a viral infection, not bacterial [1].
Question 240: A 50-year-old male presents with a painless genital ulcer and non-tender inguinal lymphadenopathy. The initial RPR is negative, but there is a high suspicion for syphilis. What is the next best diagnostic test?
- A. Dark field microscopy
- B. PCR for T. pallidum
- C. FTA-ABS (Correct Answer)
- D. HIV test
Explanation: ***FTA-ABS*** - **Fluorescent Treponemal Antibody Absorption (FTA-ABS)** is a **treponemal test** that remains positive for life and is useful in confirming syphilis in cases of high suspicion, especially when non-treponemal tests like RPR are negative (e.g., in early stages or due to the **prozone phenomenon**) [1]. - It directly detects antibodies specific to *Treponema pallidum* and is more sensitive than RPR in early syphilis [1]. *Dark field microscopy* - **Dark field microscopy** directly visualizes spirochetes from a chancre [1], but its utility is limited by the need for fresh samples and specialized equipment. - While it offers immediate diagnosis, a negative result does not rule out syphilis, especially if the lesion is healing or if antibiotics have been used. *PCR for T. pallidum* - **PCR for *T. pallidum*** is highly sensitive and specific but is not routinely available in all clinical settings, and its use is typically reserved for challenging cases or research. - While it can be useful in detecting DNA from the bacteria, it's not the initial confirmatory test of choice when a treponemal serum assay is widely available and appropriate. *HIV test* - An **HIV test** is crucial for patients with syphilis as coinfection is common, but it does not directly diagnose syphilis. - While important for comprehensive patient care, it does not address the immediate diagnostic question regarding syphilis itself.
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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