Venerology Practice Questions

Q: Which of the following conditions is characterized by a painless ulcer known as a chancre?

Syphilis. ***Syphilis*** - Syphilis, caused by *Treponema pallidum*, is characterized by primary syphilis , which presents as a painless ulcer called a chancre [1]. - The chancre typically appears at the site of infection and usually heals spontaneously within 3 to 6 weeks, even without treatment. *Chancroid* - Chancroid is caused by *Haemophilus ducreyi* and manifests as painful, irregular ulcers with ragged edges, often accompanied by tender inguinal lymphadenopathy. - This is in direct contrast to the painless nature of a syphilitic chancre. *Genital herpes* - Genital herpes, caused by the herpes simplex virus (HSV) , typically presents with clusters of painful vesicles that rupture to form shallow ulcers, often associated with systemic symptoms like fever and myalgia [2]. - The lesions are usually multiple, painful, and do not resemble the solitary, painless chancre of syphilis [2]. *Lymphogranuloma venereum* - Lymphogranuloma venereum (LGV), caused by specific serovars of *Chlamydia trachomatis*, often begins with a painless, transient papule or superficial ulcer that may go unnoticed. - The hallmark of LGV is later development of significant and often painful inguinal lymphadenopathy (buboes) , which is different from the chancre and associated symptoms of syphilis.

Q: A 30-year-old male presents with a history of a painless genital ulcer followed by a generalized rash and mucous patches in the mouth. What is the appropriate treatment?

Penicillin G. Penicillin G - The clinical presentation of a **painless genital ulcer** (chancre) followed by a **generalized rash** [1] and **mucous patches** in the mouth is classic for **secondary syphilis**. [3] - **Penicillin G benzathine** is the treatment of choice for all stages of syphilis, effectively eradicating the causative organism, *Treponema pallidum*. [2] *Azithromycin* - Azithromycin is a macrolide antibiotic primarily used for treating **atypical pneumonia**, **chlamydia**, and some **bacterial gastroenteritis**. - It is not effective against *Treponema pallidum* and is not recommended for the treatment of syphilis due to increasing resistance. *Doxycycline* - Doxycycline is a tetracycline antibiotic used for various bacterial infections, including **Lyme disease**, **Rocky Mountain spotted fever**, and **chlamydia**. - While it can be used as an alternative treatment for syphilis in patients **allergic to penicillin**, penicillin G is the preferred first-line agent due to its superior efficacy. *Acyclovir* - Acyclovir is an **antiviral medication** used to treat **herpes simplex virus (HSV)** infections, such as genital herpes and cold sores. - It has no antibacterial activity and is therefore ineffective against syphilis, which is caused by a bacterium.

Q: A 45-year-old man with a history of multiple sexual partners presents with a non-tender genital ulcer and a generalized rash. Which stage of syphilis is he likely in?

Secondary syphilis. ***Secondary syphilis*** - The coexistence of a **non-tender genital ulcer** (chancre from primary syphilis) and a **generalized rash** is a classic presentation of secondary syphilis [1]. - This stage occurs weeks to months after the primary infection, as the spirochetes disseminate throughout the body. *Primary syphilis* - Characterized by a **single, painless chancre** at the site of infection and typically **lacks systemic symptoms** like a rash [1]. - The man's presentation includes a generalized rash, which is not characteristic of primary syphilis alone. *Latent syphilis* - This stage is typically **asymptomatic**, meaning there are no visible signs or symptoms, though serological tests remain positive [1]. - The presence of both a genital ulcer and a rash indicates active disease, not latent syphilis. *Tertiary syphilis* - Occurs years to decades after the initial infection and presents with severe complications affecting the **heart, brain, or other organs** (e.g., gummas, neurosyphilis, cardiovascular syphilis) [1]. - The patient's symptoms of a genital ulcer and rash are acute manifestations, not the chronic, destructive lesions of tertiary syphilis.

Q: A 26-year-old woman presents with a painless, indurated genital ulcer, and VDRL is positive. What is the first-line treatment?

Benzathine penicillin G. Benzathine penicillin G - A painless, indurated genital ulcer combined with a positive VDRL strongly indicates primary syphilis [1]. - Benzathine penicillin G administered as a single intramuscular dose is the first-line treatment for primary, secondary, and early latent syphilis due to its efficacy and extended action. *Doxycycline* - While doxycycline is an alternative treatment for penicillin-allergic patients with early syphilis, it is not the first-line therapy due to penicillin's superior efficacy and single-dose convenience. - It would require a 14-day course of treatment, which is less convenient than a single penicillin injection. *Azithromycin* - Azithromycin is typically used for treating chlamydia or gonorrhea, but it is not effective for treating syphilis due to increasing resistance and inferior efficacy compared to penicillin. - It is not recommended as a primary or alternative treatment for syphilis by current guidelines. *Ceftriaxone* - Ceftriaxone is primarily used for the treatment of gonorrhea, bacterial meningitis, and other severe bacterial infections. - While it has some activity against Treponema pallidum, it is not the recommended first-line treatment for syphilis and its efficacy has not been as thoroughly established as penicillin.

Q: A 27-year-old man presents with a painless genital ulcer and non-tender inguinal lymphadenopathy. The VDRL test is positive. What is the next step in management?

Confirm with FTA-ABS. ***Confirm with FTA-ABS*** - A positive **VDRL test** (a non-treponemal test) for syphilis should always be confirmed with a **treponemal-specific test** like **FTA-ABS** (fluorescent treponemal antibody absorption) due to the possibility of false positives [1]. - The combination of a **painless genital ulcer** (chancre) and **non-tender inguinal lymphadenopathy** is highly suggestive of **primary syphilis**, making confirmation crucial before treatment. *Empirical treatment with benzathine penicillin* - While syphilis is treated with **benzathine penicillin**, empirical treatment without confirmation is generally not recommended, especially given the availability of confirmatory tests. - This approach could lead to unnecessary antibiotic exposure if the VDRL result is a **false positive**, and would miss an opportunity for definitive diagnosis [1]. *PCR for HSV* - **Herpes simplex virus (HSV)** typically causes painful, vesicular lesions that ulcerate, which is different from the described painless ulcer [2]. - Although HSV can cause genital ulcers, a positive VDRL specifically points towards syphilis, making HSV testing less relevant as the *next* step [2]. *Dark field microscopy for syphilis diagnosis* - **Dark-field microscopy** is a method for directly visualizing **Treponema pallidum** from chancre exudate, providing an immediate diagnosis. - However, it requires specialized equipment and expertise that may not be readily available, and a confirmatory serological test like **FTA-ABS** is still necessary for a complete diagnostic workup.

Q: A 30-year-old male presents with painful ulcers on the glans penis. A Tzanck smear reveals multinucleated giant cells. What is the most likely diagnosis?

Genital herpes. ***Genital herpes*** - The presence of **painful ulcers** on the glans penis is characteristic of genital herpes [1], [3]. - A **Tzanck smear** demonstrating **multinucleated giant cells** is a classic finding for **herpes simplex virus (HSV)** infection. *Syphilis* - Typically presents as a **painless chancre** in its primary stage, which is different from the painful ulcers described. - Diagnosis involves **darkfield microscopy** or **serological tests** (e.g., RPR, VDRL, FTA-ABS). *Chancroid* - Characterized by **painful, ragged-edged ulcers** with a **gray base**, often accompanied by **tender inguinal lymphadenopathy** [2]. - Diagnosis is usually clinical or by **culture** of *Haemophilus ducreyi*; a Tzanck smear does not reveal multinucleated giant cells. *Lymphogranuloma venereum* - Begins with a small, **painless ulcer or papule** that often goes unnoticed, followed by significant and **painful regional lymphadenopathy** (buboes) [2]. - Caused by specific strains of *Chlamydia trachomatis*, and diagnosis involves serology or PCR, not Tzanck smear findings.

Q: 28 year old female complaints of foul smelling yellowish urethral discharge since 4 days. History of burning micturation. History of sexual contact with multiple partners 2 days before the onset of symptoms. Most likely diagnosis is ?

Gonococcal urethritis. ***Gonococcal urethritis*** - The presentation of **foul-smelling, yellowish urethral discharge** and **burning micturition** shortly after unprotected sexual contact with multiple partners is highly suggestive of **gonorrhea**. [1] - Symptoms in females are often mild or asymptomatic, but when present, include **dysuria** and vaginal discharge that can be purulent. [2] *Chlamydia* - While *Chlamydia* can cause urethritis with similar symptoms, the discharge is typically **less purulent and yellowish** and more often *mucoid or clear*. [1] - The incubation period for *Chlamydia* is generally **longer (1-3 weeks)** compared to the 2-day onset in this case. [1] *Chancroid* - Characterized by **painful genital ulcers with suppurative inguinal lymphadenopathy** (buboes), rather than urethral discharge and dysuria. - It is caused by *Haemophilus ducreyi*, and ulcer formation is the primary symptom. *Non-infective urethritis* - Non-infective urethritis would present with similar symptoms but would lack the history of **recent unprotected sexual contact** with multiple partners. - This diagnosis is typically considered after excluding infectious causes, especially in sexually active individuals. [1]

Q: Patient presents with discharge per urethrum and microscopy shows presence of intracytoplasmic gram negative cocci; what is the most probable diagnosis ?

Gonococcal infection. ***Gonococcal infection*** - The presence of **intracytoplasmic gram-negative cocci** in urethral discharge is a classic microscopic finding for **Neisseria gonorrhoeae**. [1] - This presentation is highly indicative of **gonorrhea**, a sexually transmitted infection. [1] *Granuloma inguinale* - This condition, also known as **donovanosis**, is caused by **Klebsiella granulomatis**. [1] - It typically presents with **granulomatous ulcers** and is diagnosed by finding **Donovan bodies** (bacteria within macrophages) in tissue smears, not free cocci in urethral discharge. [1] *Vaginal bacterial infection* - This term is too general; however, most common vaginal bacterial infections (e.g., bacterial vaginosis) involve an imbalance of normal flora and are characterized by **clue cells** or specific bacterial types like Gardnerella vaginalis, not intracytoplasmic gram-negative cocci. - While bacteria are present, the specific morphology and location (intracytoplasmic, gram-negative cocci) described in the urethra point away from typical vaginal bacterial infections. *Treponemal infection* - **Treponemal infections** such as **syphilis** are caused by **Treponema pallidum**, which are **spirochetes**. [1] - They are typically identified using **darkfield microscopy** or serological tests, not by observing gram-negative cocci in urethral discharge. [1]

Q: In a patient presenting with inguinal lymphadenopathy, which condition is associated with the Groove sign of Greenbalt?

Lymphogranuloma venereum (LGV). ***Lymphogranuloma venereum (LGV)*** - The **Groove sign of Greenblatt** is a characteristic clinical finding in LGV, where enlarged inguinal lymph nodes (buboes) are separated by the **inguinal ligament**, creating a visible groove [1]. - LGV is caused by specific serovars of *Chlamydia trachomatis* and initially presents with a painless ulcer, followed by painful lymphadenopathy and **bubo formation** [1]. *Chancroid (Haemophilus ducreyi)* - Chancroid typically presents with **painful genital ulcers** and painful, often **unilateral inguinal lymphadenopathy** (buboes), which may suppurate [1]. - While it causes inguinal lymphadenopathy, it is not associated with the specific **Groove sign of Greenblatt**. *Genital Herpes (Herpes Simplex Virus)* - Genital herpes is characterized by **painful vesicular or ulcerative lesions** on the genitalia, often accompanied by local symptoms like itching and burning [1]. - While it can cause **tender inguinal lymphadenopathy** due to localized inflammation, the lymph node swelling is typically generalized and does not form a distinct Groove sign [1]. *Granuloma inguinale (Donovanosis)* - This condition is characterized by **progressive, beefy-red granulomatous lesions** that are typically painless and bleed easily, primarily affecting the genitals and perineum [1]. - **Inguinal lymphadenopathy is rare**; if present, it is usually due to secondary bacterial infection or pseudobuboes, not true lymphatic involvement or the Groove sign [1].

Q: Which of the following conditions is caused by Human Papillomavirus (HPV)?

Condyloma acuminata (genital warts). ***Condyloma acuminata (genital warts)*** - **Condyloma acuminata** are fleshy, exophytic lesions caused by Human Papillomavirus (**HPV**), particularly types 6 and 11. - HPV infection of the anogenital region leads to characteristic **genital warts**, which can be single or multiple, and range from small papules to large cauliflower-like masses. *Condylomata lata (associated with syphilis)* - **Condylomata lata** are broad-based, raised, gray-white lesions found in moist intertriginous areas, a manifestation of **secondary syphilis**. - They are highly infectious but are caused by the bacterium **_Treponema pallidum_**, not HPV. *Chancre (associated with syphilis)* - A **chancre** is a firm, painless ulcer with raised borders that appears at the site of inoculation during the **primary stage of syphilis**. - This lesion is also caused by the spirochete **_Treponema pallidum_**. *Bubo (associated with bacterial infections)* - A **bubo** is a painful, swollen, inflamed **lymph node**, typically in the groin, resulting from bacterial infections like **lymphogranuloma venereum** or **chancroid**. - It is caused by bacterial pathogens such as _Chlamydia trachomatis_ serovars L1-L3 or _Haemophilus ducreyi_, not HPV.

Question 1

Which of the following conditions is characterized by a painless ulcer known as a chancre?

Accepted Answer

Syphilis

Answer

Chancroid

Answer

Genital herpes

Answer

Lymphogranuloma venereum

Question 2

A 30-year-old male presents with a history of a painless genital ulcer followed by a generalized rash and mucous patches in the mouth. What is the appropriate treatment?

Accepted Answer

Penicillin G

Answer

Azithromycin

Answer

Doxycycline

Answer

Acyclovir

Question 3

A 45-year-old man with a history of multiple sexual partners presents with a non-tender genital ulcer and a generalized rash. Which stage of syphilis is he likely in?

Accepted Answer

Secondary syphilis

Answer

Primary syphilis

Answer

Latent syphilis

Answer

Tertiary syphilis

Question 4

A 26-year-old woman presents with a painless, indurated genital ulcer, and VDRL is positive. What is the first-line treatment?

Accepted Answer

Benzathine penicillin G

Answer

Doxycycline

Answer

Azithromycin

Answer

Ceftriaxone

Question 5

A 27-year-old man presents with a painless genital ulcer and non-tender inguinal lymphadenopathy. The VDRL test is positive. What is the next step in management?

Accepted Answer

Confirm with FTA-ABS

Answer

PCR for HSV

Answer

Empirical treatment with benzathine penicillin

Answer

Dark field microscopy for syphilis diagnosis

Question 6

A 30-year-old male presents with painful ulcers on the glans penis. A Tzanck smear reveals multinucleated giant cells. What is the most likely diagnosis?

Accepted Answer

Genital herpes

Answer

Syphilis

Answer

Chancroid

Answer

Lymphogranuloma venereum

Question 7

28 year old female complaints of foul smelling yellowish urethral discharge since 4 days. History of burning micturation. History of sexual contact with multiple partners 2 days before the onset of symptoms. Most likely diagnosis is ?

Accepted Answer

Gonococcal urethritis

Answer

Chlamydia

Answer

Chancroid

Answer

Non-infective urethritis

Question 8

Patient presents with discharge per urethrum and microscopy shows presence of intracytoplasmic gram negative cocci; what is the most probable diagnosis ?

Accepted Answer

Gonococcal infection

Answer

Granuloma inguinale

Answer

Vaginal bacterial infection

Answer

Treponemal infection

Question 9

In a patient presenting with inguinal lymphadenopathy, which condition is associated with the Groove sign of Greenbalt?

Accepted Answer

Lymphogranuloma venereum (LGV)

Answer

Chancroid (Haemophilus ducreyi)

Answer

Genital Herpes (Herpes Simplex Virus)

Answer

Granuloma inguinale (Donovanosis)

Question 10

Which of the following conditions is caused by Human Papillomavirus (HPV)?

Accepted Answer

Condyloma acuminata (genital warts)

Answer

Condylomata lata (associated with syphilis)

Answer

Chancre (associated with syphilis)

Answer

Bubo (associated with bacterial infections)

Venerology — MCQs

Venerology — MCQs

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