Venerology Practice Questions

Q: In the context of sexually transmitted infections, which condition is characterized by the presence of pseudobubo?

Lymphogranuloma inguinale. ***Lymphogranuloma inguinale*** - This condition is caused by specific serovars of **Chlamydia trachomatis** and is characterized by the formation of **pseudobuboes** (inflamed inguinal lymph nodes) [1]. - Pseudobuboes in LGV are typically **large, tender, matted lymph nodes** that may rupture and drain, forming multiple sinus tracts [1]. *Chancroid* - Chancroid is characterized by **painful genital ulcers with ragged borders** and often results in **suppurative inguinal lymphadenitis** [1]. - While it causes significant lymphadenopathy, the term **pseudobubo** is specifically associated with Lymphogranuloma Venereum due to the characteristic pattern of matted, inflamed nodes. *Syphilis* - Syphilis presents with a **painless chancre** in its primary stage and can cause **bilateral, nontender regional lymphadenopathy**. - The lymph nodes associated with primary syphilis are not typically inflamed or suppurative, and they do not form pseudobuboes. *Herpes simplex* - Herpes simplex virus causes **painful vesicular or ulcerative lesions** on the genitals, often accompanied by **tender, often bilateral, inguinal lymphadenopathy**. - The lymphadenopathy in herpes is usually less severe and does not typically progress to the large, matted, and potentially suppurative pseudobuboes seen in LGV.

Q: A man presents with a history of dysuria and urethral discharge after having unprotected sexual intercourse. What is the treatment of choice for this infection?

Ceftriaxone. ***Ceftriaxone*** - The combination of **dysuria** and **urethral discharge** following unprotected sexual intercourse is highly suggestive of **gonorrhea**. - **Ceftriaxone** is the recommended first-line treatment for uncomplicated gonococcal infections due to increasing antibiotic resistance. *Erythromycin* - Erythromycin is primarily used for atypical bacterial infections, such as those caused by *Mycoplasma pneumoniae* or *Chlamydia trachomatis*. - While it can be used for chlamydia, it is not the preferred treatment for suspected gonorrhea. *Azithromycin* - Azithromycin is often used in combination with ceftriaxone for gonorrhea to cover potential co-infection with **Chlamydia trachomatis**. - However, **monotherapy with azithromycin is not recommended for gonorrhea** due to concerns about emerging resistance and suboptimal efficacy. *Penicillin G* - Penicillin G was historically used to treat gonorrhea, but this is no longer the case due to widespread **resistance** of *Neisseria gonorrhoeae* strains. - Its primary use now is for susceptible bacterial infections, such as syphilis and certain streptococcal infections.

Q: Which diagnostic test is most commonly used for neurosyphilis?

FTA-ABS (Fluorescent Treponemal Antibody Absorption) test. ***FTA-ABS (Fluorescent Treponemal Antibody Absorption) test*** - The **FTA-ABS test** is a sensitive and specific **treponemal test** that remains positive for life, indicating past or present infection. - While other tests might be used for screening, a **reactive FTA-ABS in CSF** (cerebrospinal fluid) is highly indicative of neurosyphilis, especially when accompanied by CSF pleocytosis and elevated protein. *VDRL (Venereal Disease Research Laboratory) test* - The **VDRL test** is a **non-treponemal test** primarily used for screening and monitoring treatment response for syphilis [1]. - Although it can be positive in CSF for neurosyphilis, it has **limited sensitivity** for this condition and can be negative even in active neurosyphilis. *TPI (Treponema pallidum immobilization) test* - The TPI test is an older, highly specific treponemal test but is **rarely used clinically today** due to its complexity and the availability of more convenient and automated tests. - It is primarily a **confirmatory test** but has been largely replaced by FTA-ABS and TP-PA. *RPR (Rapid Plasma Reagin) test* - The **RPR test** is another **non-treponemal test** performed on serum, similar to VDRL, used for screening and monitoring syphilis and has good sensitivity but can lead to biological false positives [1]. - It is **less sensitive than FTA-ABS** for diagnosing neurosyphilis from CSF and may be negative in late-stage neurosyphilis.

Q: Which of the following is characterized by a solitary painless ulcer on genitalia?

Syphilis. ***Syphilis*** - Primary syphilis typically presents as a **painless chancre** (ulcer) at the site of infection, usually the **genitalia**. - The painless nature is a key differentiating feature as it often goes unnoticed, allowing the disease to progress. *Genital herpes* - Characterized by multiple, small, often painful vesicles or ulcers that may coalesce [1]. - Lesions are typically tender or painful, unlike the **painless chancre** of syphilis [1]. *Traumatic injury* - While a traumatic injury can cause a solitary ulcer, it is usually painful and often associated with a clear history of trauma. - The ulcer's morphology and healing process may differ from a classic syphilitic chancre. *Chancroid* - Caused by *Haemophilus ducreyi*, chancroid presents as one or more painful, tender ulcers with ragged, undermined borders. - This is a significant differentiator from the **painless ulcer** seen in primary syphilis.

Q: Hutchinson's Triad is specifically associated with which type of syphilis?

Congenital Syphilis. ***Congenital Syphilis*** - **Hutchinson's Triad** is a classic constellation of symptoms specific to **congenital syphilis**, reflecting the long-term effects of *in utero* infection [1]. - The triad includes **Hutchinson's teeth** (notched incisors), **interstitial keratitis** (corneal inflammation), and **sensorineural hearing loss**. *Tertiary syphilis* - This stage is characterized by **gummas**, **cardiovascular syphilis** (e.g., aortitis), and **neurosyphilis**, but not Hutchinson's triad [1]. - These manifestations develop years after initial infection in adults. *Primary syphilis* - The primary stage is marked by the appearance of a **painless chancre** at the site of infection [1]. - It does not involve the systemic, long-term complications seen in congenital syphilis. *Secondary Syphilis* - This stage typically presents with a **diffuse maculopapular rash**, **lymphadenopathy**, and sometimes **condylomata lata** [1]. - These are acute systemic symptoms, distinct from the developmental abnormalities of Hutchinson's triad.

Q: Saddle nose deformity is seen in?

Tertiary Syphilis. ***Tertiary Syphilis*** - **Saddle nose deformity** is a characteristic late manifestation of **tertiary syphilis** due to destructive lesions (gummas) affecting the nasal cartilage and bone [1], [2]. - It results from the **collapse of the nasal bridge**, leading to a flattened appearance [2]. *Primary Syphilis* - Characterized by a **chancre**, a painless ulcer, usually at the site of infection [1]. - This stage does not involve destructive lesions of the nose. *Secondary Syphilis* - Presents with a **widespread rash**, lymphadenopathy, and mucous patches [1]. - While systemic, it typically does not cause structural damage like saddle nose deformity. *Lupus Vulgaris* - This is a **cutaneous form of tuberculosis**, characterized by chronic, destructive skin lesions. - While it can cause facial disfigurement, saddle nose deformity is not a typical feature of lupus vulgaris.

Q: A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?

Genital herpes. Herpes simplex virus (HSV) infection of the anal canal is characterized by lesions that present as painful ulcers [1]. Direct extension into the anal canal is common in individuals with receptive anal intercourse or autoinoculation, often causing symptoms such as anal or rectal pain [1]. CMV proctitis typically causes more diffuse inflammation, often with bloody stools, diarrhea, and abdominal pain, which are not described in this case. While CMV can cause ulcers, they are usually shallow and often associated with immunocompromised states. Gonococcal proctitis often presents with purulent anal discharge, rectal pain, itching, and tenesmus, but typically without deep ulcerations. HIV infection can cause various anorectal complications, including aphthous ulcers, but isolated anal ulcers and defecation pain would prompt investigation into sexually transmitted infections like herpes as a more direct cause.

Q: What is the treatment for Trichomonas vaginalis?

Metronidazole. ***Metronidazole*** - **Metronidazole** is the **first-line drug** for treating *Trichomonas vaginalis* infection. - It is effective against this **anaerobic protozoan** and can be administered as a single dose or a 7-day course. *Azithromycin* - **Azithromycin** is a **macrolide antibiotic** primarily used to treat bacterial infections, such as **chlamydia** or certain **respiratory tract infections**. - It is **not effective** against *Trichomonas vaginalis*, which is a parasitic protozoan. *Ciprofloxacin* - **Ciprofloxacin** is a **fluoroquinolone antibiotic** used for bacterial infections, especially **urinary tract infections** and complicated **gastrointestinal infections**. - It has **no activity** against *Trichomonas vaginalis*. *None of the options* - This option is incorrect because **Metronidazole** is a highly effective and widely accepted treatment for *Trichomonas vaginalis* infections.

Q: What is the most appropriate initial investigation for a patient presenting with a history of sore throat, diarrhea, and sexual contact two weeks prior to assess for HIV?

ELISA. ***ELISA*** - **Enzyme-linked immunosorbent assay (ELISA)** is the **most appropriate initial screening test** for HIV due to its high sensitivity and ability to detect both HIV antibodies and p24 antigen in fourth-generation tests [1]. - The patient's symptoms (sore throat, diarrhea) and recent sexual contact are suggestive of acute retroviral syndrome, for which an ELISA testing for **HIV antibodies and p24 antigen** would be effective. *p24 antigen assay* - While the **p24 antigen assay** is useful for detecting HIV early (during the acute phase before antibody seroconversion), it is typically part of a **fourth-generation ELISA test**, making the stand-alone p24 assay less comprehensive as an initial investigation. - A standalone p24 antigen assay could miss the infection if the patient has already developed antibodies but not enough antigen for detection or during the window period when antibodies are rising and antigen may be declining. *Western blot* - **Western blot** is a **confirmatory test** for HIV, used to verify positive ELISA results, not as an initial screening tool [1]. - It detects specific HIV antibodies and is more expensive and labor-intensive, making it unsuitable for first-line screening [1]. *Lymph node biopsy* - **Lymph node biopsy** is an invasive procedure and is not used for routine HIV diagnosis. - It might be considered in cases of unexplained **lymphadenopathy** to rule out other conditions, but not as the initial investigation for HIV [2].

Q: Which of the following pathogens is known to cause painless genital ulcers?

Treponema pallidum. ***Treponema pallidum*** - *Treponema pallidum*, the causative agent of **syphilis**, leads to a primary lesion known as a **chancre**, which is typically **painless** and indurated [1]. - This **painless ulcer** is a key differentiating feature from other causes of genital ulcers, making it highly suggestive of primary syphilis [1]. *Herpes Simplex Virus* - **Herpes Simplex Virus (HSV)** causes **genital herpes**, characterized by painful, vesicular lesions that rupture to form **painful ulcers** [1]. - These ulcers are often accompanied by **burning, itching, and dysuria**, unlike the painless nature of a syphilitic chancre [1]. *Human Immunodeficiency Virus (HIV)* - **HIV** primarily causes systemic immunodeficiency and opportunistic infections; it does not directly cause primary **genital ulcers**. - While HIV infection can be associated with other sexually transmitted infections that cause ulcers, it is not the direct pathogen responsible for ulcer formation. *Human Papillomavirus (HPV)* - **HPV** is known to cause **genital warts**, which are raised, flesh-colored lesions, and can also lead to cervical, anal, or other cancers. - HPV does not typically cause **ulcerative lesions**; its pathology is characterized by proliferative epithelial changes.

Question 1

In the context of sexually transmitted infections, which condition is characterized by the presence of pseudobubo?

Accepted Answer

Lymphogranuloma inguinale

Answer

Chancroid

Answer

Syphilis

Answer

Herpes simplex

Question 2

A man presents with a history of dysuria and urethral discharge after having unprotected sexual intercourse. What is the treatment of choice for this infection?

Accepted Answer

Ceftriaxone

Answer

Erythromycin

Answer

Azithromycin

Answer

Penicillin G

Question 3

Which diagnostic test is most commonly used for neurosyphilis?

Accepted Answer

FTA-ABS (Fluorescent Treponemal Antibody Absorption) test

Answer

TPI (Treponema pallidum immobilization) test

Answer

VDRL (Venereal Disease Research Laboratory) test

Answer

RPR (Rapid Plasma Reagin) test

Question 4

Which of the following is characterized by a solitary painless ulcer on genitalia?

Accepted Answer

Syphilis

Answer

Genital herpes

Answer

Traumatic injury

Answer

Chancroid

Question 5

Hutchinson's Triad is specifically associated with which type of syphilis?

Accepted Answer

Congenital Syphilis

Answer

Tertiary syphilis

Answer

Primary syphilis

Answer

Secondary Syphilis

Question 6

Saddle nose deformity is seen in?

Accepted Answer

Tertiary Syphilis

Answer

Primary Syphilis

Answer

Secondary Syphilis

Answer

Lupus Vulgaris

Question 7

A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?

Accepted Answer

Genital herpes

Answer

Cytomegalovirus (CMV)

Answer

Gonococcal infection

Answer

HIV infection

Question 8

What is the treatment for Trichomonas vaginalis?

Accepted Answer

Metronidazole

Answer

Azithromycin

Answer

Ciprofloxacin

Answer

None of the options

Question 9

What is the most appropriate initial investigation for a patient presenting with a history of sore throat, diarrhea, and sexual contact two weeks prior to assess for HIV?

Accepted Answer

ELISA

Answer

Western blot

Answer

Lymph node biopsy

Answer

p24 antigen assay

Question 10

Which of the following pathogens is known to cause painless genital ulcers?

Accepted Answer

Treponema pallidum

Answer

Herpes Simplex Virus

Answer

Human Immunodeficiency Virus (HIV)

Answer

Human Papillomavirus (HPV)

Venerology — MCQs

Venerology — MCQs

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