Venerology — MCQs

A 35-year-old prostitute is seen in a community healthcare clinic, with a history of a painless labial sore and swelling of a right inguinal lymph node, which subsided uneventfully over several weeks. Approximately 3 weeks later, she developed fever and a generalized maculopapular skin rash involving the palms of the hands and the soles of the feet. Additionally, she has flattened, broad-based plaques in the anogenital region. What is the most likely diagnosis?

Q282

Jarish-Herxheimer reaction is seen in early cases of what?

Venerology Indian Medical PG Practice Questions and MCQs

Question 281: A 35-year-old prostitute is seen in a community healthcare clinic, with a history of a painless labial sore and swelling of a right inguinal lymph node, which subsided uneventfully over several weeks. Approximately 3 weeks later, she developed fever and a generalized maculopapular skin rash involving the palms of the hands and the soles of the feet. Additionally, she has flattened, broad-based plaques in the anogenital region. What is the most likely diagnosis?

A. Primary chancre
B. Chancroid (Haemophilus ducreyi)
C. Secondary syphilis (Condylomata lata) (Correct Answer)
D. Genital warts caused by HPV (Condylomata acuminata)

Explanation: ***Secondary syphilis (Condylomata lata)*** - The constellation of a **painless labial sore** (primary syphilis), followed by **generalized maculopapular rash** involving palms/soles, fever, and **condylomata lata** (broad-based plaques) is classic for **secondary syphilis**. - **Condylomata lata** are characteristic moist, fleshy, broad-based lesions found in intertriginous areas in secondary syphilis, distinct from genital warts. *Primary chancre* - This option refers only to the initial **painless labial sore**, which is the primary stage of syphilis. - The patient's subsequent symptoms (rash, fever, condylomata lata) indicate progression beyond the primary stage. *Chancroid (Haemophilus ducreyi)* - Chancroid typically presents with **painful genital ulcers** and sometimes painful inguinal lymphadenopathy. - It does not cause a generalized maculopapular rash on palms/soles or condylomata lata. *Genital warts caused by HPV (Condylomata acuminata)* - **Condylomata acuminata** are caused by Human Papillomavirus (HPV) and are typically flesh-colored to brownish, **verrucous (warty) lesions**, not flattened, broad-based plaques. - HPV infection does not cause a preceding painless sore, fever, or a generalized maculopapular rash involving palms and soles.

Question 282: Jarish-Herxheimer reaction is seen in early cases of what?

A. Syphilis (Correct Answer)
B. Gonorrhea
C. Lymphogranuloma venereum
D. Granuloma inguinale

Explanation: ***Syphilis*** - The **Jarisch-Herxheimer reaction** is an acute, self-limiting febrile reaction that occurs within a few hours of treatment initiation for spirochetal infections, most notably **syphilis** [1]. - It results from the release of **endotoxins** from dying spirochetes, leading to systemic inflammatory symptoms such as fever, chills, myalgia, headache, and exacerbation of existing skin lesions [1]. *Gonorrhea* - **Gonorrhea** is caused by the bacterium *Neisseria gonorrhoeae*, which is not a spirochete and does not typically trigger a Jarisch-Herxheimer reaction upon treatment. - Treatment for gonorrhea, usually with antibiotics like ceftriaxone, does not result in the rapid release of toxins associated with this specific immunologic response. *Lymphogranuloma venereum* - **Lymphogranuloma venereum (LGV)** is caused by specific serovars of *Chlamydia trachomatis* and is characterized by genital ulcers and prominent lymphadenopathy. - As it is not a spirochetal infection, treatment with antibiotics like doxycycline does not induce a Jarisch-Herxheimer reaction. *Granuloma inguinale* - **Granuloma inguinale**, also known as donovanosis, is caused by *Klebsiella granulomatis*. - This bacterial infection, characterized by progressive ulcerative lesions, is not a spirochetal disease, and thus, treatment does not lead to a Jarisch-Herxheimer reaction.

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HIV and STIs

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Pelvic Inflammatory Disease

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Venerology — MCQs

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