Venerology Practice Questions

Q: Which of the following conditions can cause a false-positive nontreponemal serological test for syphilis?

Paediatric age group. **Explanation:** Nontreponemal tests (VDRL and RPR) detect **reagin antibodies**—IgG and IgM directed against a cardiolipin-lecithin-cholesterol antigen. Because cardiolipin is a component of mitochondrial membranes, these tests are prone to **Biological False Positives (BFP)** in conditions involving tissue damage or immunological cross-reactivity [1]. **Why Option C is Correct:** In the **paediatric age group**, specifically neonates, a false-positive result is common due to the **passive placental transfer of maternal IgG antibodies**. If a mother has a history of treated syphilis or a BFP, her IgG can cross the placenta, leading to a positive VDRL in the neonate without an active infection. This is why a rising titer or a positive IgM-specific treponemal test is required to confirm congenital syphilis. **Analysis of Incorrect Options:** * **A & B (HIV and Collagen Disorders):** These are well-known causes of BFP [1]. However, in the context of standard NEET-PG patterns and the specific source of this question, the "paediatric age group" (passive transfer) is highlighted as a physiological cause rather than a pathological one. *Note: In many clinical scenarios, SLE (Collagen disorder) is the most common chronic cause of BFP.* * **D (Tuberculosis):** While various infections (Malaria, Leprosy, Infectious Mononucleosis) cause BFP, TB is a less frequent association compared to the other options provided [1]. **Clinical Pearls for NEET-PG:** * **Acute BFP ( 6 months):** Classically associated with **SLE**, Leprosy, IV drug use, and old age [1]. * **Prozone Phenomenon:** Can cause a false-**negative** VDRL in secondary syphilis due to excessive antibody titers; solved by diluting the serum [1]. * **Confirmatory Test:** Always use a treponemal test (FTA-ABS or TPHA) to rule out a BFP [1].

Q: In secondary syphilis, which one of the following features is not found?

Aortitis. **Explanation:** The correct answer is **C. Aortitis**. Syphilis, caused by *Treponema pallidum*, progresses through distinct clinical stages [1]. Understanding the timing of systemic involvement is crucial for the NEET-PG exam. **1. Why Aortitis is the correct answer:** Aortitis is a manifestation of **Tertiary Syphilis** (Late Syphilis), occurring typically 10–30 years after the initial infection. It results from *vasa vasorum* inflammation (endarteritis obliterans), leading to medial necrosis and weakening of the aortic wall [1]. This can result in aortic aneurysms or aortic regurgitation. It is **not** a feature of the secondary stage. **2. Why the other options are incorrect:** * **Maculopapular rashes (Option A):** This is the most common cutaneous manifestation of Secondary Syphilis. The rash is typically widespread, symmetrical, and characteristically involves the **palms and soles** [1]. * **Generalized non-tender lymphadenopathy (Option B):** Secondary syphilis is a systemic spirochaetemic stage. Rubbery, discrete, and non-tender enlargement of lymph nodes (especially epitrochlear nodes) is a hallmark finding. * **Follicular syphilides (Option C):** These are small, papular lesions localized around hair follicles, often seen in secondary syphilis. They can lead to "moth-eaten" alopecia. **Clinical Pearls for NEET-PG:** * **Secondary Syphilis** is known as "The Great Imitator" and is the most florid stage. * **Condyloma Lata:** Highly infectious, moist, flat-topped papules in intertriginous areas (Secondary stage) [1]. * **Lues Maligna:** A severe pleomorphic form of secondary syphilis seen in HIV patients. * **Drug of Choice:** Benzathine Penicillin G remains the gold standard for all stages, though dosages vary.

Q: A 19-year-old girl presents with a painless ulcer on the labia majora with rolled-out margins. What is the most likely diagnosis?

Syphilis (Treponema pallidum). ### Explanation The clinical presentation of a **painless ulcer with rolled-out margins** on the genitalia is the hallmark of **Primary Syphilis**, caused by *Treponema pallidum*. #### Why the Correct Answer is Right: The primary lesion of syphilis is the **Chancre**. It typically appears 3 weeks after exposure. Key diagnostic features include: * **Painless:** Unlike many other genital ulcers, it does not cause pain or tenderness [2]. * **Indurated base:** The ulcer feels firm or "button-like" on palpation. * **Clean base:** It usually lacks purulent discharge. * **Margins:** Classically described as sharply defined or rolled-out [2]. * **Lymphadenopathy:** Often associated with painless, non-suppurative bilateral inguinal lymphadenopathy. #### Why Other Options are Wrong: * **Chlamydia infection:** While *Chlamydia trachomatis* (Serovars L1-L3) causes Lymphogranuloma Venereum (LGV), the initial ulcer is transient, small, and often goes unnoticed. The dominant feature is painful "buboes" (inguinal lymphadenopathy) [3]. * **Gonorrhea:** Primarily presents as urethritis or cervicitis with purulent discharge, not as a solitary painless ulcer. * **Genital Herpes (HSV-2):** Presents as multiple, shallow, **exquisitely painful** vesicles or ulcers on an erythematous base [1] [2]. It is the most common cause of painful genital ulcers [2]. #### High-Yield Clinical Pearls for NEET-PG: * **Dark-field Microscopy:** The investigation of choice for a primary chancre (shows corkscrew motility). * **Serology:** VDRL/RPR may be negative in the early stages of a primary chancre (window period). * **Treatment:** Benzathine Penicillin G (2.4 million units IM, single dose) is the gold standard. * **Differential Diagnosis:** Always differentiate from **Chancroid** (*Haemophilus ducreyi*), which presents as a **painful**, soft ulcer with a ragged/undermined edge and a necrotic base ("You *do cry* with *ducreyi*") [3].

Q: A patient expresses concern over exposure to sexually transmitted diseases. During a pelvic examination, a singular, indurated, nontender ulcer is noted on the vulva. VDRL and FTA tests are positive. Without treatment, what is the characteristic clinical manifestation of the next stage of this disease?

Macular rash over the hands and feet. **Explanation:** The patient presents with a **painless, indurated ulcer (chancre)** and positive serology (VDRL, FTA-ABS), which is the hallmark of **Primary Syphilis**, caused by *Treponema pallidum* [1]. The question asks for the characteristic manifestation of the **next stage** (Secondary Syphilis). 1. **Why Option D is Correct:** Secondary syphilis occurs 2–10 weeks after the primary chancre heals. It is characterized by systemic dissemination. The most classic finding is a **diffuse maculopapular rash** that characteristically involves the **palms and soles** [1]. Other features include condyloma lata and generalized lymphadenopathy. 2. **Why Other Options are Incorrect:** * **Options A, B, and C** are all manifestations of **Tertiary Syphilis**, which occurs years after the initial infection if left untreated [1]. * **Optic nerve atrophy and generalized paresis (A):** These are late neurosyphilitic complications involving parenchymal brain damage. * **Tabes dorsalis (B):** This involves the slow degeneration of the posterior columns of the spinal cord, leading to ataxia and loss of proprioception. * **Gummas (C):** These are chronic, destructive granulomatous lesions found in the skin, bone, or internal organs during the late stage. **NEET-PG High-Yield Pearls:** * **Primary Syphilis:** Painless chancre + painless regional lymphadenopathy [1]. * **Secondary Syphilis:** "The Great Imitator." Look for palms/soles rash, snail-track ulcers in the mouth, and **Condyloma Lata** (flat-topped warts) [1]. * **Diagnosis:** Dark-field microscopy is the gold standard for primary lesions. VDRL/RPR are screening tests; FTA-ABS is the confirmatory treponemal test. * **Treatment:** **Benzathine Penicillin G** (2.4 million units IM) is the drug of choice for primary and secondary syphilis.

Q: Which of the following is NOT a risk factor for Gonorrhea?

Recurrent urinary tract infections. **Explanation:** Gonorrhea, caused by the Gram-negative diplococcus *Neisseria gonorrhoeae*, is a sexually transmitted infection (STI). Its transmission is primarily linked to behavioral and demographic factors rather than anatomical predispositions to non-specific infections. **Why "Recurrent Urinary Tract Infections" is the correct answer:** Recurrent UTIs are typically caused by enteric bacteria (like *E. coli*) and are associated with factors such as female anatomy, urinary stasis, or sexual activity (honeymoon cystitis). However, a history of UTIs does not biologically or epidemiologically predispose an individual to acquiring *N. gonorrhoeae*. While both involve the urogenital tract, their pathophysiology and risk profiles are distinct. **Why the other options are incorrect:** * **Age < 25 years:** This is a well-established demographic risk factor. Younger individuals are statistically more likely to have multiple partners, inconsistent condom use, and biological factors like cervical ectopy, which increases susceptibility. * **Prostitution (Sex Work):** High-risk sexual behaviors, including commercial sex work, significantly increase the probability of exposure to STIs due to a higher number of sexual networks and potential barriers to consistent protection. * **Drug Abuse:** Substance abuse (both intravenous and non-intravenous) is a known risk factor. It is often associated with impaired judgment, leading to unprotected sex, or "sex-for-drugs" exchanges. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Nucleic Acid Amplification Test (NAAT). * **Culture Media:** Thayer-Martin Medium (selective for *Neisseria*). * **Treatment:** CDC currently recommends a single IM dose of **Ceftriaxone (500mg)**. Always co-treat for Chlamydia (Doxycycline) if not ruled out. * **Disseminated Gonococcal Infection (DGI):** Look for the triad of tenosynovitis, dermatitis, and polyarthralgia.

Q: The 'bubos' form is characteristic of which stage of Lymphogranuloma venereum (LGV)?

Secondary. Lymphogranuloma venereum (LGV) is a systemic sexually transmitted infection caused by **Chlamydia trachomatis serovars L1, L2, and L3**. The disease typically progresses through three distinct clinical stages: 1. **Secondary Stage (Correct Answer):** Also known as the **inguinal syndrome**, this stage occurs 2–6 weeks after the primary lesion [1]. It is characterized by painful regional lymphadenopathy, most commonly in the inguinal and femoral nodes [1]. These enlarged, inflamed nodes are termed **"bubos."** A classic clinical sign during this stage is the **"Groove sign,"** where the inguinal ligament divides the matted nodes into upper and lower groups. 2. **Primary Stage:** This stage involves a small, painless, transient papule or ulcer at the site of inoculation (genitals) [1]. It often goes unnoticed because it heals rapidly without scarring. 3. **Tertiary Stage:** Known as the **anogenital syndrome**, this stage involves chronic inflammation leading to complications like proctocolitis, rectal strictures, fistulae, and lymphatic obstruction (elephantiasis of the genitalia, also known as *esthiomene*). 4. **Latent Stage:** While LGV can have periods of subclinical infection, "bubos" are an active inflammatory manifestation of the secondary stage, not a feature of latency. **High-Yield Clinical Pearls for NEET-PG:** * **Causative Agent:** *C. trachomatis* (L1-L3). * **Groove Sign:** Pathognomonic for LGV (seen in only 15-20% of cases). * **Treatment of Choice:** **Doxycycline** (100 mg BID for 21 days). Erythromycin is the alternative for pregnant patients. * **Diagnosis:** Frei’s test (historical); Nucleic Acid Amplification Test (NAAT) is the modern gold standard.

Q: In primary syphilis, what type of lesion is typically seen?

Indurated ulcer. **Explanation:** The hallmark of primary syphilis is the **Chancre**, which typically appears 3 weeks after infection with *Treponema pallidum*. The correct answer is **Indurated ulcer** because the chancre is characterized by a firm, cartilaginous base (induration) caused by dense inflammatory infiltration and obliterative endarteritis [1]. **Analysis of Options:** * **A. Indurated ulcer (Correct):** The lesion is typically a single, painless, well-circumscribed ulcer with a clean base and indurated margins [1]. * **B. Multiple lesions:** Primary syphilis usually presents as a **solitary** lesion [1]. Multiple lesions are more characteristic of Chancroid (*Haemophilus ducreyi*) or Herpes Simplex Virus (HSV) [1]. * **C. Painful ulcer:** A syphilitic chancre is classically **painless** [1]. Painful ulcers are the hallmark of Chancroid ("Sore-chancre") or Genital Herpes [1]. * **D. Bleeding ulcer:** Syphilitic ulcers have a clean base and do not bleed easily on touch, unlike the ulcers of Granuloma Inguinale (Donovanosis), which are beefy red and bleed readily. **Clinical Pearls for NEET-PG:** * **Diagnosis:** The investigation of choice for primary syphilis is **Dark-field microscopy**, which shows corkscrew-shaped motility of spirochetes. Serological tests (VDRL/RPR) may be negative in the first 1–2 weeks of the chancre. * **Lymphadenopathy:** It is associated with bilateral, painless, firm, non-suppurative inguinal lymphadenopathy (shotty nodes) [1]. * **Treatment:** The gold standard is a single dose of **Benzathine Penicillin G** (2.4 million units IM). * **Differential Table:** Remember the "P's": **P**ainless, **P**enis (common site), and **P**enicillin for Syphilis; **P**ainful for Chancroid.

Q: A 24-year-old male complains of mild urethral mucoid discharge after sexual contact. Examination findings are normal. What is the recommended drug to treat this patient?

Azithromycin 1 gram single dose. ### Explanation **Correct Answer: D. Azithromycin 1 gram single dose** **Medical Concept:** The clinical presentation of **mild, mucoid urethral discharge** following sexual contact, especially when physical examination is otherwise unremarkable, is classic for **Non-Gonococcal Urethritis (NGU)** [1]. The most common causative organism for NGU is *Chlamydia trachomatis*. According to the CDC and WHO guidelines (and the NACO syndromic management protocols in India), the first-line treatment for uncomplicated chlamydial urethritis is a **single 1-gram oral dose of Azithromycin**. This regimen ensures high patient compliance and effectively achieves the required minimum inhibitory concentration (MIC) to eradicate the pathogen. **Analysis of Incorrect Options:** * **Option A & B:** These options mention "1 mg," which is a sub-therapeutic, negligible dose. The standard therapeutic dose for Azithromycin in this context is 1 gram (1000 mg). * **Option C:** 500 mg is the standard dose for respiratory infections or the loading dose in a multi-day course, but it is insufficient as a single-dose treatment for urethritis. **Clinical Pearls for NEET-PG:** * **Syndromic Management (NACO):** For Urethral Discharge (Grey Kit), the treatment is a combination of **Azithromycin 1g (stat)** and **Cefixime 400mg (stat)** to cover both *Chlamydia* and *Neisseria gonorrhoeae*. * **Alternative for NGU:** If Azithromycin is contraindicated, **Doxycycline 100 mg BID for 7 days** is the preferred alternative. * **Incubation Period:** NGU (*Chlamydia*) typically has a longer incubation period (7–14 days) and milder symptoms compared to Gonococcal Urethritis (2–5 days, profuse purulent discharge) [1]. * **Partner Management:** Always treat the sexual partner(s) simultaneously to prevent "ping-pong" reinfection [1].

Question 1

Which of the following conditions can cause a false-positive nontreponemal serological test for syphilis?

Accepted Answer

Paediatric age group

Answer

HIV infection

Answer

Collagen disorders

Answer

Tuberculosis

Question 2

In secondary syphilis, which one of the following features is not found?

Accepted Answer

Aortitis

Answer

Maculopapular rashes

Answer

Generalized non-tender lymphadenopathy

Answer

Follicular syphilides

Question 3

A 19-year-old girl presents with a painless ulcer on the labia majora with rolled-out margins. What is the most likely diagnosis?

Accepted Answer

Syphilis (Treponema pallidum)

Answer

Chlamydia infection

Answer

Gonorrhea

Answer

Genital herpes ulcer disease

Question 4

A 35-year-old sexually active male presents with a painless penile vesicle and inguinal lymphadenopathy. The infecting organism is definitively diagnosed and is known to exist in distinct extracellular and intracellular forms. Which of the following is the most likely pathogen?

Accepted Answer

Chlamydia trachomatis

Answer

Calymmatobacterium granulomatis

Answer

Haemophilus ducreyi

Answer

Neisseria gonorrhoeae

Question 5

A patient expresses concern over exposure to sexually transmitted diseases. During a pelvic examination, a singular, indurated, nontender ulcer is noted on the vulva. VDRL and FTA tests are positive. Without treatment, what is the characteristic clinical manifestation of the next stage of this disease?

Accepted Answer

Macular rash over the hands and feet

Answer

Optic nerve atrophy and generalized paresis

Answer

Tabes dorsalis

Answer

Gummas

Question 6

A patient presents with symptoms suggestive of both gonococcal and non-gonococcal urethritis. What is the drug of choice for empirical treatment in such a patient?

Accepted Answer

Azithromycin 2 gm stat

Answer

Cefixime 400 mg stat

Answer

Ceftriaxone 250 mg stat

Answer

Doxycycline 100 mg twice daily

Question 7

Which of the following is NOT a risk factor for Gonorrhea?

Accepted Answer

Recurrent urinary tract infections

Answer

Age less than 25 years

Answer

Prostitution

Answer

Drug abuse

Question 8

The 'bubos' form is characteristic of which stage of Lymphogranuloma venereum (LGV)?

Accepted Answer

Secondary

Answer

Primary

Answer

Tertiary

Answer

Latent

Question 9

In primary syphilis, what type of lesion is typically seen?

Accepted Answer

Indurated ulcer

Answer

Multiple lesions

Answer

Painful ulcer

Answer

Bleeding ulcer

Question 10

A 24-year-old male complains of mild urethral mucoid discharge after sexual contact. Examination findings are normal. What is the recommended drug to treat this patient?

Accepted Answer

Azithromycin 1 gram single dose

Answer

Azithromycin 1 mg single dose

Answer

Azithromycin 1 mg for 3 weeks

Answer

Azithromycin 500 mg single dose

Venerology — MCQs

Venerology — MCQs

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