Venerology — MCQs

Venerology Indian Medical PG Practice Questions and MCQs

Question 51: Which of the following conditions is caused by Treponema pallidum?

A. Condyloma acuminata
B. Condyloma lata (Correct Answer)
C. Both
D. None

Explanation: **Explanation:** The correct answer is **Condyloma lata**, which is a classic clinical manifestation of **Secondary Syphilis**, caused by the spirochete *Treponema pallidum* [1]. **1. Why Condyloma Lata is correct:** Condyloma lata (singular: latum) are smooth, moist, flat-topped, wart-like papules or plaques that typically occur in warm, intertriginous areas like the anogenital region or axilla [1]. They develop due to the hematogenous spread of *T. pallidum*. These lesions are **highly infectious** as they contain a high load of spirochetes, which can be easily visualized under Dark Ground Microscopy (DGM). **2. Why other options are incorrect:** * **Condyloma acuminata:** These are commonly known as genital warts and are caused by **Human Papillomavirus (HPV)**, most frequently types 6 and 11 [3]. Unlike the flat, moist lesions of syphilis, these are typically pedunculated, "cauliflower-like," and hyperkeratotic. * **Both/None:** Since the etiologies are distinct (Spirochete vs. DNA Virus), these options are incorrect. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology Trick:** Remember **L**ata = **L**at (Flat/Broad) in syphilis; **A**cuminata = **A**cute (Pointed/Warty) in HPV. * **Secondary Syphilis Triad:** Generalized lymphadenopathy, maculopapular rash (including palms and soles), and condyloma lata [1]. * **Diagnosis:** The screening test of choice is RPR/VDRL; the most specific tests are FTA-ABS or TP-PA [2]. * **Treatment:** The gold standard for all stages of syphilis is **Benzathine Penicillin G**. For secondary syphilis, a single IM dose of 2.4 million units is sufficient.

Question 52: What is the best indicator for monitoring the treatment of syphilis?

A. VDRL (Correct Answer)
B. FTA-ABS
C. TPI
D. TPHA

Explanation: The monitoring of syphilis treatment relies on the distinction between **Nontreponemal** and **Treponemal** tests. [1] **1. Why VDRL is the Correct Answer:** The **VDRL (Venereal Disease Research Laboratory)** and RPR are nontreponemal tests that measure IgG and IgM antibodies against cardiolipin-cholesterol-lecithin antigen. These tests are **quantitative**; their titers correlate directly with disease activity. A successful response to treatment is indicated by a **fourfold decline in titer** (e.g., from 1:32 to 1:8). Because these titers decrease and often become negative (seroreversion) after effective therapy, they are the gold standard for monitoring treatment response and detecting re-infection. **2. Why Other Options are Incorrect:** * **FTA-ABS (Fluorescent Treponemal Antibody Absorption):** This is a treponemal test used for confirmation. Once positive, it usually remains positive for life (**"Treponemal Memory"**), regardless of treatment status. Therefore, it cannot distinguish between an active and a treated infection. * **TPHA (Treponema Pallidum Hemagglutination Assay):** Similar to FTA-ABS, this is a specific treponemal test. It remains reactive indefinitely in most patients and cannot be used to monitor the decline in disease activity. * **TPI (Treponema Pallidum Immobilization):** Though highly specific, it is technically difficult, expensive, and no longer used in routine clinical practice. Like other treponemal tests, it is not useful for monitoring treatment. **Clinical Pearls for NEET-PG:** * **Prozone Phenomenon:** Can cause a false-negative VDRL in secondary syphilis due to very high antibody titers; solved by diluting the serum. [1] * **Biological False Positive (BFP):** Seen in SLE, Leprosy, Malaria, and pregnancy. [1] * **Neurosyphilis:** CSF-VDRL is the specific test for diagnosis, but it is not sensitive. * **Treatment Monitoring:** Re-check VDRL titers at 6 and 12 months post-treatment.

Question 53: Which of the following is NOT true about a chancre?

A. Tender ulcer (Correct Answer)
B. Raised borders
C. Round border
D. Heals spontaneously by 6 weeks

Explanation: A **chancre** is the hallmark lesion of **primary syphilis**, caused by the spirochete *Treponema pallidum* [1]. Understanding its classic presentation is crucial for differentiating it from other genital ulcerative diseases. ### **Explanation of Options** * **A. Tender ulcer (Correct Answer):** By definition, a syphilitic chancre is **painless** (indolent) [1]. The absence of pain is due to the lack of an acute inflammatory response and the organism's stealthy nature. If a chancre becomes painful, it usually indicates a secondary bacterial infection. In contrast, *Haemophilus ducreyi* (Chancroid) causes a characteristically painful ulcer. * **B & C. Raised and Round borders:** A classic chancre is a solitary, indurated (hard), and well-circumscribed ulcer. It typically presents with a **clean base**, **round or oval shape**, and **firm, raised, "button-like" borders**. * **D. Heals spontaneously by 6 weeks:** Even without treatment, a primary chancre typically resolves within **3 to 6 weeks**. However, spontaneous healing does not mean the infection is gone; the bacteria disseminate systemically, leading to secondary syphilis [1]. ### **Clinical Pearls for NEET-PG** * **Induration:** The most characteristic feature of a chancre is its "cartilaginous" consistency upon palpation. * **Lymphadenopathy:** It is associated with **painless, non-suppurative, rubbery** bilateral inguinal lymphadenopathy (unlike the painful "buboes" of chancroid) [1]. * **Diagnosis:** The gold standard for a primary chancre is **Dark-field microscopy** (showing corkscrew motility). Serological tests (VDRL/RPR) may be negative in the first 1-2 weeks of the lesion's appearance. * **Treatment:** A single IM injection of **Benzathine Penicillin G** (2.4 million units).

Question 54: A young man presents to the emergency department with a maculopapular rash 2 weeks after healing of a painless genital ulcer. What is the most likely etiological agent?

A. Treponema pallidum (Correct Answer)
B. Treponema pennae
C. Chlamydia trachomatis
D. Calymmatobacterium granulomatis

Explanation: ### Explanation The clinical presentation describes the classic progression of **Syphilis**, caused by the spirochete ***Treponema pallidum***. **1. Why Treponema pallidum is correct:** The patient exhibits a two-stage progression: * **Primary Syphilis:** Characterized by a **painless, indurated genital ulcer (chancre)** [1]. * **Secondary Syphilis:** Occurs 2–10 weeks after the chancre heals. The hallmark is a **generalized maculopapular rash**, which characteristically involves the **palms and soles** [1]. The "2 weeks after healing" timeline is a classic "silent period" before the systemic dissemination of the spirochete manifests as secondary syphilis. **2. Why other options are incorrect:** * **Treponema pertenue (Option B):** (Often misspelled as *pennae*) This is the causative agent of **Yaws**, a non-venereal treponematosis primarily affecting skin and bones in children; it does not typically present with genital ulcers. * **Chlamydia trachomatis (Option C):** Serotypes L1-L3 cause **Lymphogranuloma Venereum (LGV)**. While it features a transient painless ulcer, the dominant clinical feature is painful, suppurative inguinal lymphadenopathy (Buboes) and the "Groove sign." * **Calymmatobacterium granulomatis (Option D):** (Now *Klebsiella granulomatis*) Causes **Granuloma Inguinale (Donovanosis)**. This presents as chronic, beefy-red, **painless** ulcers that are highly vascular (bleed on touch) but do not typically resolve spontaneously to produce a secondary rash. **Clinical Pearls for NEET-PG:** * **Gold Standard for Primary Syphilis:** Dark-field microscopy (visualizes motile spirochetes). * **Screening vs. Confirmatory:** VDRL/RPR (Non-treponemal) for screening; FTA-ABS/TPHA (Treponemal) for confirmation. * **Secondary Syphilis Hallmarks:** Condyloma lata (moist warts) [1], snail-track ulcers in the mouth, and generalized lymphadenopathy. * **Treatment:** Benzathine Penicillin G (2.4 million units IM) is the drug of choice.

Question 55: Which of the following is not a sexually transmitted infection?

A. Trichomoniasis
B. Giardiasis
C. Amoebiasis
D. Leishmaniasis (Correct Answer)

Explanation: ### Explanation The correct answer is **D. Leishmaniasis**. **1. Why Leishmaniasis is the correct answer:** Leishmaniasis is a protozoan infection caused by species of the genus *Leishmania*. It is transmitted to humans through the bite of an infected **female phlebotomine sandfly** [1]. Unlike the other options, it is not classified as a sexually transmitted infection (STI) because its primary and natural mode of transmission is via an insect vector, not through sexual contact. **2. Analysis of incorrect options:** * **A. Trichomoniasis:** Caused by *Trichomonas vaginalis*, this is a classic STI [2]. It is one of the most common non-viral STIs globally, typically presenting as vaginitis in females and urethritis in males. * **B. Giardiasis & C. Amoebiasis:** While *Giardia lamblia* and *Entamoeba histolytica* are primarily transmitted via the fecal-oral route (contaminated food/water), they are recognized as **"sexually transmissible"** infections. They are frequently transmitted during sexual practices involving oro-anal contact (common in MSM—men who have sex with men) [2]. Therefore, they are categorized under the broader spectrum of STIs in medical literature. **3. NEET-PG Clinical Pearls:** * **Vector for Leishmaniasis:** *Phlebotomus argentipes* (Sandfly) [1]. * **Other "Enteric" STIs:** Besides Giardia and Amoeba, *Shigella* and *Hepatitis A* are also transmitted via the oro-anal sexual route. * **Donovanosis vs. Leishmaniasis:** Do not confuse Leishmaniasis with **Donovanosis** (Granuloma Inguinale). Donovanosis is a confirmed STI caused by *Klebsiella granulomatis*, characterized by "beefy red" painless ulcers and **Donovan bodies** on biopsy. * **Drug of Choice for Trichomoniasis/Amoebiasis/Giardiasis:** Metronidazole is the mainstay of treatment for all three.

Question 56: A patient presents with bilateral tender lymphadenopathy and a history of sexual contact. The patient is a truck driver by profession. What is the probable causative agent?

A. Herpes simplex virus
B. Lymphogranuloma venereum (Correct Answer)
C. Haemophilus ducreyi
D. Treponema pallidum

Explanation: ### Explanation The clinical presentation of **bilateral tender lymphadenopathy** in a patient with a high-risk sexual history (often associated with mobile professions like truck driving) points toward **Lymphogranuloma venereum (LGV)** [1]. **1. Why LGV is the Correct Answer:** LGV is caused by **Chlamydia trachomatis (serotypes L1, L2, L3)**. The disease typically progresses through three stages. The second stage, the **inguinal syndrome**, is characterized by painful, often bilateral, inguinal lymphadenopathy [1]. A classic clinical sign is the **"Groove sign,"** where the inguinal ligament creates a depression between the inflamed superficial and deep inguinal nodes. **2. Why the Other Options are Incorrect:** * **Herpes simplex virus (HSV):** While HSV causes painful lymphadenopathy, it is almost always accompanied by **multiple, painful, grouped vesicles** or shallow ulcers [1]. The primary complaint here is the lymphadenopathy itself. * **Haemophilus ducreyi (Chancroid):** This causes a **painful, soft ulcer** with ragged edges [1]. While it causes tender lymphadenopathy (buboes), they are typically **unilateral** and prone to suppuration/rupture. * **Treponema pallidum (Syphilis):** Primary syphilis presents with a **painless** chancre and **painless, non-tender, rubbery** lymphadenopathy. **3. Clinical Pearls for NEET-PG:** * **Causative Agent:** *Chlamydia trachomatis* L1-L3. * **Diagnosis:** Nucleic Acid Amplification Test (NAAT) is the preferred method. * **Treatment of Choice:** **Doxycycline 100 mg BID for 21 days** [1]. (Note: Standard Chlamydia urethritis only requires 7 days). * **Esthiomene:** A chronic complication of LGV in females involving lymphatic obstruction leading to vulvar elephantiasis. * **Truck Drivers:** Frequently used in Indian medical exams as a social marker for high-risk sexual behavior and STIs [1].

Question 57: Which of the following is NOT a characteristic of the early eruption of secondary syphilis?

A. Intensely pruritic (Correct Answer)
B. Papular/maculopapular eruption
C. Symmetrical
D. Pleomorphic

Explanation: Secondary syphilis, often called the **"Great Imitator,"** occurs due to the systemic hematogenous spread of *Treponema pallidum*. [1] **Why Option A is the Correct Answer:** The hallmark of the secondary syphilitic rash is that it is **non-pruritic** (not itchy); it is classically described as non-irritable. [1] In dermatology, most generalized rashes are itchy; however, syphilis is a classic exception. If a patient presents with a generalized maculopapular rash that does **not** itch, secondary syphilis should be the first differential diagnosis. **Analysis of Incorrect Options:** * **Option B (Papular/maculopapular):** This is the most common morphology. The rash typically begins as faint pink-to-red macules that evolve into papules. [1], [2] * **Option C (Symmetrical):** The eruption is characteristically widespread and bilaterally symmetrical, involving the trunk and extremities. [1] * **Option D (Pleomorphic):** Secondary syphilis is known for its variety. Lesions can be macular, papular, pustular, or squamous (psoriasiform) occurring simultaneously. [1] However, it **never** presents as vesicular or bullous lesions in adults (except in congenital syphilis). **High-Yield Clinical Pearls for NEET-PG:** * **Palm and Sole Involvement:** A maculopapular rash involving the palms and soles is a high-yield diagnostic clue for secondary syphilis. [1], [2] * **Condyloma Lata:** These are moist, flat-topped, highly infectious papules found in intertriginous areas (e.g., perianal region). [1] * **Lues Maligna:** A rare, severe form of secondary syphilis with necrotic lesions, usually seen in HIV-positive patients. * **Diagnosis:** Screening is done via **VDRL/RPR** (non-treponemal), and confirmation is via **FTA-ABS/TPHA** (treponemal).

Question 58: What is the characteristic lesion of primary syphilis on the male genitalia?

A. Soft, ragged ulcer
B. Punched-out, painless ulcer with indurated edges (Correct Answer)
C. Raised, flat, greyish, moist, confluent lesions
D. Necrotic, rubbery lesion

Explanation: The characteristic lesion of **Primary Syphilis** (caused by *Treponema pallidum*) is the **Hard Chancre** [1]. It typically appears 3–4 weeks after exposure. The classic description is a single, **punched-out, painless ulcer** with a clean base and **indurated (firm/hard) edges** [1]. The lack of pain is due to the absence of an acute inflammatory response, and the induration is a result of perivascular infiltration by plasma cells and lymphocytes. **Analysis of Options:** * **Option A (Soft, ragged ulcer):** This describes a **Chancroid** (caused by *Haemophilus ducreyi*). Unlike syphilis, these ulcers are "soft" (non-indurated), extremely painful, and often have a purulent base. * **Option C (Raised, flat, greyish, moist, confluent lesions):** This describes **Condyloma Lata**, which is a hallmark of **Secondary Syphilis** [1]. These are highly infectious, wart-like lesions found in intertriginous areas. * **Option D (Necrotic, rubbery lesion):** This describes a **Gumma**, the characteristic lesion of **Tertiary Syphilis**. Gummas are chronic, granulomatous lesions that can lead to tissue destruction. **High-Yield Clinical Pearls for NEET-PG:** * **Lymphadenopathy:** Primary syphilis is associated with bilateral, painless, non-suppurative, "shotty" inguinal lymphadenopathy [1]. * **Diagnosis:** The gold standard for primary syphilis is **Dark-field microscopy** (shows corkscrew motility). Serological tests like VDRL/RPR may be negative in the early stages (window period) [2]. * **Treatment:** The drug of choice for primary syphilis is a single dose of **Benzathine Penicillin G (2.4 million units IM)**. * **Rule of Thumb:** If the ulcer is **P**ainless, think **P**rimary Syphilis. If it is **D**ucreyi, it "**D**o cry" (painful).

Question 59: A VDRL reactive mother gave birth to an infant. All of the following would help in determining the risk of transmission to the infant, EXCEPT:

A. TPHA test on the serum sample of the mother
B. TPHA test on the serum sample of the infant (Correct Answer)
C. VDRL on the paired serum sample of the infant and mother
D. Time interval between the treatment of the mother and her delivery

Explanation: ### Explanation The core challenge in diagnosing neonatal syphilis is distinguishing between **passive transfer of maternal antibodies** and **active fetal infection**. **Why Option B is the Correct Answer (The "Except"):** TPHA (Treponema Pallidum Hemagglutination Assay) is a treponemal test that detects **IgG antibodies**. IgG is the only immunoglobulin class that crosses the placenta. Therefore, a positive TPHA in an infant’s serum usually reflects maternal antibodies transferred during pregnancy rather than an active infection in the newborn. These antibodies can persist for up to 15 months, making the test unreliable for determining the immediate risk of transmission or diagnosing congenital syphilis at birth. **Analysis of Other Options:** * **A. TPHA on Mother:** Confirms that the mother’s reactive VDRL is due to true syphilis and not a Biological False Positive (BFP), which is essential to assess transmission risk [1]. * **C. VDRL on Paired Samples:** This is the standard approach. A diagnosis of congenital syphilis is highly likely if the infant’s VDRL titer is **fourfold higher** than the mother’s titer. * **D. Time Interval:** Maternal treatment must occur at least **30 days prior to delivery** to be considered effective in preventing congenital syphilis. Treatment initiated late in pregnancy carries a high risk of transmission. **Clinical Pearls for NEET-PG:** 1. **VDRL/RPR** are non-treponemal tests used for screening and monitoring treatment response (titers fall after therapy) [1]. 2. **TPHA/FTA-ABS** are treponemal tests used for confirmation; they usually remain positive for life ("treponemal memory"). 3. **Specific Diagnosis:** The most specific serological test for active neonatal infection is the **19S-IgM FTA-ABS** or **IgM ELISA**, as IgM does not cross the placenta [1]. 4. **Drug of Choice:** Parenteral **Penicillin G** remains the gold standard for treating both the mother and the infant.

Question 60: A 20-year-old male presents with multiple painful ulcers over the prepuce and glans, accompanied by suppurative lymphadenopathy, developing two weeks after unprotected sexual intercourse. What is the most probable diagnosis?

A. Herpes simplex
B. Molluscum contagiosum
C. Syphilis
D. Chancroid (Correct Answer)

Explanation: ### **Explanation** The clinical presentation of **painful ulcers** associated with **suppurative lymphadenopathy** (buboes) is the classic hallmark of **Chancroid**, caused by the Gram-negative coccobacillus *Haemophilus ducreyi* [1]. #### **Why Chancroid is Correct:** 1. **Painful Ulcers:** Unlike syphilis, the ulcers in chancroid are characteristically painful, soft, and often have ragged, undermined edges with a gray/yellow purulent base [1]. 2. **Suppurative Lymphadenopathy:** About 50% of patients develop painful inguinal lymphadenitis. These "buboes" are typically unilateral and frequently progress to suppuration (pus formation) and spontaneous rupture [1]. 3. **Incubation Period:** The 2-week timeline fits the typical 3–14 day incubation period of *H. ducreyi* [1]. #### **Why Other Options are Incorrect:** * **Herpes Simplex (HSV-2):** While painful, HSV presents as multiple small, superficial **vesicles** on an erythematous base that later rupture into shallow ulcers [1]. Lymphadenopathy is usually bilateral and non-suppurative. * **Molluscum Contagiosum:** Presents as **painless**, firm, pearly, umbilicated papules. It does not cause ulcers or suppurative lymphadenopathy. * **Syphilis (Primary):** Caused by *Treponema pallidum*, the classic chancre is **painless**, indurated (hard), and associated with painless, non-suppurative regional lymphadenopathy [1]. #### **NEET-PG High-Yield Pearls:** * **School of Fish Appearance:** On Gram stain, *H. ducreyi* shows a characteristic "railroad track" or "school of fish" pattern. * **The "P" Rule:** Remember **Chancroid = Painful** (Soft Chancre) vs. **Syphilis = Painless** (Hard Chancre). * **Treatment:** A single dose of **Azithromycin (1g orally)** or Ceftriaxone (250mg IM). * **Differential for Buboes:** If the lymphadenopathy is associated with a small, transient, *painless* ulcer, consider **Lymphogranuloma Venereum (LGV)** (Chlamydia trachomatis L1-L3) [1].

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Chlamydial Infections

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Genital Herpes

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HIV and STIs

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Pelvic Inflammatory Disease

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STI Screening and Prevention

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Partner Notification and Treatment

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Special Populations Management

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Venerology — MCQs

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