Venerology Practice Questions

Q: Which of the following causes genital ulcers?

All of the above. **Explanation:** Genital Ulcer Disease (GUD) is a clinical syndrome characterized by ulcerative lesions on the genitalia, often accompanied by lymphadenopathy. While most commonly associated with classic STIs, several viruses can manifest as ulcers. * **Herpes Simplex Virus (HSV):** HSV-2 (and increasingly HSV-1) is the most common cause of genital ulcers worldwide [1]. It typically presents as painful, grouped vesicles on an erythematous base that rupture to form shallow, "punched-out" ulcers [3]. * **Human Papilloma Virus (HPV):** While HPV is primarily known for causing genital warts (Condyloma acuminata), certain high-risk strains or secondary trauma/infection of a wart can lead to ulceration. Additionally, HPV-related malignancies (Vulvar/Penile intraepithelial neoplasia) can present as chronic, non-healing ulcers. * **Human Immunodeficiency Virus (HIV):** Acute HIV infection (Seroconversion illness) can present with painful mucocutaneous ulcers (aphthous-like) on the mouth or genitals. Furthermore, advanced HIV/AIDS increases the risk of "giant herpetic ulcers" or opportunistic infections that manifest ulceratively. **Clinical Pearls for NEET-PG:** 1. **Painful Ulcers:** Think **H**erpes (HSV) and **C**hancroid (*Haemophilus ducreyi*) [2]. 2. **Painless Ulcers:** Think Syphilis (Chancre), Lymphogranuloma Venereum (LGV), and Granuloma Inguinale (Donovanosis) [2]. 3. **Donovan Bodies:** Pathognomonic for Granuloma Inguinale (safety-pin appearance on Giemsa stain). 4. **School of Fish appearance:** Characteristic of *H. ducreyi* on Gram stain. 5. **Syndromic Management:** In India, the **NACO Kit 1 (Grey)** is used for the management of non-herpetic genital ulcers (covers Syphilis and Chancroid).

Q: A 20-year-old young female presented with a relatively painless ulcer of 3 cm on the labia majora with raised margins. Which of the following organisms would have most likely caused this ulcer?

Treponema palladium. ### Explanation The clinical presentation of a **relatively painless, solitary ulcer with raised, indurated margins** on the genitalia is the classic description of a **Chancre**, the hallmark of **Primary Syphilis**. [1] **1. Why Treponema pallidum is correct:** * **Morphology:** The primary chancre caused by *T. pallidum* typically begins as a papule that erodes into a clean-based, painless ulcer. [1] * **Margins:** The margins are characteristically raised and firm (indurated). * **Lymphadenopathy:** It is often associated with painless, non-suppurative bilateral inguinal lymphadenopathy. * **Healing:** Even without treatment, the ulcer usually heals within 3–6 weeks, though the infection progresses to the secondary stage. **2. Why the other options are incorrect:** * **Herpes Simplex (HSV-2):** Causes **painful**, multiple, superficial, vesicular lesions on an erythematous base. [1] They are not indurated. * **Chlamydia trachomatis (L1-L3):** Causes **Lymphogranuloma Venereum (LGV)**. While it starts with a small, painless papule or ulcer, the lesion is transient and often goes unnoticed. The dominant clinical feature is painful, suppurative inguinal lymphadenopathy (the "Groove sign"). [2] * **Candidal cervicitis:** Typically presents with thick, curd-like vaginal discharge and pruritus, not a discrete, indurated ulcer on the labia. **Clinical Pearls for NEET-PG:** * **Painful vs. Painless Ulcers:** Remember the mnemonic **"H is for Hurt"**—**H**erpes and **H**aemophilus ducreyi (Chancroid) are painful; Syphilis and LGV are generally painless. [1] * **Dark-field Microscopy:** The gold standard for diagnosing primary syphilis from ulcer exudate. * **Treatment of Choice:** Benzathine Penicillin G (2.4 million units IM, single dose) remains the first-line therapy.

Q: Which statement is true regarding gonococcal urethritis?

Most patients present with symptoms of dysuria.. Explanation: **Gonococcal Urethritis** is caused by the Gram-negative diplococcus *Neisseria gonorrhoeae*. In males, it typically presents as an acute, symptomatic infection of the anterior urethra. 1. **Why Option C is correct:** Dysuria (painful urination) and a profuse, purulent urethral discharge [1] are the hallmark symptoms of gonococcal urethritis. In males, more than 90% of cases are symptomatic, with dysuria being the most common presenting complaint. 2. **Why Option A is incorrect:** Symptoms are significantly **more severe in males** than in females. In females, the primary site of infection is the endocervix, and the infection is often asymptomatic or presents with mild, non-specific symptoms (vaginal discharge or intermenstrual bleeding). 3. **Why Option B is incorrect:** The rectum and prostate are **not resistant**. *N. gonorrhoeae* can infect any mucosal surface lined with columnar or cuboidal epithelium. Prostatitis is a known local complication in males [3], and proctitis is common in individuals practicing receptive anal intercourse. **High-Yield Clinical Pearls for NEET-PG:** * **Incubation Period:** Short, typically 2–7 days [1] (compared to 7–14 days for Chlamydia). * **Diagnosis:** Gram stain showing **Gram-negative intracellular diplococci** within polymorphonuclear leukocytes (PMNs) is highly sensitive (95%) in symptomatic males. **NAAT** (Nucleic Acid Amplification Test) is the gold standard for screening. * **Treatment:** Due to increasing resistance, the current CDC/WHO recommendation is a single dose of **Ceftriaxone (IM)** [2]. Always co-treat for Chlamydia (e.g., Doxycycline) if it hasn't been ruled out. * **Complications:** If untreated, it can lead to Epididymitis in males and Pelvic Inflammatory Disease (PID) or Fitz-Hugh-Curtis syndrome in females.

Q: Tender buboes are used in the diagnosis of which condition?

Chancroid. **Chancroid** is caused by the Gram-negative coccobacillus *Haemophilus ducreyi*. The clinical hallmark of this condition is the presence of **painful (tender) genital ulcers** [1] accompanied by **painful, fluctuant inguinal lymphadenopathy**, known as **buboes** [1]. These buboes are typically unilateral and, if left untreated, may undergo spontaneous rupture, leading to chronic draining sinuses. **Analysis of Options:** * **Gonorrhoea:** Primarily presents as urethritis (purulent discharge) or cervicitis. While it can cause pelvic inflammatory disease, it does not typically present with tender inguinal buboes. * **Herpes (HSV-2):** Presents with multiple, small, grouped vesicles on an erythematous base that rupture to form shallow, painful ulcers. While lymphadenopathy may be present, it is usually bilateral and non-suppurative, unlike the classic bubo of Chancroid. * **Granuloma venereum (Donovanosis):** Caused by *Klebsiella granulomatis*. It is characterized by **painless**, beefy-red, velvety ulcers [1]. A key feature is "pseudobuboes"—which are subcutaneous nodules rather than true lymphadenopathy. **NEET-PG High-Yield Pearls:** * **The "Pain" Rule:** Chancroid and Herpes are **Painful**; Syphilis and Lymphogranuloma Venereum (LGV) are generally **Painless** (though LGV buboes can become painful later). * **School of Fish Appearance:** Classic Gram stain finding for *H. ducreyi*. * **LGV vs. Chancroid:** Both cause buboes, but LGV (Chlamydia L1-L3) features the **"Groove Sign"** (Poupart’s ligament dividing the nodes) and the initial ulcer is usually evanescent (disappears quickly). * **Treatment of Chancroid:** Single dose of Azithromycin (1g) or Ceftriaxone (250mg IM).

Q: A 45-year-old lorry driver from Bihar presented with multiple painful, necrotic ulcers on the penis and tender inguinal lymphadenopathy. What is the diagnosis?

Haemophilus ducreyi. **Explanation:** The clinical presentation of **painful, necrotic ulcers** associated with **tender inguinal lymphadenopathy** (buboes) is the classic hallmark of **Chancroid**, caused by the Gram-negative coccobacillus ***Haemophilus ducreyi*** [2]. **1. Why Option A is Correct:** * **Painful Ulcers:** Unlike syphilis, chancroid presents with extremely painful, "soft" ulcers with ragged, undermined edges and a necrotic/purulent base [2]. * **Bubo Formation:** Inguinal lymphadenopathy in chancroid is typically unilateral, very painful, and prone to suppuration (forming a bubo) [2]. * **Demographics:** Lorry drivers are a high-risk group frequently cited in NEET-PG vignettes for Sexually Transmitted Infections (STIs). **2. Why Other Options are Incorrect:** * **B. Herpes Simplex Virus (HSV):** While painful, HSV presents as multiple small, superficial vesicles on an erythematous base that rupture to form shallow ulcers [1]. It lacks the deep, necrotic character of chancroid. * **C. Syphilis (*Treponema pallidum*):** The primary chancre of syphilis is characteristically **painless**, indurated ("hard"), and clean-based, with painless regional lymphadenopathy [1]. * **D. Chlamydia trachomatis (LGV):** Lymphogranuloma Venereum (serovars L1-L3) typically presents with a transient, painless primary papule/ulcer that heals quickly, followed later by painful "Groove sign" lymphadenopathy [2]. **Clinical Pearls for NEET-PG:** * **School of Fish Appearance:** Classic microscopic finding of *H. ducreyi* on Gram stain (parallel chains). * **Railroad Track Appearance:** Another descriptive term for the arrangement of the bacilli. * **Treatment:** A single dose of **Azithromycin (1g)** or Ceftriaxone (250mg IM). * **Mnemonic:** "Ducreyi makes you **cry**" (because it is painful).

Q: Which of the following statements is true about Donovanosis?

Caused by Klebsiella granulomatis. **Explanation:** **Donovanosis**, also known as **Granuloma Inguinale**, is a chronic, progressive bacterial infection of the genital and perianal skin. 1. **Why Option D is Correct:** Donovanosis is caused by **_Klebsiella granulomatis_** (formerly known as _Calymmatobacterium granulomatis_). It is a Gram-negative, pleomorphic intracellular bacterium. The hallmark of this disease is the presence of **Donovan bodies**—safety-pin-shaped organisms seen within the cytoplasm of large mononuclear cells (macrophages) on a Giemsa or Wright stain. 2. **Why the Other Options are Incorrect:** * **Option A:** _Leishmania donovani_ is the causative agent of **Visceral Leishmaniasis (Kala-azar)**, not Donovanosis. The similarity in names often confuses students, but they are entirely different pathogens. * **Options B & C:** Amphotericin B and Sodium stibogluconate are the mainstays of treatment for **Leishmaniasis**. For Donovanosis, the **drug of choice is Azithromycin** (1g orally once a week or 500mg daily for at least 3 weeks). **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Characterized by **painless, beefy-red, velvety ulcers** that bleed easily on touch (friable). * **Lymphadenopathy:** Unlike Syphilis or LGV, there is **no true lymphadenopathy**. Instead, it presents with **"Pseudobuboes"** (subcutaneous granulation tissue in the inguinal region). * **Diagnosis:** Crushed tissue smear from the ulcer edge showing **Donovan bodies**. * **Complications:** Long-standing cases can lead to "Elephantiasis" of the genitals due to lymphatic scarring or squamous cell carcinoma.

Question 1

Which of the following causes genital ulcers?

Accepted Answer

All of the above

Answer

Human papilloma virus

Answer

Herpes simplex virus

Answer

Human Immunodeficiency Virus

Question 2

A 20-year-old young female presented with a relatively painless ulcer of 3 cm on the labia majora with raised margins. Which of the following organisms would have most likely caused this ulcer?

Accepted Answer

Treponema palladium

Answer

Herpes simplex

Answer

Chlamydia trachomatis

Answer

Candidal cervicitis

Question 3

Which statement is true regarding gonococcal urethritis?

Accepted Answer

Most patients present with symptoms of dysuria.

Answer

Symptoms are more severe in females than in males.

Answer

The rectum and prostate are resistant to gonococci.

Answer

All of the above.

Question 4

A 35-year-old male with a history of multiple sex partners presents with urethral discharge. What is the best treatment option?

Accepted Answer

Cefixime + azithromycin

Answer

Ceftriaxone + quinolone

Answer

Erythromycin

Answer

Ceftriaxone + doxycycline

Question 5

Tender buboes are used in the diagnosis of which condition?

Accepted Answer

Chancroid

Answer

Gonorrhoea

Answer

Herpes

Answer

Granuloma venereum

Question 6

Which of the following conditions is NOT transmitted sexually?

Accepted Answer

T. vaginalis

Answer

Syphilis

Answer

Candida

Answer

Gonorrhoea

Question 7

A male patient presented with agitation, restlessness, and neck stiffness. He had undergone treatment for a penile ulcer 3 years prior. Which laboratory investigation is used for assessing the prognosis of treatment?

Accepted Answer

VDRL

Answer

TPI

Answer

FTA-ABS

Answer

Dark field microscopy

Question 8

A man presents to a sexually transmitted infection clinic with urethritis and urethral discharge. Gram stain shows numerous pus cells but no microorganisms. The culture is negative on routine laboratory media. What is the most likely causative agent?

Accepted Answer

Chlamydia trachomatis

Answer

Haemophilus ducreyi

Answer

Treponema pallidum

Answer

Neisseria gonorrhoeae

Question 9

A 45-year-old lorry driver from Bihar presented with multiple painful, necrotic ulcers on the penis and tender inguinal lymphadenopathy. What is the diagnosis?

Accepted Answer

Haemophilus ducreyi

Answer

Herpes simplex virus

Answer

Syphilis

Answer

Chlamydia trachomatis infection

Question 10

Which of the following statements is true about Donovanosis?

Accepted Answer

Caused by Klebsiella granulomatis

Answer

Caused by Leshmania donovani

Answer

Amphotericin B is the drug of choice

Answer

Sodium stibogluconate is the drug of choice

Venerology — MCQs

Venerology — MCQs

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