Sexually Transmitted Infections — MCQs
A sexually active lady came with profuse yellowish frothy discharge with intense itching. On local examination of the vagina a 'strawberry' like cervix is revealed. What condition she is likely suffering from?
Which of the following is the MOST COMMON clinical manifestation of Neisseria gonorrhoeae infection in males?
A 24-year-old man had been treated for gonorrhea 2 months previously. He developed an ulcerative lesion in the glands of the penis that is noted to be condylomata lata. The etiology of condylomata lata is which of the following?
Which of the following is not a STD -
A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?
Which of the following statements about herpes simplex virus (HSV) shedding is MOST accurate?
Which organism causes Granuloma inguinale (Donovanosis)?
Most common organism causing the pelvic inflammatory disease?
A 31-year-old man presents with dysuria and urethral discharge. Gram stain shows intracellular gram-negative diplococci. Local resistance patterns show 28% quinolone resistance. Which of the following most appropriately guides empiric therapy selection?
Which contraceptive method is most effective in preventing sexually transmitted infections?
Sexually Transmitted Infections Indian Medical PG Practice Questions and MCQs
Question 1: A sexually active lady came with profuse yellowish frothy discharge with intense itching. On local examination of the vagina a 'strawberry' like cervix is revealed. What condition she is likely suffering from?
- A. Gonorrhea
- B. Candidiasis
- C. Bacterial vaginosis
- D. Trichomonas vaginitis (Correct Answer)
Explanation: ***Trichomonas vaginitis*** - The classic presentation includes a **profuse, yellowish, frothy discharge**, intense itching, and a characteristic **'strawberry cervix'** (colpitis macularis), which is due to punctate hemorrhages on the cervical mucosa. - This condition is caused by the flagellated protozoan *Trichomonas vaginalis* and is a common sexually transmitted infection. *Gonorrhea* - While it can cause a **purulent vaginal discharge**, it is typically not frothy or yellowish and does not present with a 'strawberry cervix'. - May also present with **dysuria** and **pelvic pain**, and is caused by the bacterium *Neisseria gonorrhoeae*. *Candidiasis* - Characterized by a **thick, white, curd-like discharge** and intense itching, often described as a cottage cheese discharge. - It does not typically cause a frothy discharge or a 'strawberry cervix'. *Bacterial vaginosis* - Presents with a **thin, grayish-white discharge** and a characteristic **"fishy" odor**, especially after intercourse. - Key diagnostic features include **clue cells** on microscopy and a pH >4.5, but not frothy discharge or cervical petechiae.
Question 2: Which of the following is the MOST COMMON clinical manifestation of Neisseria gonorrhoeae infection in males?
- A. Highly sensitive to Penicillin
- B. Exclusive human pathogen
- C. Some strains may cause disseminated disease
- D. Acute urethritis is MC manifestation in males (Correct Answer)
Explanation: ***Acute urethritis is MC manifestation in males*** - For males, **acute urethritis** is the most common and often the first noticeable manifestation of *Neisseria gonorrhoeae* infection, typically presenting 2-7 days after exposure. - Symptoms include **purulent urethral discharge** and **dysuria**, which are usually severe enough to prompt patients to seek medical attention. - This early presentation allows for **prompt diagnosis and treatment**, which is crucial in preventing complications and further transmission. *Highly sensitive to Penicillin* - This statement is **incorrect** because *Neisseria gonorrhoeae* has developed significant resistance to penicillin over time. - Penicillinase-producing strains and chromosomally mediated resistance have rendered penicillin ineffective as primary treatment. - Current treatment guidelines recommend **dual therapy with ceftriaxone and azithromycin** due to widespread antibiotic resistance patterns. *Exclusive human pathogen* - While *Neisseria gonorrhoeae* is indeed an obligate human pathogen with no animal reservoir, this characteristic does not represent the most common clinical manifestation. - This is a **microbiological characteristic** rather than a clinical presentation. *Some strains may cause disseminated disease* - **Disseminated gonococcal infection (DGI)** occurs in only **0.5-3%** of untreated infections, making it relatively uncommon. - DGI can manifest as **arthritis-dermatitis syndrome**, tenosynovitis, or rarely endocarditis or meningitis. - While serious, DGI is **far less common** than localized urogenital infections like acute urethritis.
Question 3: A 24-year-old man had been treated for gonorrhea 2 months previously. He developed an ulcerative lesion in the glands of the penis that is noted to be condylomata lata. The etiology of condylomata lata is which of the following?
- A. Herpesvirus hominis, type II
- B. Hemophilus ducreyi
- C. Mixture of organisms
- D. Treponema pallidum (Correct Answer)
Explanation: ***Treponema pallidum*** - **Condylomata lata** are characteristic lesions of **secondary syphilis**, caused by *Treponema pallidum* [1]. - They are typically broad, flat, moist, wart-like lesions that occur in warm, moist areas such as the anogenital region [1]. *Herpesvirus hominis, type II* - Herpesvirus hominis, type II (HSV-2) causes **genital herpes**, which manifests as painful vesicles that ulcerate [1]. - The lesions caused by HSV-2 are typically clustered, vesicular, and very painful, which is distinct from the hypertrophic, non-painful nature of condylomata lata [1]. *Hemophilus ducreyi* - *Hemophilus ducreyi* is the causative agent of **chancroid**, which presents as painful, soft ulcers with ragged, undermined borders, often accompanied by painful inguinal lymphadenopathy. - Chancroid lesions are typically destructive and highly painful, contrasting with the proliferative and less painful nature of condylomata lata. *Mixture of organisms* - While some sexually transmitted infections can involve coinfection, **condylomata lata** specifically point to a single etiological agent: *Treponema pallidum* [1]. - Attributing condylomata lata to a "mixture of organisms" is too vague and inaccurate given the specific morphology and strong association with syphilis [1].
Question 4: Which of the following is not a STD -
- A. Amoebiasis
- B. Herpes simplex type 1
- C. Scabies
- D. Hepatitis A (Correct Answer)
Explanation: ***Hepatitis A*** - **Hepatitis A** is primarily transmitted via the **fecal-oral route** through contaminated food or water, NOT through sexual contact. - While rare transmission can occur through oral-anal contact during sexual activity, it is **not classified as a sexually transmitted disease (STD)**. - Hepatitis A is a vaccine-preventable disease and is NOT included in standard STD classifications. *Amoebiasis* - **Amoebiasis**, caused by *Entamoeba histolytica*, is primarily a **gastrointestinal parasitic infection** transmitted through the **fecal-oral route** via contaminated food or water. - While it can occasionally be transmitted through oral-anal sexual contact (particularly in MSM populations), it is **not traditionally classified as an STD** in standard medical literature. - **NOTE**: This option is also debatable as "not an STD" and creates potential ambiguity in the question. *Herpes simplex type 1* - **Herpes simplex virus type 1 (HSV-1)** can cause both oral herpes (cold sores) and genital herpes through oral-genital sexual contact. - HSV-1 is increasingly recognized as a cause of **genital herpes** and is transmitted sexually, making it an **STD**. - While HSV-2 is the classic genital herpes virus, HSV-1 genital infections are becoming more common. *Scabies* - **Scabies** is a skin infestation caused by *Sarcoptes scabiei* mite, transmitted through **prolonged close physical contact**, including sexual contact. - It is **recognized as an STD** because sexual contact is a common mode of transmission in adults. - Scabies is highly contagious and easily spreads between sexual partners.
Question 5: A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?
- A. Azithromycin 1g orally as single dose
- B. Benzathine penicillin G 2.4 million units IM
- C. Acyclovir 400mg orally TID for 7-10 days (Correct Answer)
- D. Doxycycline 100mg orally BID for 14 days
Explanation: Acyclovir 400mg orally TID for 7-10 days - The patient's presentation with painful genital ulcers and vesicles, fever, malaise, and tender inguinal lymphadenopathy is highly suggestive of primary herpes simplex virus (HSV) infection [1]. - Acyclovir is an antiviral medication that effectively reduces the duration and severity of symptoms in primary HSV outbreaks [1]. Azithromycin 1g orally as single dose - Azithromycin is primarily used to treat bacterial infections, particularly chlamydia and gonorrhea, which typically present with urethritis or cervicitis, not painful vesicles. - It is ineffective against viral infections such as HSV. Benzathine penicillin G 2.4 million units IM - Benzathine penicillin G is the treatment of choice for syphilis, which causes a painless chancre in its primary stage, not painful vesicles. - This antibiotic has no efficacy against HSV. Doxycycline 100mg orally BID for 14 days - Doxycycline is an antibiotic used for various bacterial infections, including chlamydia, lymphogranuloma venereum, and granuloma inguinale [1]. - These conditions typically present with different clinical features (e.g., painless ulcers, buboes) and not the vesicular rash seen in HSV.
Question 6: Which of the following statements about herpes simplex virus (HSV) shedding is MOST accurate?
- A. HSV-1 sheds more frequently than HSV-2 in the genital tract
- B. Viral shedding occurs only during symptomatic episodes
- C. Antiviral suppression completely eliminates viral shedding
- D. Asymptomatic shedding accounts for most sexual transmission (Correct Answer)
Explanation: ***Asymptomatic shedding accounts for most sexual transmission*** - **Asymptomatic shedding** of HSV is very common and often goes unnoticed, leading to unsuspecting transmission to sexual partners. - Studies show that a significant proportion, often over 70%, of HSV acquisition occurs during contact with an infected partner who is **asymptomatically shedding** the virus. *HSV-1 sheds more frequently than HSV-2 in the genital tract* - While HSV-1 can cause genital herpes, **HSV-2 is the predominant cause of genital herpes** and typically sheds more frequently and for longer durations from the genital tract than HSV-1. - **Recurrent genital HSV-2 outbreaks** are also more common than recurrent genital HSV-1 outbreaks, reflecting the greater propensity for shedding. *Viral shedding occurs only during symptomatic episodes* - This statement is incorrect because **viral shedding frequently occurs in the absence of visible lesions or symptoms**, a phenomenon known as asymptomatic shedding. - Patients can shed the virus before the appearance of lesions (prodrome), during symptomatic periods, and often following resolution of symptoms or in completely **asymptomatic periods**. *Antiviral suppression completely eliminates viral shedding* - Antiviral medications like acyclovir, valacyclovir, and famciclovir can **significantly reduce the frequency and duration of HSV shedding**, both symptomatic and asymptomatic. - However, they do **not completely eliminate viral shedding**, meaning that transmission is still possible even with suppressive therapy.
Question 7: Which organism causes Granuloma inguinale (Donovanosis)?
- A. Klebsiella granulomatis (Correct Answer)
- B. Haemophilus ducreyi
- C. Chlamydia trachomatis L1-L3
- D. Treponema pallidum
Explanation: ***Klebsiella granulomatis*** - This bacterium, formerly known as *Calymmatobacterium granulomatis*, is the causative agent of **Granuloma inguinale**, also known as **Donovanosis**. - It leads to chronic, progressive ulcerative lesions in the genital and perineal areas, characterized by the presence of **Donovan bodies** within macrophages. *Haemophilus ducreyi* - This organism is responsible for **chancroid**, a sexually transmitted infection (STI) characterized by painful genital ulcers and suppurative regional lymphadenopathy. - Its clinical presentation differs significantly from the slowly progressive, painless ulcers of Donovanosis. *Chlamydia trachomatis L1-L3* - These serovars of *Chlamydia trachomatis* cause **Lymphogranuloma venereum (LGV)**, which typically presents with transient small genital lesions followed by significant regional lymphadenopathy, often referred to as buboes. - This is distinct from the extensive, destructive ulcerations seen in Donovanosis. *Treponema pallidum* - This spirochete is the causative agent of **syphilis**, a multi-stage STI. - Primary syphilis presents as a single, painless chancre, which is different from the chronic, beefy red, friable ulcers of Granuloma inguinale.
Question 8: Most common organism causing the pelvic inflammatory disease?
- A. Gardnerella Vaginalis
- B. Bacteroides
- C. Neisseria gonorrhoeae
- D. Chlamydia (Correct Answer)
Explanation: ***Chlamydia*** - **Chlamydia trachomatis** is the most common bacterial cause of **pelvic inflammatory disease (PID)**, often leading to subtle or asymptomatic infections [1]. - Untreated chlamydial infections can ascend from the lower genital tract, causing inflammation and scarring in the fallopian tubes and other pelvic organs [1]. *Gardnerella Vaginalis* - **Gardnerella vaginalis** is primarily associated with **bacterial vaginosis (BV)**, a common cause of vaginal discharge. - While BV can sometimes predispose to PID, *Gardnerella* itself is not considered a primary causative agent of ascending PID. *Bacteroides* - **Bacteroides species** are anaerobic bacteria that are part of the normal vaginal flora and can be found in some cases of PID, particularly in **tubo-ovarian abscesses** [1]. - However, they are typically considered secondary invaders or coinfecting organisms rather than the initial causative agent of PID. *Neisseria gonorrhoeae* - **Neisseria gonorrhoeae** is a common and significant cause of **pelvic inflammatory disease (PID)**, historically being the most recognized pathogen [1]. - While still prevalent and capable of causing severe PID, **Chlamydia trachomatis** has surpassed it in overall incidence as the leading cause of PID [1].
Question 9: A 31-year-old man presents with dysuria and urethral discharge. Gram stain shows intracellular gram-negative diplococci. Local resistance patterns show 28% quinolone resistance. Which of the following most appropriately guides empiric therapy selection?
- A. Patient preference
- B. Duration of therapy
- C. Local antimicrobial susceptibility patterns (Correct Answer)
- D. Route of administration
- E. Organism identification confirmation
Explanation: ***Local antimicrobial susceptibility patterns*** - Understanding local resistance patterns is crucial for selecting effective empiric therapy, especially with the high quinolone resistance (28%) mentioned. - **Empiric therapy** for suspected **gonorrhea** (suggested by intracellular gram-negative diplococci) must target common resistance mechanisms to ensure initial treatment success. *Patient preference* - While patient preferences can influence adherence, they do not guide the initial choice of antibiotic for a serious infection like gonorrhea, which requires an effective agent. - Clinical efficacy and public health considerations for preventing resistance take precedence over patient preference in selecting empiric therapy. *Duration of therapy* - The duration of therapy is determined *after* an effective antibiotic is chosen and is based on the specific infection and organism; it does not guide the initial selection of the drug itself. - Most gonorrhea treatments are single-dose, but this is a consequence of the chosen drug's efficacy rather than a guiding principle for selection. *Route of administration* - While practical for the patient, the route of administration (e.g., oral vs. intramuscular) is a secondary consideration after an effective agent is identified based on susceptibility. - Many empiric gonorrhea treatments include an intramuscular injection for single-dose efficacy, making route less of a primary guide for selection. *Organism identification confirmation* - Waiting for definitive organism identification and susceptibility testing would delay treatment and is inappropriate for symptomatic gonorrhea, which requires immediate empiric therapy. - The Gram stain already provides strong presumptive evidence, and empiric treatment must be initiated based on likely pathogens and local resistance patterns rather than waiting for culture confirmation.
Question 10: Which contraceptive method is most effective in preventing sexually transmitted infections?
- A. Male condoms (Correct Answer)
- B. Spermicides
- C. Hormonal contraceptives
- D. Intrauterine devices
Explanation: ***Male condoms*** - **Male condoms** are the most effective method available for preventing the transmission of **STIs**, including HIV, gonorrhea, chlamydia, and syphilis, when used correctly and consistently. - They act as a **physical barrier** that prevents the exchange of bodily fluids and skin-to-skin contact where infections might be present. *Spermicides* - **Spermicides** are chemical substances designed to kill sperm and prevent pregnancy, but they offer **no protection against STIs**. - In fact, some spermicides, especially those containing **nonoxynol-9**, can irritate genital tissues and may even increase the risk of STI transmission by causing micro-abrasions. *Hormonal contraceptives* - **Hormonal contraceptives** (e.g., birth control pills, patches, injections, vaginal rings) are highly effective at preventing pregnancy by inhibiting ovulation. - However, they offer **no protection against STIs** because they do not create a physical barrier to prevent the exchange of infectious bodily fluids or skin contact. *Intrauterine devices* - **Intrauterine devices (IUDs)** are T-shaped devices inserted into the uterus for long-term pregnancy prevention. They are highly effective for contraception. - Similar to hormonal contraceptives, IUDs provide **no protection against STIs**, as they do not block the transmission pathways for infections.
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