Venerology Practice Questions

Q: Rectal stricture is a common manifestation of which of the following conditions?

Lymphogranuloma inguinale. **Explanation:** **Lymphogranuloma inguinale** (also known as **Lymphogranuloma Venereum or LGV**) is caused by *Chlamydia trachomatis* serotypes L1, L2, and L3. The correct answer is B because rectal stricture is a classic late-stage complication of the **genito-anorectal syndrome** seen in LGV. In women and MSM (men who have sex with men), the infection can spread via lymphatic drainage to the perirectal and pelvic lymph nodes. This leads to chronic inflammation, proctocolitis, and lymphatic obstruction. Over time, the resulting fibrosis and scarring lead to the formation of **rectal strictures**, fistulae, and "esthiomene" (chronic hypertrophic ulceration of the external genitalia). **Analysis of Incorrect Options:** * **A. Syphilis:** Caused by *Treponema pallidum*. While it can cause proctitis in the secondary stage, it typically presents with a painless chancre (primary) or a generalized rash; it does not typically lead to fibrotic rectal strictures. * **C. Granuloma inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents with painless, beefy-red, highly vascular ulcers (pseudobuboes). It involves the skin and subcutaneous tissues rather than deep pelvic lymphatics. * **D. Chancroid:** Caused by *Haemophilus ducreyi*. It presents with painful, soft ulcers and painful inguinal lymphadenopathy (suppurative buboes), but it does not cause chronic rectal fibrosis. **NEET-PG High-Yield Pearls:** * **Groove Sign of Greenblatt:** Pathognomonic for LGV; it is the depression between inflamed inguinal and femoral lymph nodes separated by the inguinal ligament. * **Donovan Bodies:** Safety-pin appearance in macrophages, diagnostic for Granuloma inguinale. * **School of Fish appearance:** Characteristic Gram stain finding for Chancroid. * **Frei Test:** A historical skin test used for LGV diagnosis (now replaced by NAAT).

Q: What condition typically presents with multiple painful bleeding ulcers and inguinal bubo?

Chancroid. ### Explanation **Chancroid** is caused by the Gram-negative coccobacillus *Haemophilus ducreyi*. It is classically characterized by the "Four Ps": **P**ainful, **P**urulent, **P**olymicrobial (multiple), and **P**unch-out ulcers. These ulcers are soft and bleed easily upon manipulation (friable). A hallmark feature is the development of a painful, unilateral **inguinal bubo** (suppurative lymphadenopathy) which may rupture spontaneously [1]. **Analysis of Incorrect Options:** * **Chancre (Syphilis):** Caused by *Treponema pallidum*. It typically presents as a **painless**, single, indurated (hard) ulcer with clean base and painless lymphadenopathy. * **Granuloma Inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents as chronic, **painless**, beefy-red velvety ulcers that bleed on touch [1]. There is no true lymphadenopathy; instead, it causes "pseudobuboes" (granulomatous nodules). * **Lymphogranuloma Venereum (LGV):** Caused by *Chlamydia trachomatis* (L1-L3). The initial ulcer is small, **painless**, and transient (often missed) [1]. It is followed by painful inguinal lymphadenopathy with the characteristic "Groove sign." **Clinical Pearls for NEET-PG:** * **School of Fish Appearance:** Classic Gram stain finding for *H. ducreyi*. * **Railroad Track Appearance:** Another description for the parallel arrangement of *H. ducreyi*. * **Treatment of Choice:** Azithromycin (1g orally, single dose) or Ceftriaxone. * **Differential Tip:** If the ulcer is **P**ainful, think **H**erpes or **H**aemophilus (**P**ainful **H**oles). If **P**ainless, think Syphilis or Donovanosis.

Q: A young long-distance lorry driver presents with a painless penile ulcer 9 days after sexual intercourse with a professional sex worker. What is the likely diagnosis?

Chancre. The clinical presentation points toward **Primary Syphilis**, characterized by the **Chancre**. [1] ### 1. Why Chancre is the Correct Answer The diagnosis is based on three classic features described in the stem: * **Painless nature:** The hallmark of a syphilitic chancre is that it is typically painless, indurated (hard), and clean-based. * **Incubation Period:** The ulcer appeared 9 days after exposure. The incubation period for *Treponema pallidum* is typically 9–90 days (average 3 weeks), making 9 days a perfect fit. * **Risk Factors:** Long-distance lorry drivers are a classic high-risk group mentioned in NEET-PG vignettes for Sexually Transmitted Infections (STIs). ### 2. Why Other Options are Incorrect * **Herpes Genitalis:** Caused by HSV-2, these ulcers are characteristically **multiple, superficial, and very painful**. [1] They are preceded by vesicles. * **Chancroid:** Caused by *Haemophilus ducreyi*, these ulcers are **painful** ("Soft Chancre") with ragged edges and a necrotic base. * **Traumatic Ulcer:** These usually have an immediate onset following trauma and lack the specific induration of a chancre. ### 3. Clinical Pearls for NEET-PG * **Investigation of Choice:** The gold standard for a primary chancre is **Dark Ground Microscopy (DGM)** to visualize spirochetes. Serology (VDRL/RPR) may be negative in the first 1–2 weeks of the ulcer. * **Lymphadenopathy:** Syphilis presents with **painless, rubbery, non-suppurative** regional lymphadenopathy. In contrast, Chancroid presents with painful, suppurative "buboes." * **Treatment:** The drug of choice is **Benzathine Penicillin G** (2.4 million units IM single dose).

Q: What is the drug of choice for secondary syphilis in pregnant women?

Benzathine Penicillin. **Explanation:** **1. Why Benzathine Penicillin is Correct:** Benzathine Penicillin G (BPG) is the gold standard and the **only** recommended treatment for syphilis during pregnancy. It is highly effective at treating maternal infection and, crucially, it crosses the placenta to prevent or treat congenital syphilis in the fetus. For secondary syphilis (which falls under early syphilis), a single intramuscular dose of **2.4 million units** is the standard regimen. **2. Why the Other Options are Incorrect:** * **Doxycycline:** While used as an alternative in non-pregnant patients allergic to penicillin, it is **contraindicated in pregnancy** due to the risk of fetal tooth discoloration and bone growth inhibition (Tetracycline group). * **Ceftriaxone:** Although it has some anti-treponemal activity, it is not the first line. There is insufficient data regarding its efficacy in preventing congenital syphilis compared to penicillin. * **Cotrimoxazole:** This drug has no activity against *Treponema pallidum* and is used for conditions like UTI or PCP prophylaxis. **3. Clinical Pearls for NEET-PG:** * **Penicillin Allergy in Pregnancy:** If a pregnant woman with syphilis is allergic to penicillin, the mandatory next step is **Skin Testing and Desensitization**, followed by treatment with Benzathine Penicillin. No other drug is an acceptable substitute in pregnancy. * **Jarisch-Herxheimer Reaction:** Warn patients about this acute febrile reaction occurring within 24 hours of treatment. In pregnancy, it can trigger preterm labor or fetal distress, necessitating fetal monitoring. * **Staging:** Early syphilis (Primary, Secondary, Early Latent) requires **one dose** of BPG. Late Latent or syphilis of unknown duration requires **three doses** at weekly intervals [1].

Q: Condylomata lata are seen in which stage of syphilis?

Secondary syphilis. **Explanation:** **Condylomata lata** are highly infectious, moist, flat-topped, wart-like papules found in intertriginous areas (like the anogenital region or axilla) [1]. They are a hallmark clinical feature of **Secondary Syphilis** [1]. 1. **Why Secondary Syphilis is correct:** Secondary syphilis represents the hematogenous dissemination of *Treponema pallidum*. It typically occurs 4–10 weeks after the initial infection. This stage is characterized by systemic symptoms, generalized lymphadenopathy, and mucocutaneous lesions [1]. Condylomata lata develop due to the accumulation of treponemes in warm, moist skin folds, leading to local inflammatory hypertrophy [1]. 2. **Why other options are incorrect:** * **Primary Syphilis:** Characterized by the **chancre**, a painless, indurated ulcer at the site of inoculation [1]. * **Tertiary Syphilis:** Characterized by **gummas** (granulomatous lesions), cardiovascular syphilis (aortitis), and neurosyphilis (tabes dorsalis) [1]. * **Congenital Syphilis:** Presents with features like snuffles, Hutchinson’s teeth, Mulberry molars, and Sabre shin. While skin lesions occur, condylomata lata are specifically associated with the acquired secondary stage. **High-Yield Clinical Pearls for NEET-PG:** * **Condyloma Lata vs. Condyloma Acuminata:** Do not confuse them. Lata is seen in **Syphilis** (flat/broad); Acuminata is caused by **HPV 6 and 11** (pedunculated/cauliflower-like). * **Serology:** Secondary syphilis is the stage where non-treponemal tests (VDRL/RPR) reach their highest titers. * **Other Secondary features:** Maculopapular rash (involving palms and soles) [1],

Q: A 19-year-old male develops painless penile ulcers 9 days after sexual intercourse. What is the likely diagnosis?

Chancre. **Explanation:** The clinical presentation of a **painless penile ulcer** following an incubation period of approximately 9–90 days (average 3 weeks) is the classic hallmark of **Primary Syphilis**, where the lesion is termed a **Chancre**. **Why Chancre is correct:** A chancre is the primary lesion of syphilis caused by *Treponema pallidum*. Key diagnostic features include its **painless** nature, indurated (hard) base, clean floor, and associated non-tender, rubbery regional lymphadenopathy. An incubation period of 9 days fits within the typical window for syphilis. **Why other options are incorrect:** * **Chancroid:** Caused by *Haemophilus ducreyi*, these ulcers are characteristically **painful**, soft, and often have a ragged, undermined edge with a necrotic base ("You *do cry* with Ducreyi"). * **Herpes (Genitalis):** Caused by HSV-2, this typically presents as multiple, **painful**, superficial vesicles that rupture to form ulcers. They are often preceded by prodromal tingling. * **Traumatic ulcer:** These occur immediately after the insult (no 9-day incubation) and are usually painful with an irregular shape based on the mechanism of injury. **High-Yield NEET-PG Pearls:** * **Investigation of Choice:** Dark-ground microscopy (DGM) is the gold standard for early primary syphilis (chancre) to visualize motile spirochetes. * **Serology:** VDRL/RPR may be negative in the first 1–2 weeks of the chancre appearing (window period). * **Treatment:** Injection Benzathine Penicillin G (2.4 million units IM) is the first-line treatment. * **Painful vs. Painless:** Remember the mnemonic: **S**yphilis is **S**ilent (Painless); **C**hancroid is **C**utting (Painful).

Q: A 30-year-old sexually active pregnant female with a history of SLE has a positive VDRL test. What is the next best step?

Perform an FTA-ABS test.. ### Explanation **1. Why Option D is Correct:** The VDRL (Venereal Disease Research Laboratory) test is a **non-treponemal screening test** that detects non-specific antibodies (reagin) against cardiolipin. Because it is not specific to *Treponema pallidum*, it has a high rate of **Biological False Positives (BFP)**. In this clinical scenario, the patient has **Systemic Lupus Erythematosus (SLE)** and is **pregnant**—both are classic conditions known to cause BFP in VDRL tests [1]. Therefore, a positive screening result must always be confirmed with a **specific treponemal test**, such as the **FTA-ABS** (Fluorescent Treponemal Antibody Absorption) or TPHA, to differentiate true syphilis from a false positive. **2. Why Other Options are Incorrect:** * **Option A:** One cannot assume it is a false positive without confirmation. If the patient truly has syphilis, untreated infection can lead to devastating **congenital syphilis**. * **Option B:** Contact tracing is an essential public health step, but it is only initiated *after* a definitive diagnosis of syphilis is confirmed. * **Option C:** Treatment (usually Penicillin G) is indicated only after confirmation. Starting treatment based solely on a VDRL in an SLE patient is premature and may lead to unnecessary medical intervention. **3. NEET-PG Clinical Pearls:** * **BFP Causes (Mnemonic: STOP BFP):** **S**LE, **T**uberculosis, **O**ld age, **P**regnancy, **B**ertiary (IV) drug use, **F**ever (Malaria/Leprosy), **P**olyarteritis nodosa [1]. * **Screening vs. Confirmation:** Always use a non-treponemal test (VDRL/RPR) for screening and monitoring treatment response (titers fall), and a treponemal test (FTA-ABS/TPHA) for lifetime confirmation (remains positive for life) [1]. * **Pregnancy:** Syphilis screening is mandatory in the first trimester of all pregnancies. If confirmed, **Penicillin G** is the only recommended treatment to prevent vertical transmission.

Question 1

Rectal stricture is a common manifestation of which of the following conditions?

Accepted Answer

Lymphogranuloma inguinale

Answer

Syphilis

Answer

Granuloma inguinale

Answer

Chancroid

Question 2

What condition typically presents with multiple painful bleeding ulcers and inguinal bubo?

Accepted Answer

Chancroid

Answer

Chancre

Answer

Granuloma inguinale

Answer

Lymphogranuloma Venereum

Question 3

What is the recommended dose of benzathine penicillin for early syphilis?

Accepted Answer

2.4 million units intramuscularly as a single injection

Answer

3-4 million units intravenously

Answer

2.4 million units intramuscularly daily, plus probenecid 500 mg orally for 14 days

Answer

2.4 million units intramuscularly weekly for three doses

Question 4

A patient presenting with vaginal discharge, whose husband is a long-haul truck driver, attends a sexually transmitted disease clinic. What is the recommended empirical treatment?

Accepted Answer

Azithromycin + metronidazole + fluconazole

Answer

Azithromycin

Answer

Metronidazole + fluconazole

Answer

Fluconazole

Question 5

A young long-distance lorry driver presents with a painless penile ulcer 9 days after sexual intercourse with a professional sex worker. What is the likely diagnosis?

Accepted Answer

Chancre

Answer

Herpes Genitalis

Answer

Chancroid

Answer

Traumatic ulcer

Question 6

What is the drug of choice for secondary syphilis in pregnant women?

Accepted Answer

Benzathine Penicillin

Answer

Doxycycline

Answer

Ceftriaxone

Answer

Cotrimoxazole

Question 7

Condylomata lata are seen in which stage of syphilis?

Accepted Answer

Secondary syphilis

Answer

Congenital syphilis

Answer

Primary syphilis

Answer

Tertiary syphilis

Question 8

What is the dosage of benzyl penicillin in the treatment of primary syphilis?

Accepted Answer

2.4 MU single i.m.

Answer

1.2 MU single i.m.

Answer

1.2 MU single i.v.

Answer

4.8 MU single i.m.

Question 9

A 19-year-old male develops painless penile ulcers 9 days after sexual intercourse. What is the likely diagnosis?

Accepted Answer

Chancre

Answer

Chancroid

Answer

Herpes

Answer

Traumatic ulcer

Question 10

A 30-year-old sexually active pregnant female with a history of SLE has a positive VDRL test. What is the next best step?

Accepted Answer

Perform an FTA-ABS test.

Answer

Consider the VDRL positive as a biological false positive and take no further action.

Answer

Initiate contact tracing.

Answer

Treat the patient for syphilis.

Venerology — MCQs

Venerology — MCQs

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