Venerology Practice Questions

Q: A 32-year-old HIV-positive man (CD4 count 320/μL) presents with painless perianal ulcer for 3 weeks. Dark field microscopy shows spirochetes. What is the appropriate treatment?

Benzathine penicillin G 2.4 million units IM single dose. ***Benzathine penicillin G 2.4 million units IM single dose*** - The presence of a painless perianal ulcer and **spirochetes on dark field microscopy** is highly suggestive of **primary syphilis**. - For primary syphilis, the recommended treatment is a **single intramuscular dose of benzathine penicillin G 2.4 million units**, regardless of HIV status unless there's evidence of neurosyphilis. *Benzathine penicillin G 2.4 million units IM weekly for 3 weeks* - This regimen is typically reserved for **late latent syphilis** or syphilis of unknown duration. - It is not indicated for primary syphilis, which can be cured with a single dose. *Azithromycin 2g orally single dose* - **Azithromycin** is a potential alternative for syphilis in some cases, particularly for penicillin-allergic patients, but it is not the first-line treatment due to increasing rates of macrolide resistance. - The recommended dosage for early syphilis (including primary) is typically **2g orally as a single dose**, but penicillin remains superior. *Doxycycline 100mg orally twice daily for 14 days* - **Doxycycline** is an alternative treatment for early syphilis (primary, secondary, or early latent) in **penicillin-allergic patients**. - The standard duration for early syphilis is **14 days**, but it is not the preferred treatment for patients without penicillin allergy.

Q: A 40-year-old man with a history of untreated syphilis presents with ataxia, diminished deep tendon reflexes, and impaired vibratory and position sense. He was recently diagnosed with HIV (CD4 count 450/μL). VDRL is 1:8, and TPHA is positive. CSF shows pleocytosis, elevated protein, and positive VDRL. Which form of neurosyphilis is most likely?

Tabes dorsalis. ***Tabes dorsalis*** - This condition is characterized by **demyelination of the dorsal columns** and dorsal roots, leading to **ataxia**, **diminished deep tendon reflexes**, and impairment of **vibratory and position sense.** - These symptoms are classic for tabes dorsalis and are consistent with long-term, untreated syphilis. *Syphilitic meningitis* - This form typically presents with **meningeal signs** like headache, neck stiffness, and cranial neuropathies, which are not the primary symptoms described. - While present, the CSF findings are more broadly indicative of neurosyphilis rather than specifically localizing to meningitis as the dominant clinical picture. *General paresis* - This condition primarily affects the **cerebral cortex** and presents with symptoms of dementia, personality changes, and psychiatric disturbances. - The patient's symptoms are more focused on sensory and motor deficits rather than cognitive decline. *Meningovascular syphilis* - This involves inflammation of blood vessels in the brain or spinal cord, leading to **strokes** or transient ischemic attacks. - While a possibility with neurosyphilis, the patient's presentation of ataxia and sensory deficits [1] is less typical of a vascular event.

Q: Which statement about the CDC recommendation for gonorrhea treatment is MOST accurate?

Monotherapy with high-dose ceftriaxone is now preferred. ***Monotherapy with high-dose ceftriaxone is now preferred*** - The CDC recently updated its recommendations, endorsing **monotherapy with a single, higher dose of ceftriaxone (500 mg IM)** for uncomplicated gonococcal infections in adults [1]. - This change reflects concerns about rising **antimicrobial resistance** and simplifies treatment strategies [1]. *Spectinomycin is the recommended alternative for cephalosporin allergy* - While spectinomycin *was* an alternative in some regions, it is **not available in the United States**, rendering it impractical for current CDC recommendations. - For patients with **cephalosporin allergy**, alternative regimens such as gentamicin plus azithromycin or azithromycin monotherapy (if susceptibility can be confirmed) are considered. *Fluoroquinolones remain first-line for uncomplicated infection* - **Fluoroquinolones are no longer recommended** for gonorrhea treatment due to widespread resistance; this recommendation was withdrawn in 2007. - The CDC specifically advises against the use of **ciprofloxacin, ofloxacin, or levofloxacin** for gonorrhea [1]. *Dual therapy with ceftriaxone plus azithromycin is recommended* - **Dual therapy with ceftriaxone and azithromycin** was recommended in the past to prevent the development of resistance. - However, due to concerns about **azithromycin resistance** and data showing the efficacy of higher-dose ceftriaxone monotherapy, the CDC has revised its guidelines [1].

Question 1

A 43-year-old businessman presents with a purulent penile discharge, reporting unprotected sexual contact one week prior. Gram stain of the discharge does not show any organisms. What is the most likely cause of the discharge?

Accepted Answer

Chlamydia trachomatis

Answer

Bowen disease

Answer

Herpes simplex virus

Answer

Treponema pallidum

Question 2

A patient presents with a painless penile ulcer of 2 weeks duration. A VDRL test is reactive at a dilution of 1:4. The patient also reports a recent diagnosis of hepatitis A. Which one of the following actions would be most appropriate?

Accepted Answer

Order a confirmatory test such as FTA-ABS test

Answer

Order a rapid plasma reagin (RPR) test

Answer

Perform a spinal tap to rule out neurosyphilis

Answer

Repeat the VDRL test

Question 3

Which of the following drugs are included in the 'Green STD kit'?

Accepted Answer

Secnidazole, Fluconazole

Answer

Azithromycin, Cefixime

Answer

Acyclovir

Answer

Azithromycin, Doxycycline

Question 4

Non-gonococcal urethritis is caused by which of the following?

Accepted Answer

Chlamydia

Answer

Lymphogranuloma venereum (LGV)

Answer

Syphilis

Answer

Gardnella vaginalis

Question 5

A patient presents with mental confusion, visual and auditory hallucinations, perceived changes of body shape, swelling of the tongue, and a fear of impending death after being treated for primary chancre of syphilis with an intramuscular injection. What is the likely diagnosis?

Accepted Answer

Hoigne Syndrome

Answer

Jarisch-Herxheimer Reaction

Answer

Undiagnosed Psychosis

Answer

Schizophrenia

Question 6

A 25-year-old man presents with penile ulcers for 10 days. Initial VDRL and dark field microscopy are negative. Two weeks later, repeat VDRL is 1:32. What is the most appropriate interpretation?

Accepted Answer

The initial presentation was in early primary syphilis before seroconversion

Answer

The second test is a false positive due to cross-reactivity

Answer

The first test was a false negative due to lab error

Answer

The patient acquired syphilis between the two tests

Question 7

A 32-year-old HIV-positive man (CD4 count 320/μL) presents with painless perianal ulcer for 3 weeks. Dark field microscopy shows spirochetes. What is the appropriate treatment?

Accepted Answer

Benzathine penicillin G 2.4 million units IM single dose

Answer

Benzathine penicillin G 2.4 million units IM weekly for 3 weeks

Answer

Azithromycin 2g orally single dose

Answer

Doxycycline 100mg orally twice daily for 14 days

Question 8

What is the underlying pathophysiology of post-gonococcal urethritis?

Accepted Answer

Concurrent chlamydial infection unaffected by gonococcal treatment

Answer

Development of antibiotic resistance

Answer

Immunological reaction to gonococcal antigens

Answer

Incomplete treatment of gonorrhea

Question 9

A 40-year-old man with a history of untreated syphilis presents with ataxia, diminished deep tendon reflexes, and impaired vibratory and position sense. He was recently diagnosed with HIV (CD4 count 450/μL). VDRL is 1:8, and TPHA is positive. CSF shows pleocytosis, elevated protein, and positive VDRL. Which form of neurosyphilis is most likely?

Accepted Answer

Tabes dorsalis

Answer

Syphilitic meningitis

Answer

General paresis

Answer

Meningovascular syphilis

Question 10

Which statement about the CDC recommendation for gonorrhea treatment is MOST accurate?

Accepted Answer

Monotherapy with high-dose ceftriaxone is now preferred

Answer

Spectinomycin is the recommended alternative for cephalosporin allergy

Answer

Fluoroquinolones remain first-line for uncomplicated infection

Answer

Dual therapy with ceftriaxone plus azithromycin is recommended

Venerology — MCQs

Venerology — MCQs

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