Venerology Practice Questions

Q: A 28-year-old sexually active male presents with burning micturition. On clinical examination, there is no ulcer in the genitals. Urine examination shows 50 WBCs/HPF, no RBCs, leucocyte esterase positive, gonococcal culture negative. What could be the most probable causative organism

Chlamydia trachomatis. ***Chlamydia trachomatis*** - This patient presents with **urethritis symptoms** (burning micturition, numerous WBCs in urine, positive leukocyte esterase) but a **negative gonococcal culture**. This clinical picture is classic for **non-gonococcal urethritis**, with *Chlamydia trachomatis* being the most common cause [1]. - The absence of genital ulcers further supports a diagnosis of complicated urethritis rather than other STIs that typically cause ulcers. *Treponema pallidum* - *Treponema pallidum* is the causative agent of **syphilis**, which typically presents with **genital ulcers (chancres)** in its primary stage. - While it is a sexually transmitted infection, the patient's symptoms of burning micturition and WBCs in urine are not characteristic of primary syphilis. *Neisseria* - *Neisseria gonorrhoeae* causes **gonococcal urethritis**, which would present with similar symptoms of burning micturition and pyuria [1]. - However, the question states that the **gonococcal culture was negative**, effectively ruling out *Neisseria gonorrhoeae* as the causative agent. *Hemophilus ducreyi* - *Hemophilus ducreyi* is the bacterium responsible for **chancroid**, a sexually transmitted infection characterized by the formation of **painful genital ulcers**. - The patient's presentation does not include genital ulcers, making chancroid an unlikely diagnosis.

Q: Most common genital infection in HIV infected patient

Herpes. ***Herpes*** - **Herpes simplex virus (HSV)** infections, particularly HSV-2, are highly prevalent and often more severe and recurrent in HIV-infected individuals due to compromised immunity. - HIV coinfection can lead to atypical presentations of herpes, including chronic, non-healing ulcers and extensive mucocutaneous lesions. *Syphilis* - While syphilis is common among HIV-infected individuals, its prevalence is generally lower than that of herpes. - Syphilis often progresses more rapidly and can have more severe neurological complications in HIV-positive patients, but it is not the *most common* genital infection. *Chlamydia* - **Chlamydia trachomatis** infections are common sexually transmitted infections, but they typically present with less severe symptoms than herpes and are not generally cited as the *most common* genital infection in this population. - While Chlamydia can increase HIV transmission risk, it does not have the same increased severity or prevalence in HIV-infected patients as herpes. *Candida* - **Candida** infections (e.g., candidiasis) are very common in HIV-infected patients, especially oral and esophageal candidiasis, indicating a decline in immune function. - While genital candidiasis (vulvovaginal candidiasis or balanitis) can occur, it is generally considered an opportunistic infection rather than the *most common* primary sexually transmitted genital infection.

Q: Treatment of partner is required in all infection except:

Gardnerella. ***Gardnerella*** - **Gardnerella vaginalis** is a common inhabitant of the vaginal flora and its overgrowth causes **bacterial vaginosis**, which is not typically considered a sexually transmitted infection (STI) in the same way others are. - While it can be transmitted sexually, treating the male partner has not been shown to prevent recurrence in the female; therefore, routine **partner treatment is generally not recommended**. *Trichomonas* - **Trichomoniasis** is a sexually transmitted infection caused by the parasite **Trichomonas vaginalis**. [1] - **Partner treatment is essential** to prevent reinfection and interrupt the cycle of transmission, as asymptomatic infection is common. [1] *Herpes* - **Genital herpes** is caused by the **Herpes Simplex Virus (HSV)** and is highly transmissible sexually. [2] - While treatment often focuses on managing symptoms in the infected individual, open communication and potential treatment or counseling for partners are crucial to prevent transmission and manage outbreaks. *Candida* - **Candidiasis** (yeast infection) is typically caused by an overgrowth of **Candida albicans**, a fungus naturally present in the body. - While it is not strictly an STI, sexual activity can sometimes trigger or exacerbate symptoms, and in recurrent cases, treating a male partner might be considered, but **it's not routinely required** as it is for true STIs like trichomonas or chlamydia. [2]

Q: A 25 year old male presents to the clinic with a lesion on his penis. On examination he was noted to have a beefy red ulcer on the glans which bled when touched. Smear taken from the ulcer showed gram-negative intracytoplasmic cysts filled with deeply staining bodies that had a safety-pin appearance. What is he most likely suffering from?

Granuloma inguinale. **Granuloma inguinale** - The characteristic features of a **beefy red ulcer** that bleeds easily on touch, along with the presence of **Gram-negative intracytoplasmic cysts** (Donovan bodies) with deeply staining bodies described as having a **safety-pin appearance**, are pathognomonic for granuloma inguinale, caused by *Klebsiella granulomatis* (formerly *Calymmatobacterium granulomatis*) [1]. - This infection causes progressive, destructive lesions in the genital and perianal areas without significant regional lymphadenopathy, differentiating it from other causes of genital ulcers [1]. *Chancroid* - Caused by *Haemophilus ducreyi*, chancroid typically presents as **painful, soft chancres** with a ragged border and purulent base, often accompanied by **tender inguinal lymphadenopathy** (buboes) [1]. - Microscopic examination of chancroid smears would show **Gram-negative coccobacilli** in "school of fish" arrangements, not intracytoplasmic cysts with safety-pin morphology [1]. *Syphilis* - Primary syphilis manifests as a **painless chancre**, which is a firm, indurated ulcer with a clean base, and typically **does not bleed easily** on touch. - Diagnosis relies on direct visualization of **spirochetes** via darkfield microscopy or serological tests (VDRL, RPR, FTA-ABS), not the "safety-pin" forms seen in granuloma inguinale. *HSV infection* - Genital herpes simplex virus (HSV) infection typically causes **painful vesicles** that quickly rupture to form **superficial, tender ulcers** on an erythematous base, often with a prodromal tingling sensation [1]. - Microscopic findings in HSV infection (Tzanck smear) would show **multinucleated giant cells** and **intranuclear inclusions**, not the distinctive Donovan bodies of granuloma inguinale.

Q: Chancre redux is a clinical feature of

Early relapsing syphilis. ***Early relapsing syphilis*** - **Chancre redux** refers to the reappearance of a chancre-like lesion at the site of the original primary chancre during the **early relapsing phase of syphilis**. - This phenomenon indicates a **failure of treatment** or an **immune system response** that allows the *Treponema pallidum* bacteria to reactivate locally. *Recurrent herpes simplex infection* - Recurrent herpes simplex presents as **vesicular lesions** that evolve into ulcers, typically not referred to as chancre redux [1]. - Herpes lesions are characterized by **painful grouped vesicles** on an erythematous base [1]. *Chancroid* - Chancroid is characterized by **painful, soft chancres** caused by *Haemophilus ducreyi*, which are distinct from the indurated chancre of syphilis. - While it can recur, its recurrence is not termed chancre redux and it is not a treponemal infection. *Late syphilis* - **Late syphilis** is characterized by conditions such as **gummas, cardiovascular syphilis, or neurosyphilis**, not by a recurrence of the primary chancre. - The primary chancre is a feature of **primary syphilis**, and its recurrence suggests an issue during the early stages of disease progression or treatment.

Q: A young female with asymptomatic macules and papules over trunk and reddish patch over palate with a flat, moist lesion on vulva. Patient has generalized lymphadenopathy. What is the line of management?

Benzathine penicillin. ***Benzathine penicillin*** - This clinical presentation, including **asymptomatic macules and papules** on the trunk, a **reddish palatal patch**, a **flat, moist vulval lesion (condyloma lata)**, and **generalized lymphadenopathy**, is highly suggestive of **secondary syphilis** [1]. - **Benzathine penicillin G** is the *drug of choice* for treating all stages of syphilis, particularly effective for early syphilis like this manifestation. *Fluconazole* - **Fluconazole** is an **antifungal medication** primarily used to treat *candidiasis* and other fungal infections [1]. - The symptoms described are *not characteristic* of a fungal infection. *Ceftriaxone* - **Ceftriaxone** is a *beta-lactam antibiotic* used to treat a wide range of bacterial infections, especially *gonorrhea*, *meningitis*, and *respiratory tract infections*. - While a potent antibiotic, it is *not the primary treatment* for syphilis, which requires penicillin. *Acyclovir* - **Acyclovir** is an *antiviral drug* used to treat *herpes simplex virus* infections (e.g., genital herpes, cold sores) and *varicella-zoster virus* [1]. - The lesions described, particularly the *flat, moist condyloma lata* and *generalized maculopapular rash*, are *not typical manifestations of herpes* [1].

Q: A patient presents with painful genital ulcers and vesicles. Which of the following findings best differentiates HSV-1 from HSV-2 infection?

Rate of recurrence. ***Rate of recurrence*** - **HSV-2** infections typically have a **higher rate and greater frequency of recurrence** compared to HSV-1 genital infections. - This difference in recurrence patterns is a key clinical indicator for differentiating between the two types. *Severity of symptoms* - While initial HSV-2 outbreaks are often more severe than HSV-1, the **severity can vary greatly** between individuals and is not a definitive differentiating factor. - Both types can cause mild or severe symptoms depending on host factors and viral load. *Appearance of lesions* - The **lesions of both HSV-1 and HSV-2 are clinically indistinguishable**, typically presenting as painful vesicles that ulcerate. - Microscopic examination or visual inspection alone cannot reliably differentiate the viral types. *None of the above* - The rate of recurrence is a significant differentiating factor, making this option incorrect. - While other factors might contribute to a diagnosis, recurrence frequency provides a stronger clinical clue.

Q: Which of the following statements about non-gonococcal urethritis is INCORRECT?

Trichomonas vaginalis never causes urethritis in males. ***Trichomonas vaginalis never causes urethritis in males*** - This statement is incorrect because **Trichomonas vaginalis** can indeed cause **urethritis** in males, though it is often asymptomatic [1]. - While more commonly associated with vaginitis in women, it can lead to symptoms like dysuria and urethral discharge in men. *Mycoplasma genitalium requires extended azithromycin therapy* - This statement is generally correct, as **Mycoplasma genitalium** is known for developing **macrolide resistance**, often necessitating extended or alternative antibiotic regimens. - Standard single-dose azithromycin regimens are often insufficient, and longer courses (e.g., 5-day azithromycin) or moxifloxacin may be required. *Chlamydia trachomatis is the most common cause* - This is a correct statement, as **Chlamydia trachomatis** is the most frequently identified pathogen responsible for **non-gonococcal urethritis (NGU)** [1]. - It accounts for a significant proportion of NGU cases, making it a primary target for screening and treatment. *Incubation period is typically longer than gonococcal urethritis* - This statement is also correct; the **incubation period for NGU** (often caused by Chlamydia) is generally **7-14 days**, which is longer than that for gonococcal urethritis (2-7 days) [1]. - This difference can be a clue in clinical diagnosis, though definitive diagnosis relies on specific testing [2].

Q: A 20-year-old presents with painful inguinal lymphadenopathy and genital ulcer. Gram stain shows streptobacilli in 'school of fish' arrangement. Most likely diagnosis is:

Chancroid. Chancroid - The combination of **painful inguinal lymphadenopathy** and a **painful genital ulcer** is highly suggestive of chancroid [1]. - The Gram stain finding of **streptobacilli** arranged in a "**school of fish**" pattern is a classic diagnostic feature of *Haemophilus ducreyi*, the causative agent of chancroid. *Primary syphilis* - Primary syphilis presents with a **painless chancre** and typically **painless lymphadenopathy** [1]. - Gram stain would show **spirochetes**, not streptobacilli, and requires darkfield microscopy for visualization. *Lymphogranuloma venereum* - Caused by *Chlamydia trachomatis* serovars L1, L2, or L3, which would not be visible on a Gram stain as streptobacilli. - Presents initially with a **transient, often unnoticed, painless lesion**, followed by **painful, often suppurative, inguinal lymphadenopathy** (buboes). *Donovanosis* - Characterized by **painless, progressive ulcerative lesions** that bleed easily, often without significant regional lymphadenopathy. - Diagnosis involves identifying **Donovan bodies** (intracellular Gram-negative bacteria) within macrophages, which are different from streptobacilli in a "school of fish" arrangement.

Q: The groove sign is most commonly associated with which condition?

Lymphogranuloma venereum (LGV). ***Lymphogranuloma venereum (LGV)*** - The **groove sign** is a classic clinical finding in LGV, particularly in the inguinal region, characterized by a visible and palpable furrow separating swollen lymph nodes above and below the inguinal ligament. - This sign is due to the involvement of both superficial and deep inguinal lymphatics, leading to marked **lymphadenopathy** that is compartmentalized by the inguinal ligament. *Syphilis* - Syphilis is typically associated with a **chancre** (painless ulcer) in primary syphilis, and a widespread rash in secondary syphilis, but not the groove sign. - Lymphadenopathy in syphilis is usually generalized and less prominent or compartmentalized compared to LGV. *Dermatomyositis* - Dermatomyositis is an **inflammatory myopathy** characterized by muscle weakness and distinctive skin rashes, such as Gottron's papules and a heliotrope rash. - It does not involve significant lymphadenopathy or the specific anatomical signs like the groove sign. *Systemic lupus erythematosus* - Systemic lupus erythematosus is a **chronic autoimmune connective tissue disease** with diverse manifestations affecting multiple organ systems. - While it can cause lymphadenopathy, it does not produce the characteristic compartmentalized swelling known as the groove sign.

Question 1

A 28-year-old sexually active male presents with burning micturition. On clinical examination, there is no ulcer in the genitals. Urine examination shows 50 WBCs/HPF, no RBCs, leucocyte esterase positive, gonococcal culture negative. What could be the most probable causative organism

Accepted Answer

Chlamydia trachomatis

Answer

Treponema pallidum

Answer

Neisseria

Answer

Hemophilus ducreyi

Question 2

Most common genital infection in HIV infected patient

Accepted Answer

Herpes

Answer

Syphilis

Answer

Chlamydia

Answer

Candida

Question 3

Treatment of partner is required in all infection except:

Accepted Answer

Gardnerella

Answer

Trichomonas

Answer

Herpes

Answer

Candida

Question 4

A 25 year old male presents to the clinic with a lesion on his penis. On examination he was noted to have a beefy red ulcer on the glans which bled when touched. Smear taken from the ulcer showed gram-negative intracytoplasmic cysts filled with deeply staining bodies that had a safety-pin appearance. What is he most likely suffering from?

Accepted Answer

Granuloma inguinale

Answer

Chancroid

Answer

Syphilis

Answer

HSV infection

Question 5

Chancre redux is a clinical feature of

Accepted Answer

Early relapsing syphilis

Answer

Recurrent herpes simplex infection

Answer

Chancroid

Answer

Late syphilis

Question 6

A young female with asymptomatic macules and papules over trunk and reddish patch over palate with a flat, moist lesion on vulva. Patient has generalized lymphadenopathy. What is the line of management?

Accepted Answer

Benzathine penicillin

Answer

Fluconazole

Answer

Ceftriaxone

Answer

Acyclovir

Question 7

A patient presents with painful genital ulcers and vesicles. Which of the following findings best differentiates HSV-1 from HSV-2 infection?

Accepted Answer

Rate of recurrence

Answer

Severity of symptoms

Answer

Appearance of lesions

Answer

None of the above

Question 8

Which of the following statements about non-gonococcal urethritis is INCORRECT?

Accepted Answer

Trichomonas vaginalis never causes urethritis in males

Answer

Mycoplasma genitalium requires extended azithromycin therapy

Answer

Chlamydia trachomatis is the most common cause

Answer

Incubation period is typically longer than gonococcal urethritis

Question 9

A 20-year-old presents with painful inguinal lymphadenopathy and genital ulcer. Gram stain shows streptobacilli in 'school of fish' arrangement. Most likely diagnosis is:

Accepted Answer

Chancroid

Answer

Primary syphilis

Answer

Lymphogranuloma venereum

Answer

Donovanosis

Question 10

The groove sign is most commonly associated with which condition?

Accepted Answer

Lymphogranuloma venereum (LGV)

Answer

Syphilis

Answer

Dermatomyositis

Answer

Systemic lupus erythematosus

Venerology — MCQs

Venerology — MCQs

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