Sexually Transmitted Diseases (Syphilis, Gonorrhea, Genital Ulcers) MCQs

Dermatology · 38 free questions with answers & explanations.

1. A 25-year-old man presents with a painless ulcer on the glans penis with indurated margins for 3 weeks. Inguinal lymph nodes are enlarged but non-tender. Dark field microscopy of the serous discharge shows motile spirochetes. What is this primary lesion called?
2. A 22-year-old woman presents with multiple small, painful genital ulcers with soft, ragged, undermined edges and a necrotic grey base. Inguinal lymphadenopathy is tender and fluctuant (bubo). Culture on chocolate agar with vancomycin shows gram-negative coccobacilli. What is the causative organism?
3. A 30-year-old man presents with painless progressive ulceration of the genitalia with beefy-red granulation tissue and no lymphadenopathy. Tissue smear shows large mononuclear cells containing intracytoplasmic cyst-like bodies. What are these called?
4. A patient with secondary syphilis presents with highly infectious, moist, flat, raised warty growths in the perianal region and moist intertriginous areas. RPR is 1:64. What are these lesions called?
5. A 28-year-old man presents with a painless inguinal swelling that is matted, multilocular, and discharges through multiple sinuses. He had a small transient genital papule 3 weeks ago. Frei test was historically used for this condition. What is the etiological agent?
6. A 28-year-old man presents with a painless indurated genital ulcer. Dark-field microscopy of the serous exudate shows corkscrew-shaped organisms with characteristic motility. The RPR test is positive. Secondary syphilis manifests approximately how long after the primary chancre?
7. A 25-year-old man presents with painless, progressive, non-tender inguinal lymphadenopathy with a bubonic swelling that has developed a groove sign. The most likely diagnosis and causative organism are:
8. Donovanosis (granuloma inguinale) is characterized histologically by which pathognomonic finding?
9. A 30-year-old woman is diagnosed with secondary syphilis. She is allergic to penicillin. What is the recommended alternative treatment?
10. Neisseria gonorrhoeae can disseminate hematogenously. The most common manifestation of disseminated gonococcal infection (DGI) is:
11. A sex worker presents with a painless clean-based genital ulcer with indurated margins and a firm rubbery inguinal lymph node. Dark-field microscopy confirms spirochetes. Which serological test becomes positive EARLIEST in primary syphilis?
12. A patient with secondary syphilis develops condylomata lata in the perianal region. Histopathology of the lesion reveals which characteristic vascular finding?
13. A 25-year-old man presents with painful genital ulcers with ragged undermined edges, a purulent base, and painful inguinal lymphadenopathy (bubo). Culture on chocolate agar with vancomycin yields Gram-negative coccobacilli. What is the FIRST-LINE treatment currently recommended?
14. A 30-year-old HIV-positive man presents with painless inguinal swelling. Aspiration reveals 'sulcus sign' — groove sign above and below Poupart's ligament. Which serological test confirms the causative agent?
15. Donovanosis (granuloma inguinale) is caused by Klebsiella granulomatis. The diagnostic finding on tissue smear stained with Giemsa is:
16. A 28-year-old man presents with a painless indurated ulcer on the glans penis for 2 weeks. Dark-field microscopy is negative. VDRL is non-reactive. FTA-ABS (IgM) is positive. The most likely interpretation is:
17. A patient is diagnosed with secondary syphilis. During treatment with benzathine penicillin, he develops fever, rigors, hypotension, and worsening rash within 4 hours. The mechanism of this reaction is:
18. A 25-year-old woman presents with painless unilateral inguinal lymphadenopathy that becomes fluctuant (bubo). She reports a healed painless genital ulcer 3 weeks ago. LGV complement fixation titre is 1:64. The responsible Chlamydia trachomatis serovars are:
19. Donovanosis (granuloma inguinale) is caused by Klebsiella granulomatis. The characteristic histopathological finding is:
20. Chancroid is caused by Haemophilus ducreyi. Which culture medium is used for isolation, and what is the characteristic colonial morphology?
21. A 28-year-old man presents with a painless genital ulcer with indurated edges and clean base. Dark-ground illumination (DGI) of the ulcer exudate shows motile spiral organisms. Which stage and causative organism is most consistent?
22. A patient presents with painless groins swelling. Examination reveals matted inguinal lymph nodes with 'groove sign' (groove between inguinal and femoral groups of nodes). The most likely diagnosis and responsible organism are:
23. Histopathological examination of a biopsy from a progressive granulomatous ulcer involving the genitalia and perineum of a 40-year-old man shows large mononuclear cells with intracytoplasmic clusters of bacteria. These clusters within phagolysosomes are called:
24. A 30-year-old man treated for primary syphilis 3 weeks ago now develops a generalized maculopapular rash involving the palms and soles, mucous patches on the tongue, and condylomata lata in the perineum. His VDRL titre is 1:64. The treatment of choice is:
25. A newborn presents at 2 weeks of age with rhinitis, hepatosplenomegaly, and skin fissures at the angles of the mouth. X-ray shows periostitis of long bones. VDRL of the mother was reactive at 1:128. The pathognomonic radiological finding in congenital syphilis is:
26. Jarisch-Herxheimer reaction occurs after treating syphilis. The mechanism is:
27. Jarisch-Herxheimer reaction occurring after penicillin treatment of early syphilis is mediated by:
28. A 25-year-old man presents with a painful genital ulcer with undermined edges, a necrotic base, and associated tender inguinal lymphadenopathy ('bubo'). Gram stain of the ulcer exudate shows gram-negative bacilli in a 'school of fish' or 'railroad track' arrangement. What is the diagnosis and treatment of choice?
29. A patient with secondary syphilis has a positive RPR titre of 1:64. After appropriate treatment with benzathine penicillin 2.4 MU IM, what RPR titre response at 6 months would be considered an adequate treatment response?
30. Donovanosis (granuloma inguinale) is caused by Klebsiella granulomatis. The diagnostic cell seen on Giemsa-stained tissue smear is:
31. A 28-year-old man presents with a painless indurated ulcer at the coronal sulcus for 10 days. He has bilateral, non-tender, rubbery inguinal lymphadenopathy. Dark-field microscopy of serum from the lesion base shows motile spirochetes. VDRL is reactive (1:8). Which histopathological feature is most characteristic of primary syphilitic chancre?
32. A woman presents with multiple, deep, painful, punched-out ulcers with undermined edges on the labia. Culture on chocolate agar shows small, Gram-negative coccobacilli. Which organism is responsible and what is the drug of choice as per current Indian guidelines?
33. A 30-year-old man presents with a painless genital ulcer and large unilateral inguinal lymphadenopathy with groove sign. Frei test is positive. The causative organism type (serovars) is:
34. Donovanosis (granuloma inguinale) is caused by Klebsiella granulomatis. The diagnostic tissue finding on Giemsa-stained smear of crush preparation is:
35. Secondary syphilis classically involves the palms and soles. Which additional feature, if present along with a maculopapular rash involving palms/soles and condylomata lata, is most diagnostic of secondary syphilis?
36. A 28-year-old man presents with a painless indurated genital ulcer for 3 weeks. VDRL is reactive (titre 1:32), TPHA is positive, and FTA-ABS is positive. He had a penicillin allergy (anaphylaxis) in childhood. The best treatment alternative for primary syphilis is:
37. A man presents with a tender unilateral inguinal mass with overlying erythema. The mass fluctuates and the overlying skin shows a groove sign (groove between two groups of nodes separated by Poupart's ligament). He has no genital ulcer currently. The diagnosis and causative organism are:
38. A pregnant woman in the third trimester is diagnosed with latent syphilis of unknown duration. She gives a history of anaphylaxis to penicillin. The correct management is: