A 32-year-old labourer from coastal Andhra Pradesh has had a slowly enlarging painless ulcer on the penile shaft for 2 months. It is beefy red, raised and granular, with rolled edges, and bleeds readily on touch. A soft subcutaneous swelling in the groin overlies normal-sized nodes. A crush smear stained with Giemsa shows macrophages with intracytoplasmic bipolar-stained bodies. What is the most appropriate treatment?

Azithromycin weekly until healed, at least 3 weeks

Acyclovir 400 mg three times daily for 7 days

Benzathine penicillin G 2.4 MU IM single dose

Ceftriaxone 250 mg IM as a single dose

A 27-year-old woman with systemic lupus erythematosus, at 10 weeks of her first pregnancy, has antenatal screening at a medical college. VDRL is reactive at 1:2; repeated, it is again reactive at 1:2. TPHA is non-reactive. She has no genital lesions or rash, and her husband's VDRL and TPHA are non-reactive. What is the most appropriate interpretation?

Biological false positive; no syphilis treatment

Prozone reaction; repeat VDRL on diluted serum

Late latent syphilis; three weekly injections

Early latent syphilis; benzathine penicillin now

Sexually transmitted infections and syndromic management

15 NEET-PG practice questions on Sexually transmitted infections and syndromic management, part of Dermatology. The first 15 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
On a ward round, four statements are made about acquired syphilis: 1. Condylomata lata are a feature of secondary syphilis. 2. The primary chancre is usually painful and soft. 3. Argyll Robertson pupils occur in neurosyphilis. 4. Gummas are a feature of the secondary stage. Which statements are correct?
1. A2 and 3 only
2. B1, 3 and 4 only
3. C1, 2, 3 and 4
4. D1 and 3 only
Show answerHide answer
Answer: D · 1 and 3 only
Statements 1 and 3 are correct. Condylomata lata, moist flat papules in warm folds teeming with treponemes, are lesions of secondary syphilis, and Argyll Robertson pupils (small, irregular, reacting to accommodation but not to light) are a sign of neurosyphilis, especially tabes dorsalis. The primary chancre is typically painless and indurated, not soft and painful as in chancroid. Gummas are granulomatous lesions of late (tertiary) syphilis.
- A: The chancre is painless and indurated; a painful soft ulcer suggests chancroid.
- B: Gummas belong to tertiary, not secondary, syphilis.
- C: Statements 2 and 4 are false.
Question 2 · Medium
A 31-year-old migrant worker in Surat had a small painless genital papule 3 weeks ago that healed in a few days. He now has fever and a painful matted mass of inguinal nodes on the left, with a groove where the inguinal ligament crosses it and violaceous skin over it. What is the most likely diagnosis?
1. ALymphogranuloma venereum
2. BGenital herpes
3. CChancroid
4. DDonovanosis
Show answerHide answer
Answer: A · Lymphogranuloma venereum
A transient, painless primary lesion followed weeks later by painful inguinal lymphadenitis is lymphogranuloma venereum, caused by Chlamydia trachomatis serovars L1-L3. Enlarged femoral and inguinal nodes on either side of the inguinal ligament produce the 'groove sign'. Treatment is doxycycline 100 mg twice daily for 21 days, and fluctuant nodes are aspirated rather than incised. Untreated disease can lead to genital elephantiasis (esthiomene) and rectal strictures.
- B: Genital herpes gives painful grouped vesicles with tender, non-suppurating nodes.
- C: Chancroid has a persisting painful ulcer at the same time as the bubo.
- D: Donovanosis gives a beefy red ulcer and pseudobubo, not true lymphadenitis.
Question 3 · Hard
A 32-year-old labourer from coastal Andhra Pradesh has had a slowly enlarging painless ulcer on the penile shaft for 2 months. It is beefy red, raised and granular, with rolled edges, and bleeds readily on touch. A soft subcutaneous swelling in the groin overlies normal-sized nodes. A crush smear stained with Giemsa shows macrophages with intracytoplasmic bipolar-stained bodies. What is the most appropriate treatment?
1. AAcyclovir 400 mg three times daily for 7 days
2. BAzithromycin weekly until healed, at least 3 weeks
3. CBenzathine penicillin G 2.4 MU IM single dose
4. DCeftriaxone 250 mg IM as a single dose
Show answerHide answer
Answer: B · Azithromycin weekly until healed, at least 3 weeks
A painless, beefy red, friable granulating ulcer with a subcutaneous granuloma in the groin (pseudobubo) and safety-pin Donovan bodies inside macrophages is donovanosis (granuloma inguinale), caused by Klebsiella granulomatis. Treatment is azithromycin 1 g weekly (or 500 mg daily), or doxycycline, for at least 3 weeks and until the lesions have healed completely. Short courses lead to relapse, and long-standing disease causes genital deformity and, rarely, squamous carcinoma.
- A: Acyclovir treats herpes, which gives painful grouped vesicles, not a granulating ulcer.
- C: Penicillin treats syphilis, whose chancre is clean, indurated and does not bleed easily.
- D: Single-dose ceftriaxone treats chancroid, which gives painful soft ulcers and a true bubo.
Question 4 · Easy
A 24-year-old man in Pune has had painless, soft, skin-coloured cauliflower-like growths on the coronal sulcus and inner prepuce for 2 months. They turn white when 5% acetic acid is applied. Which human papillomavirus types cause most such lesions?
1. AHPV 1 and 2
2. BHPV 6 and 11
3. CHPV 31 and 33
4. DHPV 16 and 18
Show answerHide answer
Answer: B · HPV 6 and 11
Soft, cauliflower-like papules on the genitals are condylomata acuminata (anogenital warts). About 90% are caused by the low-risk types HPV 6 and 11, which rarely lead to cancer. Treatment options include podophyllotoxin, imiquimod, cryotherapy and electrocautery; podophyllin is avoided in pregnancy. Quadrivalent HPV vaccines, such as Cervavac made in India, protect against types 6 and 11 as well as 16 and 18.
- A: HPV 1 and 2 cause plantar and common skin warts.
- C: HPV 31 and 33 are high-risk oncogenic types, not the usual cause of genital warts.
- D: HPV 16 and 18 are high-risk types that cause most cervical and anal cancers, not most warts.
Question 5 · Hard
A 27-year-old woman with systemic lupus erythematosus, at 10 weeks of her first pregnancy, has antenatal screening at a medical college. VDRL is reactive at 1:2; repeated, it is again reactive at 1:2. TPHA is non-reactive. She has no genital lesions or rash, and her husband's VDRL and TPHA are non-reactive. What is the most appropriate interpretation?
1. AProzone reaction; repeat VDRL on diluted serum
2. BBiological false positive; no syphilis treatment
3. CLate latent syphilis; three weekly injections
4. DEarly latent syphilis; benzathine penicillin now
Show answerHide answer
Answer: B · Biological false positive; no syphilis treatment
The VDRL detects antibodies to cardiolipin, which are also produced in autoimmune disease (SLE, antiphospholipid syndrome), pregnancy and some infections, giving low-titre biological false-positive results. A non-reactive specific treponemal test (TPHA) excludes syphilis, so she needs no antisyphilitic treatment. The finding is a clue to antiphospholipid antibodies, which matter for pregnancy loss and thrombosis and should be tested. Treating on VDRL alone would expose her needlessly and mislabel the family.
- A: Prozone gives a falsely non-reactive VDRL; hers is reactive at a low titre.
- C: Late latent syphilis also has a reactive TPHA, which she does not have.
- D: Syphilis needs a reactive treponemal test; her TPHA is non-reactive.
Question 6 · Medium
A 27-year-old woman visits a designated STI/RTI clinic with a curdy, itchy vaginal discharge for a week. On speculum examination the cervix looks healthy with no mucopurulent discharge, and she has no lower abdominal tenderness. Under NACO syndromic management, which treatment is given?
1. AAzithromycin 1 g and cefixime 400 mg, single dose
2. BSecnidazole 2 g and fluconazole 150 mg, single dose
3. CBenzathine penicillin and azithromycin, single dose
4. DCefixime, metronidazole and doxycycline, 14 days
Answer and explanation in LearnFree account
Question 7 · Medium
A 35-year-old man at a district hospital STI clinic has a single genital ulcer for 5 days. There are no vesicles and no history of recurrent blisters. The laboratory cannot do dark-field microscopy or Gram stain. He has no drug allergy. Under NACO syndromic management, what should he receive?
1. AAzithromycin 1 g and cefixime 400 mg orally
2. BBenzathine penicillin 2.4 MU IM and azithromycin 1 g
3. CDoxycycline 100 mg twice daily for 21 days
4. DAcyclovir 400 mg three times daily for 7 days
Answer and explanation in LearnFree account
Question 8 · Medium
A 24-year-old man has a non-itchy coppery rash on the trunk, palms and soles, painless mucous patches in the mouth and moist flat papules around the anus. His VDRL is non-reactive on undiluted serum, and the TPHA is reactive. What explains the VDRL result?
1. AVery early primary infection
2. BBiological false-negative in HIV
3. CProzone from excess antibody
4. DAdequate treatment in the past
Answer and explanation in LearnFree account
Question 9 · Easy
A 12-year-old girl is brought to the eye OPD with photophobia and hazy corneas from interstitial keratitis. She has had progressive hearing loss for a year, and her upper central incisors are small, widely spaced and notched at the biting edge. What is the most likely diagnosis?
1. ACongenital rubella syndrome
2. BHypohidrotic ectodermal dysplasia
3. CCongenital CMV infection
4. DLate congenital syphilis
Answer and explanation in LearnFree account
Question 10 · Hard
A 46-year-old man has had shooting pains in his legs and a wide-based unsteady gait for a year, worse in the dark. Romberg's sign is positive, ankle jerks are absent and both pupils are small and irregular, reacting to near vision but not to light. He recalls a painless penile ulcer 15 years ago that was never treated. Serum TPHA is reactive and CSF VDRL is reactive. What is the treatment of choice?
1. AOral doxycycline 100 mg twice daily for 28 days
2. BBenzathine penicillin 2.4 MU IM weekly x 3
3. CIV aqueous penicillin G for 10-14 days
4. DBenzathine penicillin 2.4 MU IM once
Answer and explanation in LearnFree account
Question 11 · Easy
A 26-year-old man has a single painless, clean-based, button-like indurated ulcer on the glans for 10 days, with rubbery, non-tender bilateral inguinal nodes. Dark-field microscopy of the ulcer serum shows motile spirochaetes. He has no drug allergy. What is the treatment of choice?
1. ACiprofloxacin 500 mg twice daily for 3 days
2. BCeftriaxone 250 mg IM single dose
3. CDoxycycline 100 mg twice daily for 7 days
4. DBenzathine penicillin G 2.4 MU IM once
Answer and explanation in LearnFree account
Question 12 · Medium
Four hours after an injection of benzathine penicillin for secondary syphilis, a 25-year-old man in the STI clinic has fever of 38.8 °C, chills, headache and myalgia, and his rash looks redder. BP is 118/76 mmHg, there is no wheeze, urticaria or lip swelling. What is the most appropriate management?
1. ALabel him allergic to penicillin
2. BSwitch to oral doxycycline
3. CAdrenaline 0.5 mg intramuscularly
4. DReassure and give antipyretics
Answer and explanation in LearnFree account
Question 13 · Medium
A 23-year-old primigravida at 14 weeks has VDRL reactive at 1:8 and TPHA reactive on antenatal screening, consistent with early latent syphilis. She had an urticarial rash with wheeze after an injection of penicillin some years ago. What is the most appropriate treatment?
1. APenicillin desensitisation, then penicillin
2. BDoxycycline 100 mg twice daily for 14 days
3. CDefer treatment until after delivery
4. DErythromycin 500 mg four times a day
Answer and explanation in LearnFree account
Question 14 · Medium
A 30-year-old woman was treated for secondary syphilis with benzathine penicillin. Her results are: at treatment VDRL 1:64, TPHA reactive; 6 months later VDRL 1:16, TPHA reactive. She has no symptoms and no new exposure. How should these results be interpreted?
1. ATreatment failure; repeat the course
2. BAdequate response; continue follow-up
3. CReinfection; treat her and her partner
4. DNeurosyphilis; perform lumbar puncture
Answer and explanation in LearnFree account
Question 15 · Medium
A 21-year-old college student has had painful genital sores for 3 days, with fever, body ache and burning micturition. There are multiple grouped small erosions on a red base on the shaft and a few intact vesicles, with bilateral tender inguinal nodes. This is his first such episode. Which treatment is recommended?
1. ABenzathine penicillin 2.4 MU IM single dose
2. BAzithromycin 1 g orally single dose
3. CAcyclovir 400 mg three times daily for 7 days
4. DDoxycycline 100 mg twice daily for 21 days
Answer and explanation in LearnFree account

Sexually transmitted infections and syndromic management

A 24-year-old man in Pune has had painless, soft, skin-coloured cauliflower-like growths on the coronal sulcus and inner prepuce for 2 months. They turn white when 5% acetic acid is applied. Which human papillomavirus types cause most such lesions?

A 27-year-old woman visits a designated STI/RTI clinic with a curdy, itchy vaginal discharge for a week. On speculum examination the cervix looks healthy with no mucopurulent discharge, and she has no lower abdominal tenderness. Under NACO syndromic management, which treatment is given?

A 35-year-old man at a district hospital STI clinic has a single genital ulcer for 5 days. There are no vesicles and no history of recurrent blisters. The laboratory cannot do dark-field microscopy or Gram stain. He has no drug allergy. Under NACO syndromic management, what should he receive?

A 24-year-old man has a non-itchy coppery rash on the trunk, palms and soles, painless mucous patches in the mouth and moist flat papules around the anus. His VDRL is non-reactive on undiluted serum, and the TPHA is reactive. What explains the VDRL result?

A 12-year-old girl is brought to the eye OPD with photophobia and hazy corneas from interstitial keratitis. She has had progressive hearing loss for a year, and her upper central incisors are small, widely spaced and notched at the biting edge. What is the most likely diagnosis?

A 26-year-old man has a single painless, clean-based, button-like indurated ulcer on the glans for 10 days, with rubbery, non-tender bilateral inguinal nodes. Dark-field microscopy of the ulcer serum shows motile spirochaetes. He has no drug allergy. What is the treatment of choice?

A 23-year-old primigravida at 14 weeks has VDRL reactive at 1:8 and TPHA reactive on antenatal screening, consistent with early latent syphilis. She had an urticarial rash with wheeze after an injection of penicillin some years ago. What is the most appropriate treatment?

A 30-year-old woman was treated for secondary syphilis with benzathine penicillin. Her results are: at treatment VDRL 1:64, TPHA reactive; 6 months later VDRL 1:16, TPHA reactive. She has no symptoms and no new exposure. How should these results be interpreted?