Sexually Transmitted Infections and Genital Ulcer Diseases — WACS Viva & Clinical Scenarios (Dermatology and Venereology)

Exam-style sexually transmitted infections and genital ulcer diseases viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old male presents with a painless, indurated, clean-based solitary ulcer on the coronal sulcus of the penis and non-tender bilateral inguinal lymphadenopathy of two weeks duration. Outline the diagnostic approach, differential diagnoses, staging criteria, and pharmacotherapeutic management for this patient, including the prevention and management of treatment-related complications.
• SCENARIO 2: A 24-year-old female presents with severe vulvar pain, dysuria, and multiple painful vesicles and shallow erosions on an erythematous base accompanied by tender inguinal lymphadenopathy. Detail the diagnostic evaluation, differentiation between primary and recurrent presentations, antiviral management protocols, and counseling considerations.
• SCENARIO 3: A 32-year-old male presents with profuse purulent urethral discharge and severe dysuria 4 days after unprotected sexual intercourse. Discuss the laboratory evaluation, empiric syndromic versus etiologic treatment protocols, management of antimicrobial resistance, and screening protocols for concurrent sexually transmitted infections.
• SCENARIO 4: A 35-year-old commercial sex worker presents with painful, ragged-edged, non-indurated genital ulcers with a purulent base and an exquisitely tender, fluctuant unilateral inguinal mass. Detail the etiologic diagnosis, clinical differentiation from other genital ulcer diseases, definitive medical management, and procedural handling of the fluctuant inguinal lymphadenopathy.
• SCENARIO 5: A 40-year-old HIV-positive patient presents with extensive, cauliflower-like verrucous lesions involving the perianal region and vulva. Discuss the oncogenic risks, histopathological and diagnostic evaluation, therapeutic modalities including provider-administered and patient-applied regimens, and indications for surgical intervention.