Question

• 23 year old previously healthy female • Presents to ER with 4 day history of fever, chills and myalgia • 2 days prior developed painful genital lesions • On day of admission has headache, photophobia, stiff neck • Is sexually active, but no history of STI Your patient: Poll Pelvic exam: extensive vesicular lesions on the cervix • Specimens are taken for detection of N. gonorrhoeae, C. trachomatis, T. pallidum and viruses • CSF is drawn, and the lab reports back that the following lab results can be important: WBC 41/mm3 (normal < 5) with 21% PMN (neutrophils) and 79% Mononuclear cells Gram stain is negative.

Which of the following organisms can cause painful ulcerative genital lesions?
A. Papillomavirus
B. Strep group B
C. Chlamydia trachomatis D-K
D. Herpes simplex
E. Treponema pallidum

Answer 1

The organism that can cause painful ulcerative genital lesions in the described case is Herpes simplex (D). Other options provided, like Chlamydia trachomatis and Treponema pallidum, either cause asymptomatic infections or non-ulcerative lesions or painless chancres, respectively.

Step-by-step explanation:

The organism most related to the symptoms described by the 23-year-old female patient, particularly painful genital lesions, fever, chills, myalgia, and signs of meningitis (headache, photophobia, stiff neck), in conjunction with negative Gram stain and elevated white cell count in the CSF, is Herpes simplex (D). Herpes simplex virus (HSV) causes painful vesicular and ulcerative lesions in the genital area. Chlamydia trachomatis (D-K), while a common STI, typically presents with asymptomatic infections or non-ulcerative cervicitis in women. Treponema pallidum, which causes syphilis, is also a cause of genital lesions, but these are usually painless chancres in primary syphilis, which is not consistent with the painful lesions described in this scenario. Papillomavirus causes warts, not ulcerative lesions, and Group B strep is more commonly associated with neonatal infections and not commonly responsible for genital ulcers.