A positive VDRL test for syphilis in a patient with hepatitis and no partner history: what is the appropriate next step?

• A. Treat her with penicillin
• B. Identify her sexual contacts for serologic testing
• C. Test her serum using a Treponema pallidum-particulate antigen assay
• D. Reassure her that it is a biologic false-positive caused by liver disease

Answer: (C)

When a non-treponemal test like VDRL comes back positive, you need a confirmatory test that is specific for Treponema pallidum. The reason is that non-treponemal tests can give false-positive results in conditions such as liver disease, autoimmune processes, or other infections. A treponemal-specific test, such as the Treponema pallidum–particle assay, is more precise and helps determine whether the patient truly has syphilis.

So the correct next step is to perform a treponemal-specific confirmatory test to verify the infection status. If the confirmatory test is positive, treatment and partner notification become appropriate. If it’s negative, the initial VDRL result was likely a false positive due to the hepatitis. The other options either jump to treatment without confirmation, involve partner testing as the immediate step without confirming infection, or prematurely reassure the patient without verifying the result.