A positive VDRL result in a patient with hepatitis prompts which next step?

• A. Identify her sexual contacts for serologic testing
• B. Test her serum using a fluorescent treponemal antibody-absorbed assay
• C. Treat her with penicillin
• D. Reassure her that it was a biologic false-positive caused by liver disease

Answer: (B)

VDRL is a non-treponemal screening test that can give false-positive results in conditions such as liver disease. When a patient with hepatitis has a positive VDRL, the correct next step is to use a treponemal-specific test, such as a fluorescent treponemal antibody-absorbed assay (FTA-ABS), to confirm whether there is a true Treponema pallidum infection. Treponemal tests are more specific and help distinguish true syphilis from a biologic false-positive VDRL.

If the treponemal test is positive, you then move on with appropriate clinical evaluation and management. If it’s negative, the VDRL result was a false positive, and no syphilis infection is present. Identifying sexual contacts or starting treatment without confirmation could lead to unnecessary interventions or missed diagnoses, and reassuring the patient without confirmation would be inappropriate given the initial positive screen.