From the Guidelines
A positive VDRL test with a negative TPHA result in an asymptomatic individual is most likely a biological false positive VDRL result, and this person can typically continue to work without restrictions. This pattern suggests the VDRL test is reacting to something other than syphilis infection, as TPHA is more specific for Treponema pallidum, the bacterium that causes syphilis 1. False positive VDRL results can occur due to various conditions including acute viral infections, autoimmune diseases, pregnancy, recent vaccination, or other inflammatory conditions. To confirm this interpretation, follow-up testing with another treponemal test such as FTA-ABS (Fluorescent Treponemal Antibody Absorption) may be warranted. If the second treponemal test is also negative, this further supports that the individual does not have syphilis. While no treatment for syphilis would be indicated in this scenario, identifying the underlying cause of the false positive reaction might be beneficial for the individual's overall health. Regular monitoring with repeat testing in 3-6 months may be recommended in some cases to ensure the status remains unchanged.
Some key points to consider:
- The VDRL test is a nontreponemal test that can produce false-positive results due to various factors, including other infections or conditions 1.
- The TPHA test is a treponemal test that is more specific for syphilis, and a negative result in the presence of a positive VDRL suggests a false-positive VDRL result 1.
- The Centers for Disease Control and Prevention (CDC) recommends the use of both nontreponemal and treponemal tests for the diagnosis of syphilis, as the use of only one type of test can lead to false-positive or false-negative results 1.
- In pregnant women, the CDC recommends universal screening for syphilis, as the infection can have serious consequences for the fetus if left untreated 1.
In terms of the individual's ability to work, there is no need for restrictions or modifications based on a false-positive VDRL result, as this does not indicate an active syphilis infection. However, it is essential to confirm the diagnosis and rule out any underlying conditions that may have caused the false-positive result.
From the Research
Serological Test Results
- A VDRL positive and TPHA negative result without clinical symptoms can be due to a biological false reactive VDRL test 2.
- In such cases, it is recommended to re-test for syphilis serology after 10 weeks 2.
Treatment and Work Fitness
- There is no direct evidence to suggest that a person with a VDRL positive and TPHA negative result without clinical symptoms is unfit to work.
- However, it is essential to note that syphilis can be transmitted through contact with an infected person's lesions, and therefore, it is crucial to take precautions to prevent transmission.
- The treatment of syphilis typically involves the use of antibiotics, such as penicillin or doxycycline, and the choice of treatment depends on the stage and severity of the disease 3, 4, 5, 6.
Serological Treatment Response
- Studies have shown that doxycycline and tetracycline can be effective second-line treatments for syphilis, with similar serological treatment success rates compared to penicillin 5, 6.
- However, the treatment response may vary depending on the stage and severity of the disease, as well as individual patient factors 4.