{"id":4308,"date":"2021-10-22T08:00:00","date_gmt":"2021-10-22T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=4308"},"modified":"2026-08-22T05:30:01","modified_gmt":"2026-08-21T22:30:01","slug":"vdrl-false-positive-test-causes","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/km\/2021\/10\/22\/vdrl-false-positive-test-causes\/","title":{"rendered":"A Positive Syphilis Screening Test That Isn&#8217;t Syphilis: The Biological False Positive"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Best Urologist working in Chonburi and Cambodia\" class=\"wp-image-7037\" 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aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"has-drop-cap wp-block-paragraph\">Few laboratory results cause as much distress as a reactive syphilis screening test in someone who was not expecting one \u2014 a routine check-up, a pre-employment screen, an antenatal panel. And in a meaningful proportion of those people, it is not syphilis. The phenomenon has a name: the <strong>biological false positive<\/strong>, or BFP. This article explains what it is, how it is settled, and \u2014 the part usually left out \u2014 why a false positive that refuses to go away is worth taking seriously for an entirely different reason.<\/p>\n\n\n<script type=\"application\/ld+json\">\r\n{\r\n  \"@context\": \"https:\/\/schema.org\",\r\n  \"@type\": \"FAQPage\",\r\n  \"mainEntity\": [\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What is the VDRL test?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"The VDRL (Venereal Disease Research Laboratory) test is a widely used blood screening test for syphilis. It is accessible at most laboratories worldwide, even without a doctor's referral, making it one of the most common STD screening tools available.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What does a VDRL false positive mean?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"A VDRL false positive, also called a Biological False Positive (BFP) reaction, occurs when the test returns a positive result in a person who does not actually have syphilis. This affects approximately 1\u20132% of people tested and is typically seen at low dilution levels of less than 1:8.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What are the causes of a VDRL false positive test?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Common causes of a VDRL false positive include laboratory error or poorly trained technicians, autoimmune diseases such as SLE (Systemic Lupus Erythematosus) and Rheumatoid arthritis, febrile illnesses such as malaria, tuberculosis, and filariasis, pregnancy, recent vaccination, aging, drug addiction, liver disease, and malignancy.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Can pregnancy cause a false positive VDRL test?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Yes. Pregnancy is one of the recognized causes of a biological false positive VDRL result. Pregnant women who test positive on VDRL screening should undergo further confirmatory testing to rule out true syphilis infection.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Can a recent vaccination cause a false positive VDRL?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Yes. Recent immunization with any type of vaccine is an important cause of false positive VDRL results and should always be mentioned in the medical history when evaluating an unexpected positive syphilis test.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What should I do if my VDRL test is positive but I don't have syphilis symptoms?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"If a biological false positive is suspected, a thorough medical history and further confirmatory investigations are needed to identify the true cause. It is recommended to repeat the VDRL test at 10 weeks, as most false positive results will become non-reactive by that time. Always consult a physician for proper evaluation.\"\r\n      }\r\n    }\r\n  ]\r\n}\r\n<\/script>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4322\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/10\/22\/vdrl-false-positive-test-causes\/upset-patient-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;3.5&quot;,&quot;camera&quot;:&quot;ILCE-7M2&quot;,&quot;caption&quot;:&quot;Close up face of unhappy Asian pretty young woman siting alone on couch with feeling sadness , emotional young woman was depressed on sofa&quot;,&quot;created_timestamp&quot;:&quot;1559227186&quot;,&quot;focal_length&quot;:&quot;49&quot;,&quot;iso&quot;:&quot;200&quot;,&quot;shutter_speed&quot;:&quot;0.0125&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"The patients who experience with this problem will affect their mentally and daily performance.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;The patients who experience with this problem will affect their mentally and daily performance.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A distressed man reading a laboratory report \u2014 an unexpected reactive syphilis screening result causes considerable anxiety\" class=\"wp-image-4322\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient-1.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">An unexpected reactive result is frightening \u2014 and in a proportion of people it is not syphilis at all.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Why the Test Can Be Wrong<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">VDRL and RPR are <strong>nontreponemal<\/strong> tests. They do not detect the syphilis organism at all \u2014 they detect antibodies against lipid material released when cells are damaged. Syphilis produces that pattern, but so do a number of other conditions, which is precisely why a reactive result is a reason to test further rather than a diagnosis. The companion <strong>treponemal<\/strong> test (TPHA, TPPA, FTA-ABS) looks for antibodies against the organism itself and is what settles the question. I set out the difference between the two in <a href=\"https:\/\/drsoaraweeurology.com\/2020\/11\/27\/syphilis-confusion-tests\/\">why there are two kinds of syphilis test<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Biological false positives are usually <strong>low-titre<\/strong> \u2014 typically below 1:8 \u2014 whereas active syphilis more often produces higher titres. That is a useful hint, not a rule, and it does not replace the confirmatory test.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Recognised causes<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Autoimmune disease<\/strong> \u2014 systemic lupus erythematosus, rheumatoid arthritis, and in particular <strong>antiphospholipid syndrome<\/strong>, discussed below<\/li>\n\n\n\n<li><strong>Acute infections<\/strong> \u2014 viral illness, malaria, tuberculosis, and other febrile illnesses<\/li>\n\n\n\n<li><strong>HIV infection<\/strong><\/li>\n\n\n\n<li><strong>Pregnancy<\/strong><\/li>\n\n\n\n<li><strong>Recent vaccination<\/strong><\/li>\n\n\n\n<li><strong>Chronic liver disease<\/strong><\/li>\n\n\n\n<li><strong>Injecting drug use<\/strong><\/li>\n\n\n\n<li><strong>Older age<\/strong> and, less commonly, malignancy<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A laboratory or clerical error is also always worth considering \u2014 a repeat sample is cheap. The distinction usually drawn is between <strong>acute<\/strong> false positives, which follow an infection or vaccination and settle within about six months, and <strong>chronic<\/strong> ones, which persist beyond that and are the group associated with autoimmune disease.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4320\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/10\/22\/vdrl-false-positive-test-causes\/young-pregnant-woman-holds-her-hands-on-her-swollen-belly-love-concept-horizontal-with-copy-space-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;3.2&quot;,&quot;camera&quot;:&quot;Canon EOS 7D&quot;,&quot;caption&quot;:&quot;Young pregnant woman holds her hands on her swollen belly. Love concept. Love and maternity concept.&quot;,&quot;created_timestamp&quot;:&quot;1482326059&quot;,&quot;focal_length&quot;:&quot;100&quot;,&quot;iso&quot;:&quot;160&quot;,&quot;shutter_speed&quot;:&quot;0.033333333333333&quot;,&quot;title&quot;:&quot;Young pregnant woman holds her hands on her swollen belly. Love concept. Horizontal with copy space&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"VDRL fasle positive test sometimes can be detected in Pregnancy.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;VDRL fasle positive test sometimes can be detected in Pregnancy.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A pregnant woman \u2014 pregnancy is a recognised cause of a biological false positive syphilis screening test\" class=\"wp-image-4320\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pregnancy.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Pregnancy is a recognised cause \u2014 and also the situation where confirming the answer quickly matters most.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">The Cause That Matters More Than the Others<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A persistent biological false positive is one of the recognised laboratory features of <strong>antiphospholipid syndrome<\/strong> \u2014 an autoimmune condition that causes blood clots in the veins and arteries and recurrent pregnancy loss. This is the reason a chronic false positive should not simply be filed away with a shrug once syphilis has been excluded.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It matters most if you also have, or have had, any of the following \u2014 mention them to your doctor rather than waiting to be asked:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A previous <strong>deep vein thrombosis or pulmonary embolism<\/strong>, or a stroke at a young age<\/li>\n\n\n\n<li><strong>Recurrent miscarriage<\/strong>, stillbirth, or severe pre-eclampsia<\/li>\n\n\n\n<li>A known autoimmune diagnosis, or a low platelet count found on a blood test<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In that situation, the false positive is not a nuisance result \u2014 it is a clue, and it belongs with a rheumatologist or physician rather than being dismissed. This is not urology, and I refer these patients on; but a positive test that nobody investigates is a missed opportunity, and it is the single most useful thing to know about this subject.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The Mirror Image: When the Test Is Falsely Negative<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Less well known, and worth stating because it runs the other way: in <em>very<\/em> high-titre syphilis, the sheer quantity of antibody can overwhelm the reaction and produce a <strong>falsely negative<\/strong> VDRL or RPR. This is the <strong>prozone phenomenon<\/strong>, and it is resolved by the laboratory diluting the sample and retesting. It is uncommon, but it is a reason a negative screening test does not override a lesion or a rash that looks like syphilis \u2014 the clinical picture still counts.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Happens Next<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>A treponemal test is done.<\/strong> Reactive nontreponemal test with a <strong>negative<\/strong> treponemal test, in someone without symptoms or exposure, is a biological false positive.<\/li>\n\n\n\n<li><strong>If the treponemal test is positive<\/strong>, it is not a false positive \u2014 that pattern means syphilis at some point in life: current, or past and treated. The history and the titre decide which, and <a href=\"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/\">treatment<\/a> follows if needed.<\/li>\n\n\n\n<li><strong>A repeat after a few months<\/strong> distinguishes an acute false positive, which settles, from a chronic one, which does not and prompts the autoimmune question above.<\/li>\n\n\n\n<li><strong>Testing for the other infections<\/strong> is offered, since a screening panel that flagged one thing is a good moment to check the rest. HIV testing, and pre- or post-exposure prophylaxis, are handled by the Infectious Diseases department at Bangkok Hospital Headquarters rather than in the urology clinic.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>In pregnancy this is not a wait-and-see situation.<\/strong> Untreated syphilis in pregnancy causes stillbirth and congenital syphilis, so a reactive result is confirmed promptly rather than at leisure, and treatment is given if there is doubt.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One last thing, because it is the question everyone actually wants answered: <strong>a biological false positive does not mean you have had syphilis, and it is not something you can pass to anyone.<\/strong> It is a quirk of what the test measures.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What is a biological false positive syphilis test?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">A reactive VDRL or RPR in a person who does not have syphilis. These are nontreponemal tests: they detect antibodies against lipid material released from damaged cells rather than the syphilis organism itself, so several other conditions can make them reactive. False positives are usually low-titre, typically below 1:8. A treponemal test such as TPHA, TPPA or FTA-ABS settles the question.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What causes a false positive VDRL or RPR?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Autoimmune disease including lupus, rheumatoid arthritis and antiphospholipid syndrome; acute infections such as viral illness, malaria and tuberculosis; HIV infection; pregnancy; recent vaccination; chronic liver disease; injecting drug use; and older age. Laboratory or clerical error is also worth excluding with a repeat sample.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">My VDRL is positive but TPHA is negative. Do I have syphilis?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In someone with no symptoms and no exposure, that combination indicates a biological false positive rather than syphilis. It does not mean you have had syphilis in the past, and it is not infectious to anyone. If the treponemal test is <em>positive<\/em>, that is a different situation entirely: it means syphilis at some point in life, either current or past and treated, and the history and titre decide which.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Should a persistent false positive be investigated?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes. A false positive that persists beyond about six months is one of the recognised laboratory features of antiphospholipid syndrome, an autoimmune condition causing venous and arterial clots and recurrent pregnancy loss. It is particularly worth pursuing in anyone with a previous clot, a stroke at a young age, recurrent miscarriage or stillbirth, a known autoimmune diagnosis, or a low platelet count. That assessment belongs with a rheumatologist or physician rather than a urologist.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Can pregnancy cause a false positive syphilis test?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, pregnancy is a recognised cause. It is also the situation in which the answer is needed quickly rather than after a wait, because untreated syphilis in pregnancy causes stillbirth and congenital syphilis. A reactive antenatal result is confirmed promptly with a treponemal test, and treatment is given where doubt remains.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Can a syphilis screening test be falsely negative?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, though it is uncommon. In very high-titre syphilis the quantity of antibody can overwhelm the reaction and give a falsely negative VDRL or RPR \u2014 the prozone phenomenon \u2014 which the laboratory resolves by diluting the sample and retesting. A negative screening test therefore does not override a sore or rash that looks like syphilis; the clinical picture still counts. A test taken very soon after exposure can also be negative before antibodies develop.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Book an Appointment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Soarawee Weerasopone provides confidential testing and treatment for sexually transmitted infections at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital, Chonburi \u2014 Urology department <a href=\"tel:0880221445\">088-022-1445<\/a>. HIV testing and PrEP or PEP are handled by the Infectious Diseases department rather than the urology clinic. Questions about cost are answered by the hospital rather than by Dr. Soarawee \u2014 for Bangkok Hospital, by email to <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. It is a useful way to review results you already have; blood testing itself requires an in-person visit. Samitivej Sriracha is in-person only.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This article is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is educational only, is not medical advice, and does not create a doctor\u2013patient relationship. A reactive syphilis screening result should always be interpreted by a doctor with your history in front of them rather than from a web page, and it should never be ignored. Investigation of antiphospholipid syndrome is not urological and is referred to a rheumatologist or physician. No diagnosis, prescription or individual medical advice is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account \u2014 any account offering private consultation in his name is fraudulent.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/22\/vdrl-false-positive-test-causes\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/22\/vdrl-false-positive-test-causes\/\",\n      \"name\": \"A Positive Syphilis Screening Test That Isn't Syphilis: The Biological False Positive\",\n      \"description\": \"What a biological false positive VDRL or RPR means, what causes it, how a treponemal test settles it, why a persistent false positive should be investigated for antiphospholipid syndrome, and the prozone phenomenon that can make the test falsely negative.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-10-22\",\n      \"dateModified\": \"2026-08-22\",\n      \"lastReviewed\": \"2026-08-22\",\n      \"specialty\": \"https:\/\/schema.org\/Urologic\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"medicalAudience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/22\/vdrl-false-positive-test-causes\/#bfp\" },\n      \"disambiguatingDescription\": \"Rewritten August 2026. 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It is particularly worth pursuing in anyone with previous thrombosis, stroke at a young age, recurrent miscarriage or stillbirth, a known autoimmune diagnosis, or a low platelet count. Assessment belongs with a rheumatologist or physician.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Can pregnancy cause a false positive syphilis test?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Yes, pregnancy is a recognised cause, and it is also the situation where the answer is needed quickly, because untreated syphilis in pregnancy causes stillbirth and congenital syphilis. A reactive antenatal result is confirmed promptly with a treponemal test and treatment is given where doubt remains.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Can a syphilis screening test be falsely negative?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Yes, though uncommonly. In very high-titre syphilis the quantity of antibody can overwhelm the reaction and produce a falsely negative VDRL or RPR, known as the prozone phenomenon, which the laboratory resolves by diluting and retesting. A negative screening test therefore does not override a sore or rash that looks like syphilis. A test taken very soon after exposure can also be negative before antibodies develop.\"\n          }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>A reactive VDRL or RPR in someone with no risk and no symptoms is often not syphilis at all. Dr. Soarawee Weerasopone explains what a biological false positive is, the one cause that matters more than the rest, and why a persistent one should never simply be dismissed.<\/p>","protected":false},"author":185281453,"featured_media":10127,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Biological false positive VDRL or RPR explained \u2014 what causes a reactive syphilis screening test without syphilis, how a treponemal test settles it, and why a persistent false positive should be investigated for antiphospholipid syndrome.","jetpack_seo_html_title":"VDRL False Positive: What It Means and What to Do | Dr. Pom","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1365],"tags":[1510,1445,1446,1447],"class_list":["post-4308","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sexual-transmitted-diseases","tag-std","tag-syphilis","tag-syphilis-test","tag-vdrl"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-17u","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/VDRL-False-Positive.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/4308","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/comments?post=4308"}],"version-history":[{"count":21,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/4308\/revisions"}],"predecessor-version":[{"id":11610,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/4308\/revisions\/11610"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/media\/10127"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/media?parent=4308"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/categories?post=4308"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/tags?post=4308"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}