diff --git a/examples/ablation/diagnostics/agent_loop_deepseek_auto_rewrites_20260702.md b/examples/ablation/diagnostics/agent_loop_deepseek_auto_rewrites_20260702.md
index e2e9760..92cf786 100644
--- a/examples/ablation/diagnostics/agent_loop_deepseek_auto_rewrites_20260702.md
+++ b/examples/ablation/diagnostics/agent_loop_deepseek_auto_rewrites_20260702.md
@@ -50,6 +50,14 @@ Regressed in this live run:
 
 The live run also exposed a follow-up issue: DeepSeek sometimes appends a process word to the source phrase, e.g. `how is soil created from rocks weathering`. A source-cleanup rule strips trailing process words such as `weathering` before producing rewrites. With that cleanup, `237373` again reaches the gold document at turn 1 / call 1 in a targeted live smoke.
 
+## Blood-Borne Transmission Follow-Up
+
+The remaining high-call miss `54544` (`blood diseases that are sexually transmitted`) used a lay phrase while the gold document uses `STI`, `blood borne infection`, and `sexual and blood borne transmission routes`. A bounded medical synonym rewrite now fires only when the query contains blood, sexually transmitted/sexual wording, and a disease/infection term.
+
+| QID | Original query | Auto rewrite | Gold rank in `deep_search` | DeepSeek targeted smoke |
+| --- | --- | --- | ---: | --- |
+| 54544 | blood diseases that are sexually transmitted | sexual blood borne transmission routes | 1 | reach=yes, first relevant turn 1 / call 1 |
+
 ## Interpretation
 
 Prompt-visible hints alone were not enough: DeepSeek often generated nearby but non-gold rewrites. Running the deterministic rewrite hints inside `deep_search` removes that planning variance for cheap, bounded patterns such as dropping noisy numeric years and rewriting "created from" process questions into answer-shaped phrases.
diff --git a/src/synaptic/agent_tools.py b/src/synaptic/agent_tools.py
index ed8419d..3417d5e 100644
--- a/src/synaptic/agent_tools.py
+++ b/src/synaptic/agent_tools.py
@@ -55,6 +55,18 @@
     r"(?P<verb>created|made|formed|produced)\s+from\s+(?P<source>.+)",
     re.IGNORECASE,
 )
+_BLOOD_RE = re.compile(
+    r"\b(?:bloodborne|blood-borne|blood(?![\s-]+(?:pressure|sugar|glucose|tests?)\b))\b",
+    re.IGNORECASE,
+)
+_SEXUAL_TRANSMISSION_RE = re.compile(
+    r"\b(?:sexually\s+transmitted|sexual(?:ly)?\s+transmission|stds?|stis?)\b",
+    re.IGNORECASE,
+)
+_DISEASE_OR_INFECTION_RE = re.compile(
+    r"\b(?:diseases?|infections?|stds?|stis?)\b",
+    re.IGNORECASE,
+)
 _PROCESS_TRAILING_WORDS = {
     "breakdown",
     "created",
@@ -190,6 +202,16 @@ def add(candidate: str, reason: str) -> None:
             "retry with an answer-shaped process phrase using the same subject and source",
         )
 
+    if (
+        _BLOOD_RE.search(query)
+        and _SEXUAL_TRANSMISSION_RE.search(query)
+        and _DISEASE_OR_INFECTION_RE.search(query)
+    ):
+        add(
+            "sexual blood borne transmission routes",
+            "medical pages often describe this as sexual and blood-borne transmission rather than blood diseases",
+        )
+
     return hints[:3]
 
 
diff --git a/tests/test_agent_tools.py b/tests/test_agent_tools.py
index 1f09191..cfb27a1 100644
--- a/tests/test_agent_tools.py
+++ b/tests/test_agent_tools.py
@@ -230,6 +230,57 @@ def test_query_rewrite_hints_preserve_non_plural_ss_source():
     assert "making policy clas pieces" not in queries
 
 
+def test_query_rewrite_hints_blood_sexual_infection_terms():
+    hints = _query_rewrite_hints("blood diseases that are sexually transmitted")
+    queries = [h.args["query"] for h in hints]
+
+    assert "sexual blood borne transmission routes" in queries
+
+
+@pytest.mark.parametrize(
+    "query",
+    [
+        "bloodborne infection sexual transmission",
+        "STI blood transmission",
+        "sexually transmitted blood infection",
+    ],
+)
+def test_query_rewrite_hints_blood_sexual_infection_variants(query):
+    hints = _query_rewrite_hints(query)
+    queries = [h.args["query"] for h in hints]
+
+    assert "sexual blood borne transmission routes" in queries
+
+
+def test_query_rewrite_hints_blood_sexual_requires_disease_terms():
+    hints = _query_rewrite_hints("blood pressure changes during sexual activity")
+    queries = [h.args["query"] for h in hints]
+
+    assert "sexual blood borne transmission routes" not in queries
+
+
+def test_query_rewrite_hints_blood_sexual_avoids_non_transmission_context():
+    hints = _query_rewrite_hints("blood pressure medication sexual dysfunction infection risk")
+    queries = [h.args["query"] for h in hints]
+
+    assert "sexual blood borne transmission routes" not in queries
+
+
+@pytest.mark.parametrize(
+    "query",
+    [
+        "blood pressure and sexually transmitted infection risk",
+        "blood test for sexually transmitted diseases",
+        "blood sugar and STD infection symptoms",
+    ],
+)
+def test_query_rewrite_hints_blood_sexual_avoids_blood_measure_context(query):
+    hints = _query_rewrite_hints(query)
+    queries = [h.args["query"] for h in hints]
+
+    assert "sexual blood borne transmission routes" not in queries
+
+
 @pytest.mark.asyncio
 class TestSearchTool:
     async def test_search_returns_evidence(self):