Testing by PCR RNA

[PM1998]

I am a male who had a low risk encounter with a CS man. I was the insertive partnern only and I used protection with a lot of lubrication. I am confident the condom did not break or tear. We did have unprotected oral and deep kissing.  I did not finish inside, but finished myself manually (hoping none of his rectal fluids made there way inside my penis).  I fell slightly ill at 7 days (slight fever, slight sore throat, which I understand is too early for ARS), that lasted 5 days.  In any case, I became worried.  I had a Aptima PCR RNA test at 10 days come back not detected.  I had a Clearview Stat Pak at 28 days come back negative.  I had another RNA test at 32 days (not sure if they did an antibody too, as my PCP ordered it) and that came back negative. As a side note at 10 weeks I had an perinanal abscess (near the anus), that was a first for me, but I am told that has nothing to do with any STD, and I have had a wheeze for about 8 weeks.

Tomorrow is 12 weeks (84 days) since the encounter, I am going to get another Stat Pak, what is the probability that I would remain negative?

[Edward W Hook, MD]

Welcome to the Forum.  I am confident that your 12 week test will be negative as your combination of antibody test at 28 days and a PCR at 32 days are equivalent (although more expensive) to a DUO (combined HIV p24 antigen/HIV antibody test and thus was conclusive at that time.  

As you point out, your flu-like illness occurred too early to be the ARS and it is flu-season.  Further, your exposures, condom protected anal and unprotected oral and masturbation have no appreciable risk for HIV.

Please don't worry related to this exposure- there is no reason.  EWH

[Edward W Hook, MD]

Let me answer you this way.  If I were you, I would not feel they need to test further.  Recommendations for further testing given the testing you mention are based on older, out of date information and overly conservative thinking.

I hope this comment helps.  EWH

[PM1998]

Allow me one more question.  In the 83 days that I have been occupied with this, I have done lots of research (most likely too much in the eyes of some).  As I have seen in forums, and in speaking with my providers, there seems to be debate or perhaps a disconnect, on words like: conclusive and accuracy, especially (and obviously) when discussing the window period, and tests available.  

So my question, if you are a person of some means (as I, with insurance that covers all blood work at no OOP cost to me), in a developed country (USA) does in fact "conclusive" truly apply, to where I would not have to get a 12 week test?  

I ask this because I have been wondering for 8 weeks on end (since my last tests as noted).  I had to talk myself out of getting tested at week 6, 8, 10, and now I am at the supposed window period termination.  I could see if I only, and could only, get Antibody tests, but I am fortunate enough to have these other options.  Besides, does not the viral load spike incredibly high during initial infection (let su say within a month) to where a PCR test would have to catch it (okay two questions)?