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Is negative RNA PCR test on day 12 a conclusive one?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At August 26, 2016
Reviewed AtDecember 19, 2023

Patient's Query

Hello doctor,

A month ago, I engaged in unprotected oral sex with a paid female partner. On the fourth day, I experienced a severe headache that lasted for five days, along with one day of pain in the tip of the shaft. On the twelfth day, I underwent an RNA polymerase chain reaction (PCR) test, which came back negative. Additionally, on the twelfth day, I underwent a chemiluminescent microparticle immunoassay (CMIA) antibody test, which also came back negative. After the tests, unfortunately, I was involved in an accident and sustained a fracture and a piercing wound. My blood levels showed low red blood cell (RBC) count at 4.3 million/mm, low hemoglobin at 11.0 gm/dL , and a white blood cell (WBC) count of 11.8, with neutrophils at 85 % and lymphocytes at 10 %. Following surgery, I received treatment with antibiotics, paracetamol, and pain killer for ten days due to a blood infection. Currently, I have been taking medications containing Calcium and vitamin D3 Tablet once weekly for the past 25 days. During this time, I noticed a white tongue during the fourth week, and experienced a stiff neck for a few hours a day during the fourth and fifth weeks, which improved after I stopped taking the vitamin D3 and Calcium tablet. In the fifth and sixth weeks, I developed white spots in my throat and have been dealing with tonsillitis. Is the RNA PCR test conducted on the twelfth day considered conclusive? Can white tongue, white spots in the throat, and a stiff neck alone be symptoms of HIV? I have not experienced fever, rashes, body pain, or swollen lymph nodes, among other things. Could these symptoms be related to side effects of antibiotics or an infection? Could they be indicative of any other sexually transmitted infections (STIs) resulting from oral sex?

Kindly help.

Hello,

Thank you for stopping by at icliniq.com.

I am here to provide expert opinions on your medical queries. Below are the answers to your queries.

  1. The RNA PCR (polymerase chain reaction) test conducted at 12 days is not considered conclusive. It has a sensitivity of 99.5 percent.
  2. I would suggest you undergo an enzyme-linked immunosorbent assay (ELISA) test at 12 weeks, as this will provide a conclusive result.
  3. Your symptoms of tonsillitis and stiff neck are not indicative of early HIV infection. Early infection typically manifests with flu-like symptoms such as fever, chills, sore throat, body aches, and rashes.
  4. These symptoms are most likely associated with the infection you acquired after the accident. However, they could also be related to other sexually transmitted infections (STIs). To rule out STIs, it is advisable to undergo throat swabs and culture tests.
  5. I hope this has helped you. Kindly follow up if you have more doubts.

    Thank you.

Patient's Query

Thank you doctor for the reply,

I am uncertain whether it is a sore throat or another condition, but I am experiencing a white tongue and painless white spots on my tonsils. However, the area at the back of my throat, specifically the voice box, is significantly inflamed and causing discomfort. Following my accident, I underwent a blood test, and after two weeks, my red blood cells (RBC) appeared normocytic and hypochromic. Additionally, my platelet count showed mild thrombocytosis. Is there any connection between white spots on the throat and voice box inflammation to iron deficiency? Should HIV symptoms manifest in combination, or can a single symptom be sufficient for a conclusion?

Hi,

Welcome back to icliniq.com.

I read your query and understood your concern. I would like to inform you that iron deficiency anemia is not associated with white spots on the tonsils and voice box. The presence of white dots appears to be related to an infection. And also typically, symptoms of HIV (human immunodeficiency virus) manifest in combination. However, it is rare but possible for one or two symptoms to occur independently. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thank you doctor for the reply,

I have recently received the results of the HIV ELISA fourth generation test, and it came back negative on the 54th day. Is this result considered conclusive?

Hi,

Welcome back to icliniq.com.

I read your query and understood your concern. I would like to inform you that the HIV ELISA test conducted on the 54th day is considered 99.9 percent conclusive in determining that you are HIV-negative. However, to attain 100 percent certainty, I would still suggest you undergo an ELISA test at 12 weeks, as that timeframe is considered absolutely conclusive for determining your HIV status. I have examined the provided photograph (attachment removed to protect patient's identity), and it appears to be normal, except for some glossitis and a few dots on the soft palate. These findings are commonly associated with non-specific viral infections. It is advisable to monitor them closely, as they should resolve within three to four days. If they persist beyond that timeframe, I suggest you consult a specialist for a comprehensive evaluation, including a swab examination and possible culture if necessary. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thank you doctor for the reply,

As there were no P24 antigens generated at the 54th week, which is an early marker of the infection, should I still get an ELISA test?

Hi,

Welcome back to icliniq.com.

Sometimes, the levels of antigens are so low that they cannot be detected by the available HIV tests, and it also takes time for antibodies to develop. Therefore, undergoing an antibody ELISA test at 12 weeks is crucial to ensure absolute certainty regarding the infection status. So I still strongly suggest you proceed with the ELISA test at 12 weeks. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thank you for the prompt reply. I also need to ask you that, should I get the 12th week ELISA on the 84th day or the 90th day? If it is the 84th day, can I have the test done on the 82nd day, which is two days before the 12th week? At the 12th week, is it recommended to have an HIV antibody screening test or a fourth-generation test? Please advise. I have heard that many countries consider the fourth-generation test result conclusive at six to eight weeks. Is this true? Even my test consultant is suggesting the same, as I have already taken two sensitive tests and both came back negative.

Kindly provide your insights.

Hi,

Welcome back to icliniq.com.

I read your query and understood your concern. I suggest you undergo the test on the 90th day, which corresponds to 12 weeks. At this point, the ELISA screening test is considered sufficient. I cannot provide specific information about the protocols followed in other countries. However, according to the guidelines set by the World Health Organization (WHO), an ELISA test at three months is considered confirmatory for determining a non-infected status. There is no need for further testing beyond the three month mark. The tests you have already conducted are highly sensitive, with a 99.9 percent accuracy rate in detecting any HIV infection. However, to achieve 100 percent certainty, it is recommended to undergo the ELISA test at three months. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thank you doctor for the reply,

I am planning to have the test on the 89th day. Have you heard of any cases where a person tested negative at eight weeks and two weeks but turned out positive at the 13th week? For the white spots on my throat and white tongue, I consulted an ENT doctor online and provided pictures. The doctor mentioned that it is a very mild condition and suggested using pan-gastric tablets and betabime for two weeks. It has been a week now, and I feel about 50 % better. However, there are still a few white spots in my throat, particularly in the morning, which cause some discomfort. What STI test should I go for to address this issue? Or should I opt for a swab examination and culture test?

Please provide your suggestion.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I suggest you proceed with the test on the 89th day. To the best of my knowledge, I have not come across any cases where someone tested negative at the eighth week and later tested positive at the 13th week. For the white spots issue, I suggest you undergo a swab examination and culture test. This will provide confirmatory results and help in diagnosing your condition accurately. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I just had my regular monthly visit to the orthopedic doctor for my leg fracture today, and I underwent an X-ray and a complete blood picture (CBP) due to low hemoglobin (Hb) levels during my treatment. The CBP showed a Hb level of 10.5 g/dl and an RBC count of 3.9 million/cumm, with a PCV of 33.2 vol % - indicating normocytic and hypochromic RBCs. The WBC count was within normal limits at 5100 cells/cumm (neutrophils 59 %, lymphocytes 36 %), and the platelet count was 2.4 lakhs. I wanted to ask you the following questions.

  1. Does the Hb level and normocytic, hypochromic RBCs have any impact on the generation of antibodies during the eighth-week fourth-generation test I underwent? Although the test detects antigens as well. In fact, I had an RNA PCR test on the 12th day, which came back negative.
  2. Also, for my 89th-day test, does the low RBC count have an impact? I plan to undergo the fourth generation test for more accuracy, or should I also consider the RNA PCR test? Please suggest.
  3. I have been using the antibiotic containing Amoxicillin and Clavulanic acid for my sore throat as per the doctor's advice for a week. Does this have any impact on my RBC and Hb levels?
  4. Should I undergo any further tests for my low RBC and Hb levels? My Hb and RBC levels have been varying over the past two months, with values of 12.2 and 4.43 on 1st day three months ago, 13.6 and 5.1 on the sixth day, 11.0 and 4.1 on the 15th day, 11.6 and 4.3 on 22nd day, 11.9 and 4.3 on 1st day of the following month, 12.2 and 4.5 on 10th of that month, and 10.5 and 3.9 on 7th of the next month, respectively.

Kindly provide your insights.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. Hemoglobin and RBC levels do not have any impact on HIV testing, whether for antigens or antibodies. Low hemoglobin will not affect your test on the 89th day. You only need to undergo ELISA testing, there is no need for an RNA PCR test. Even Augmentin does not have any effect on hemoglobin and RBC levels. If you have low hemoglobin and RBC levels, I suggest you undergo iron studies to determine the cause of these low values. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thanks for the prompt reply,

I heard that strep throat infection can lead to the release of blood while being treated with Augmentin. As I had traces of protein in a complete urine examination conducted a month ago, does this lead to low Hb and RBC levels due to blood or protein loss during treatment? Also, does the calcium supplement I am using medication containing Calcium and vitamin D3 for my fracture healing may reduce my iron levels, resulting in low Hb and RBC counts?

Kindly suggest.

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. I would like to inform you that streptococcal throat infection does not cause blood loss from the body, and treatment with antibiotic containing Amoxicillin and Clavulanic acid does not result in a decrease in hemoglobin and RBC count. Streptococcal throat infection may occasionally lead to inflammation of the kidneys' glomeruli, which can result in traces of protein being detected in the urine sample. However, the presence of traces of protein indicates mild inflammation and is not a cause for concern. Additionally, consuming calcium supplements does not cause a decrease in hemoglobin and RBC count. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply,

Today, I underwent a nutritional anemic profile test to investigate my hemoglobin level two days ago. My blood tests results are as follows:

  1. Ferritin: 18.62 ng/ml.
  2. Serum folic acid: 19.6 bg/ml.
  3. Vitamin B12: 145 pg/ml.
  4. TIBC: 471 ug/dl.
  5. Transferrin saturation: 10.1 %.
  6. Serum iron: 48 ug/dl.
  7. Hemoglobin (Hb): 14.2 g/dl.
  8. Red blood cell count (RBC): 5.7 million/cumm.
  9. PCV/HTC: 44 %.
  10. Mean corpuscular volume (MCV): 77.2 fl.
  11. Mean corpuscular hemoglobin (MCH): 25 pg.
  12. Mean corpuscular hemoglobin concentration (MCHC): 32.4 g/dl.
  13. Red cell distribution width (RDW): 14.3 %.
  14. Total white blood cell count (TWBC): 5.7 thousand/cumm (with differential counts: neutrophils 57 %, lymphocytes 35 %).
  15. Platelets: 345 thousand/cumm.
  16. Reticulocyte count: 1.0 %.

The findings are predominantly normocytic, normochromic RBCs, with a few microcytes and hypochromic cells present. Additionally, I tested my urine for albumin, and the result showed a trace amount. Kindly provide any suggestions and insights regarding these results. Also since last three days I am having slight pain at my right testes and right abdomen close to my genitals like a sharp pain. Is this pain is related to above results or due to something else?

Kindly suggest.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. All the values are within the normal range except for serum iron and transferrin saturation, which are slightly below normal. The presence of a few microcytes and hypochromic red blood cells indicates iron deficiency anemia. This can be addressed by taking iron supplements. I suggest you take one capsule containing Iron, Folic acid, Manganese, and Copper daily with water, one hour after a meal, for a period of two months. The trace amount of protein in your urine is not a cause for concern. The pain you are experiencing in the lower right abdomen and testicular area is unrelated to the test results mentioned above. To alleviate the pain, you can take anti-inflammatory medications such as diclofenac or ibuprofen for three to four days. I suggest you consult a specialist, talk with them and take the medications with their consent. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks doctor for the prompt reply, I have the following doubts, please provide the information regarding them.

  1. Both ferritin and vitamin B12 levels are low. Please clarify the reason for this iron deficiency as per the test reports. Is it due to insufficient iron production or inadequate iron intake?
  2. I have been prescribed Iron hydroxide with Carboxymaltose1000mg medication with 200 ml and a intravenous injection for iron deficiency. Additionally, I have been given Mecobalamin (1m) for vitamin B12 deficiency on alternate days for nine days. The doctor believes my iron levels are very low. I took the iron dose and one dose of vitamin B12 yesterday. Is this the correct course of action?
  3. The doctor advised me to discontinue the use of antibiotic containing Amoxicillin and Clavulanic acid as they believe the sore throat is due to low iron deficiency, and this medication will help in curing it. Is it advisable to follow this recommendation?
  4. Will this low iron deficiency have any impact on my HIV test results? I am planning to take the test after ten days.
  5. Regarding the pain in my testicular area, it is localized below the nerve of the right testicle and seems to follow a path parallel to the body, extending towards the right crack in the abdomen. Could this be caused by any STI bacteria, considering the presence of protein passing through the kidneys? Or is it related to iron deficiency? Can a urine test help in identifying the cause?

Kindly suggest.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. Vitamin B12 deficiency is commonly observed in vegetarians. All these symptoms appear to be a result of iron deficiency in your diet. The medications prescribed for iron and Vitamin B12 deficiency were appropriate. Sore throat does not appear to be related to iron deficiency. However, you can discontinue antimicrobial medication and monitor the sore throat. Iron deficiency will not affect the results of your HIV test. You can proceed with the tests after ten days. The pain you are experiencing could be due to a bacterial infection. I suggest you undergo urine culture and an ultrasound of the abdomen and pelvic organs to identify the cause of the pain. Routine urine examination alone will not provide sufficient information. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

Towards iron deficiency, my doctor has requested a stool sample for occult blood for three consecutive days. The first sample was negative, but the second sample was positive. I have provided the third sample today, and the result will be available tomorrow. Regarding the earlier mentioned trace of albumin in my urine, I am unsure if it is related to the sore throat, blood cracks, STI, or gastric issues. Today, I experienced a slight fever in the morning, which subsided during the day. I underwent a urine culture and sensitivity test yesterday, and the report will be available in three days. Does this report provide some insights into the possibility of STIs or HIV?

Kindly suggest.

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. Usually, the presence of occult blood in stool can be observed in individuals taking iron supplements. To obtain accurate results, this test should be conducted after discontinuing iron supplementation for five days. Occult blood can also be detected in cases of intestinal inflammation, infections, or bleeding within the digestive system. Determining the exact cause requires a comprehensive investigation. In regards to urine culture, it identifies the microorganisms responsible for the infection and their susceptibility to antibiotics. While it may offer some insights into STIs, HIV cannot be detected through urine culture. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks doctor for the reply,

I have just received the urine culture report, which indicates that no bacterial growth was observed in the culture after 48 hours of aerobic incubation at 98.6 degrees Fahrenheit. This suggests that I do not have any STI. However, I am still experiencing a sore throat with white spots on my throat, tonsils, and tongue. What should I do to alleviate this sore throat?

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. If the urine culture is negative, it means you do not have any bacterial infection. To address the white spots in your oral cavity and tongue, you can try taking antifungal medication such as fluconazole (antifungal medicine)150 mg twice weekly. Additionally, you can use clotrimazole (antifungal) mouth paint two to three times a day. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thanks for the reply,

Does this culture test mean that I do not have only bacterial or viral infections as well? Also, does this test mean that I do not have any of the STIs including Chlamydia, Gonorrhea, Herpes, HPV, Syphilis, Bacterial Vaginosis, or Trichomoniasis? Does this mean I do not need to undergo additional STI testing related to my exposure? Please confirm. Additionally, out of the three stool occult blood samples, the first and third samples were negative, while the second sample was positive. As a result, the doctor has suggested upper endoscopy and colonoscopy. Is this okay? Regarding my sore throat, should I continue taking antibiotic containing Amoxicillin and Clavulanic acid?

Please suggest.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. Urine culture can detect bacterial growth but not viral growth in the urine. It only identifies common bacteria that cause urinary tract infections and does not detect herpes, HPV, syphilis, bacterial vaginosis, or trichomoniasis. To rule out these infections, specific tests are required. Your doctor may suspect a gastrointestinal bleed based on the positive occult blood test result. If you have been taking iron supplements, it is recommended to repeat the test after discontinuing iron intake for five days, as iron can also cause occult blood in stools. If the result remains positive, your doctor may suggest colonoscopy and upper endoscopy. For your sore throat, I suggest you continue taking antibiotic containing Amoxicillin and Clavulanic acid and also take a tablet of combination of Levocetirizine and Montelukast once daily at bedtime for five days. Additionally, perform warm saline gargles two to three times a day to help alleviate your sore throat. I suggest you consult a specialist, talk with them and take the medications with their consent. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

Based on the exposure of unprotected oral and protected vaginal sex I had 87 days ago, along with symptoms of sore throat, stiff neck, pain in the epididymitis for a week when using medication for sore throat, and fever for a day in the last three months, along with recent tests like urine culture, high neutrophil count during the second week, iron deficiency, and trace amounts of protein or albumin in urine, I would like to know which STI tests I should undergo as part of the three-month period to move forward with my life. Please suggest the STI tests I should take, apart form HIV.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I suggest you undergo the VDRL test and ELISA for HSV 1 and 2, specifically for IgG and IgM antibodies. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

Are tests for Chlamydia and Gonorrhea not required? Is it because my urine culture came negative?

Kindly suggest.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. Yes, they are not required as your urine culture was negative. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

I received the HIV test result on the 89th day, and it came back negative. The test performed was a fourth generation duo test. Can I consider this result conclusive?

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. Yes your test result is conclusive. No need of further testing. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

I have undergone Chlamydia urine test, gonorrhea urine and swab tests, syphilis blood test, Herpes 1 and 2 blood test, hepatitis B and C blood tests on the 94th day, and all results came back negative. Therefore, I do not have any STIs. Please confirm. I have consulted an ENT doctor regarding my sore throat and tongue. After examination, the doctor diagnosed it as inflammation in the tongue and throat. The prescribed medication is a capsule containing beta-carotene, zinc, copper, manganese and selenium once a day for 30 days and Rebamipide (amino acid analog of 2 - quinolinone) three times a day for ten days. I also shared the urine culture report, which indicated no bacterial growth. Is this medication appropriate?Regarding my 89th day Duo HIV test, I would like to know if it is conclusive. Some websites online suggest a six month testing period, but I am unsure if this information is up-to-date. Could you please provide the latest guidelines from CDC and WHO? Can I consider the 89th day test as conclusive and move on with my life? Also, is there any connection between my sore throat and tongue issues and HIV?

Kindly help.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. According to your tests you do not have any sexually transmitted diseases. The medicines for your ENT problem are fine. You can continue with them. As per WHO (world health organization) and CDC (centers for disease control and prevention) guidelines three months is conclusive. You can move ahead as negative at three months is conclusive. Your sore throat does not seem to be linked to any sexually transmitted diseases. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

I read from a website that refers to CDC guidelines stating that at three months, the HIV test is 97 % accurate, and the remaining 3 % of individuals may take up to six months for conclusive results. I am unsure if this information is accurate or outdated. On the 89th day, I took a fourth generation test, which is believed to provide a higher level of accuracy. I notice blood stains mixed with saliva when I deep gargle or spit, but I do not experience any pain, heartburn, or irritation. What could be the possible reasons for this?

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

According to CDC guidelines, three months is considered conclusive for HIV testing. Your fourth-generation test is highly accurate, providing reliable results. There is no need to worry. The presence of blood stains while brushing could be attributed to minor trauma caused by brushing or gum-related issues. If the issue persists without any apparent cause, I suggest you consult a specialist for further evaluation. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

I have undergone a fourth generation test at six months, specifically 180 days after the potential exposure, and the result came back negative. Can I consider this result conclusive, or should I retest at 12 months?

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I would like to inform you that this test is conclusive and there is no need to repeat the test at 12 months. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thanks for the reply,

If the test is conclusive, Can I have intercourse without condom with my wife and plan second kid now with my wife. Kindly suggest.

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. Yes you can have unprotected intercourse with your wife and plan your second child. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

I have not engaged in any risky behavior for the past 12 months, and I am approaching the 12-month mark soon. Is it necessary to undergo another test to achieve 100 % conclusiveness, or is it not required?

Please suggest.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. No need of further testing. Your earlier reports are already conclusive. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thank you doctor for your suggestions.

Hello,

Welcome to icliniq.com.

You are welcome. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Asmeet Kaur Sawhney
Dr. Asmeet Kaur Sawhney

Dermatology

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