PCR Test

Originally Posted: 
Tuesday, April 24, 2012
Question: 

Hi, I had sex with a sex worker on February 17th 2012 in the Red Light District. I was ignorant of proper condom usage and put on two condoms, she gave me oral for about 3 minutes, then I had vaginal sex with her for about 1 minute and a half, pulled out because it was my first time with a sex worker and it felt kind of wrong. She then pulled off my condoms, which didn't look ripped but intact, and put a new one on finishing me with a hand job.

I started sweating that very night from fear, and haven't had a good night sleep without a nightmare since (67 days now) pain in my body prevents me as well. I began developing joint pain, then muscle burning on my shoulders, and hips 2 weeks later that migrated from my feet up to my shoulders. 13 days after Amsterdam I got a PCR test, my doctor told me any virus would show up in 8 days. It came out negative as well as all STDs. I know it was too short for the STDs to show up in a test. I don't have any ulcers, no vomiting, no swollen lymph nodes, no rashes, no mysterious fevers. Just pain throughout my body that migrates, I don't know what to do. I checked for lyme disease, rhuematoid arthritis, and all came out clear. 
 
I'm still left with the real pain in my body, it's been 7 weeks of pain in my body, and I don't know if it's acute HIV because it usually doesn't just last for 7 weeks from what I've read. There is a part of me that I have HIV, it shows up in my nightmares, so I'm gonna put a rest on the 90 day mark, but do you know if anxiety/ depression can cause this? Or another STIs that I should test for associated with migrating pain? Thanks again, and I'm on my 68th day.
Answer: 

Hello and thank you for using AIDS Vancouver as your source for HIV/AIDS related information.

First of all, a sex worker is not necessarily at a higher risk for HIV than anyone else.  Any individual can pass an STI/HIV, no matter what age, occupation, ethnicity, sexual orientation or gender.  It is the activity that poses the risk.

As well, condoms are still the most effective way to prevent HIV transmission because if the condom does not break or fail in some way and is used properly, transmission of HIV is really not possible. However, using two condoms is not advised, as it increases the likelihood of the condoms ripping.

Receiving oral sex is a negligible risk, which means there have been no confirmed cases of HIV acquisition this way. The primary reason for this is that saliva is not a fluid that can pass HIV and it also contains an enzyme that actually inhibits HIV from entering the bloodstream. Protected vaginal sex is considered a low risk activity. As mentioned previously, with proper condom use and no breakage, there is really no way for HIV to pass through the latex or polyurethane of the condom (but wearing two condoms is not recommended in the future). Handjobs pose no risk of HIV transmission.

It is great to hear that you got tested for both HIV and other STIs. The PCR HIV test detects the genetic material of HIV itself, and the window period for a PCR test is 2-3 weeks (14-21 days). BCCDC Testing Guidelines here in Vancouver only discuss antibody testing (ELISA) and not PCR testing, and these guidelines recommend re-testing at 12 weeks to be completely sure or "conclusive." Saying that, your negative PCR test at 13 days is a good indication of your status, however, I would recommend re-testing at the 12 week mark (84 days) for both HIV and STI testing to be completely sure and to help ease your anxiety and nightmares. However, since a standard antibody test (3rd generation/ELISA) has a window period of 4 weeks to 3 months (28-84 days) and since you are at your 68th day post exposure, you can test right away and get a very reliable result and that may ease your worry.

As well, we do recommend all those who are sexually active to get regularly tested for other STIs, as well, so when you do re-test, it would be beneficial to be tested again for other STIs, as well as HIV.

In terms of symptoms, a strong flu-like illness may arise 2-6 weeks after HIV acquisition, but this is very variable and symptoms may be due to other things. As well, HIV symptoms are not chronic and do not persist for very long. Therefore, as you said, since HIV symptoms do not last, your ongoing body pain for 7 weeks would not be due to HIV.

I am sorry to hear about the ongoing pain in your body and your anxiety and nightmares. All your stress may, in fact, be causing your body pain, however, I am not a medical professional and am not able to diagnose your symptoms. If this persists, I would recommend seeking a medical professional you trust to discuss and address your symptoms.

I hope this helps answer your questions and eases your anxiety, but if you have any further questions please feel free to email or call us.

Take care,

Stephanie
AIDS Vancouver Helpline Volunteer
E-mail: helpline@aidsvancouver.org
Phone (Mon-Fri 9-4pm): (604) 696-4666
Web: www.aidsvancouver.org/helpline

Comments

Submitted by Edward (not verified) on

Thanks you so much for your reply.

This pain along with the nightmares, hasn't allowed me to sleep a proper night since February 17th. I'm a college student studying abroad in Europe but am from California, so I don't really have any of my friends or family back home to talk about this specific situation.

My doctor told me after she checked for lyme disease, rheumatoid arthritis that the pain can be "psychosomatic disorder" or a mind body disorder. I literally have a nightmare about something relating me and HIV every night,I just feel guilty that I actually hired a sex worker and it has left me disoriented throughout the day since I'm sleep deprived. I'm going to a therapist today, but I think the only way I can get over this is if I get tested again on the 84th day, maybe the pain will go away I just don't know the chances of me getting a positive which scares me to death; I wore two condoms which was idiotic (thought it would protect me more), but they didn't rip from what I saw; it's supposed to be obvious. I have been given pain killers, and they don't even work. I don't have any symptoms that would point to syphilis, or gonorrhea, or hepatitis .

My doctor told me that I could rely on the PCR test, since they are very accurate after 8 days here in Germany. Also that Amsterdam sex workers are recommended to check every two weeks(which gives me a little bit more peace of mind), and I would've noticed if the condoms broke I've just never been so depressed in my life, and if this pain is anxiety caused, I've never experienced pain from anxiety so I originally thought I had contracted acute HIV for the first couple of weeks, i've also never been so anxious too, or sleep deprived. I don't know, I just want to see my family again HIV negative when I return. May 11th would be my 84th day, it takes about a week for my results to show up here.

Is there any difference that I can get checked May 3rd (making it 76 days) they only check tuesdays and thursdays here. I would like to get my results before I say Happy Mother's Day to my mom on Sunday the 13th. Or would you recommend against it? Also how accurate is the PCR test? Why isn't it FDA approved?

I've read that a false positive is like 2.6% but a false negative is much lower. I know you're not a medical professional, but from my exposure, PCR results, and so called symptoms do you think I have a good chance at getting a negative? Thank you so much for your help, it means alot. and sorry for so many questions.

Submitted by monicaf on

Hi there,

Thank you for using AIDS Vancouver Helpline Online.

I know the testing process can be an overwhelming to go through without a support system. We are available through email or phone if you would like to speak with someone & hopefully assist you in working through some of your questions in more detail.

I am sorry that you are feeling guilty and anxious about having sex with a sex worker. It is very common for people to feel guilty and anxious after this because of personal ideas and perceptions society teaches us about that occupation. As Stephanie already mentioned, sex workers aren't at a higher risk for HIV than anyone else and may actually test more regularly for STIs and HIV than the average person. Regardless, it is most important to focus on the activies you engaged in and not the person whom they were with. It is activities and not individuals which determines your risk of acquiring HIV.

The PCR test has a window period of 2-3 weeks therefore your test at the 13 day mark is a good indication of your status. A negative result with a PCR at 13 days is very unlikely to change with further testing however, an antibody test at the 3 month (84 days) mark will be definite and conclusive. Taking the test at the 76th day mark will again be a good indication of your status and it is very unlikely that your test would change in a matter of a  week as long as you have not had any other exposures.

The accuracy of the PCR test is 99.6% and as to your questions about PCR not being FDA approved, here is the view of a doctor from a trusted website.
Again, if you choose not to wait till the 84 day mark and test at 76 days, this will be a very good indication of your status and I hope this will relieve any anxiety you are still experiencing.

Given that you seem very anxious and concerned and that this worry sounds like it is greatly affecting your emotional well-being, I would encourage you to work on addressing some of the underlying reasons for your anxiety and help you come to terms with your negative results.

If you have any more questions feel free to comment on this post or email.

Have a good day,
Kamani
AIDS Vancouver Helpline Volunteer

Submitted by Ali (not verified) on

Hi, I am looking for some advice about HIV testing and there results, I hope you will help me for that. About 4 months ago I had sex with a sex worker, I did floating and a virginal sex, I am not sure for use of condom or not after 12 days I start getting rashes up to 4 months, I had pain in my elbow and shoulder from week 2 to week 3, I had night sweets up to 4 months, I have stuffy neck from week 3 to 4 months, and I had some eye sight problem too from week 4 to week 8, I had oral thrush twice from week 7 to 8 and from week 9 to11 I had tonsils in short I had all ARS in last 4 months. I just came to know one friend of sex worker that she was HIV positive and now she left the message parllor too. I took hepatitis vaccination, amoxicillin 500mg for 7 days for tonclis and telefast 120 mg for 3 month for rash.

I tested 15 times for HIV and other STIs.

I tested on day 9, 28, 56, 63, 65, 70,77, 84, 91, 112 with HIV DUO 4th generation test and get negative results.

I also tested with Insti rapid test on day 45, 49, 58, 75, 88, 112 all come back negative.

My questions are:

  1. As I used some medicines like amoxicillin, hepatitis vaccination course, telefast teblelts, is these medicines can delay to build antibodies in my blood?
  2. As I had sex with HIV positive and had all ARS do I need to keep testing up to 6 months or more?
  3. Do you my tests or conclusive and I need not to worry about HIV any more?
  4. Is there is any other type of HIV which 4th generation DUO test and Insti rapid test can not cover?
  5. If I do PCR RNA test after 4 month is it will give me accurate result or you suggest PCR RNA Or DNA test for me now?
  6. It is very hard to believe on my test results after all ARS on right time what should I do now?
  7. Did you ever see any one turn positive after16 week negative ? What is my chance that my result can change after 16 weeks and 15 time negative test results?
  8. Last what you think I should do now, can I go back to my life and can I do unprotected sex with my girl friend because she want baby and after testing negative she is fighting me to do unprotected sex with her, what should I do?

So for long post, but I am so scared even now I am so afraid to do any more test after 16 weeks, I hope you will help me to come out of this situation and will give me proper advice, and want to say you thanks for help in advance.

Submitted by monicaf on

Hello there, 

Thank you for using AIDS Vancouver Helpline Online. 

I will answer your questions in the order you asked them.

  1. Some conditions that are suspected to maybe cause a delay in antibody production include individuals who: have taken PEP, are undergoing HCV treatment or have a diagnosed immunodeficiency disorder. So no, the medications nor the vaccination will have an effect on the production of antibodies.
  2. An HIV test is conclusive and definite at the 3 month mark, so no you don't need to keep re-testing. The only time it is suggested to test at the 6 month mark is for those who have had a delay in their antibody production.
  3. Yes your tests are conclusive and definite because your last test is beyond the 3 month (90 days) mark.
  4. No, you do not need to use any other type of HIV test to acquire conclusive results. Both the 4th Generation and Rapid (Insti) tests screen for both HIV-1 and HIV-2, although it is extremely unlikely that you were exposed to HIV-2 unless you are located in West Africa. 
  5. A PCR RNA test at the 4 month mark is a very good indication of your test however it is suggested that an antibody test at the 3 month mark is taken to confirm the results. You may choose to take an antibody test but it is unlikely that your status will change. There is also no need to take another PCR RNA or DNA test.
  6. If you did in fact experience ARS, your test results would be accurate and find an infection. Since you have tested negative 15 times, you are negative, you do not have HIV and your symptoms are being caused by something other than ARS. 
  7. It is rare for someone to have a positive result after they have tested negative as long as you have not had any new exposures.
  8. Your test results are all negative so you do not have HIV therefore if you choose to have unprotected sex there is no risk of passing on HIV to the baby as long as your partner is also HIV negative. I'm in no position to tell you what to do but if you are hesitant to have unprotected sex you may express this concern with your girlfriend and talk to her about your feelings. 

Hopefully my answers have helped you. Feel free to comment on this post or email. 

Have a good day, 

Kamani
AIDS Vancouver Helpline Volunteer

Submitted by Ali (not verified) on

Thanks for reply, it's now more then 20+ weeks of my possible exposure with a sex worker I tested all togather 17 times and last test was after 19 weeks 4th generation result come back negative, but I still have rash coming and going, and I have oral thrush from last 2 months, my toung is gray and hairy, I went to Gp but he could not find any cause of rash and oral thrush, I want to belive my test but I really can not.
Please guid me
1. What and which test I need to do now, do you think PCR RNA or DNA will be good after 5 months.
2. Do u ever see 19 week negative turn positive latter on?
3. Do I need to do full blood count?
4. Do I need to do my CD4 counts?
5. Any other advice which can help me to come out of this terrible Situation?
Thanks for your help in this hard time of my life, God bless you.

Helpline1's picture
Submitted by Helpline1 on

Hi again,

Thank you for your comment.  I will answer your questions in the same order as you asked them.

  1. International HIV testing guidelines suggest testing after 12 weeks for conclusive results.  Given that you have had many negative results after that time, you are HIV negative.  As long as you have not had any other exposures in the interim.
  2. No
  3. No
  4. No
  5. As we mentioned previously, you are HIV negative for your original exposure.

Hopefully this gives you some peace of mind and you can move on with your life.  If you have any additional questions please feel free to contact us.

Take Care,
Joanna, Jonathan, Cameron
AIDS Vancouver Helpline Volunteers

Submitted by Ali (not verified) on

Dear sir
Many thanks for your kind reply, just few more last follow up questions, I hope you will not mind and reply me for these questions.
1. What is HTLV? Is HTLV have same symptoms as HIV?
2. Do I need to test for HTLV? And is this blood or urine test?
3. Is HTLV is same dangerous as HIV?
4. What is window period of HTLV?
5. Any other information which can help me to calm down will appreciate?
6. Do you think I do not need any more test 4 HIV even not for PCR DNA or RNA test?
Thanks for keep helping me.

Helpline1's picture
Submitted by Helpline1 on

Hi Ali,

First of all, I would just like to note that we are not medical professionals here at the Helpline. Instead, we are a trained team of volunteers who specialize in HIV-related information. As such, I will do my best to address your questions and concerns with reliable and accurate sources but for more detailed information on HTLV, you may wish to discuss it with your doctor.

To answer your questions:

  1. HTLV Human T-Lymphotropic Virus (HTLV)  is a retrovirus associated with depression of the immune system. Unlike HIV, viruses in this group work by initially stimulating the immune system, which ultimately leads the immune system to go into overdrive, at which point it starts attacking itself. However, as the immune system becomes weaker, the patient is at risk of opportunistic infections which may take advantage of the vulnerable body. This is a similar to the symptomatic portion of an HIV infection.
  2. HTLV is about one-tenth as prevalent as HIV in the US population. HTLV is passed similarly to HIV, through needle sharing and unprotected sex.  Screening for HTLV is not justified given the fact that disease is rare and there is no treatment.
  3. Like HIV, HTLV is a retro-virus and infection is for life. If infected with HTLV, the immune system may diminish to the point that you are unable to fight off opportunistic infections, and this may eventually result in death.
  4. The window period for HTLV is unknown.
  5. I recommend talking to your doctor about your concerns regarding HTLV. Again, we here at AIDS Vancouver focus mostly on HIV/AIDS , so I apologize that we may not be best suited to completely answer your questions regarding HTLV.
  6. No, as Jonathan mentioned before you do not require any additional HIV tests (even PCR DNA and RNA test) based on your original exposure.

Stay Healthy,
Elyse
AIDS Vancouver Helpline Volunteers

Submitted by Ali (not verified) on

Dear sir, I need some help regarding HIV & HTLV I hope you will help me as soon as possible because I am too stress.
5 months ago I had unprotected sex with sex worker, after two weeks I had every single symptom of HIV which were rash, pain, itches, tiredness, peeling of skin, night sweets, floating, Lymph node swelling, shoulder & elbow pain, sore throught, dry cough,  white coated tong, and oral thrush.
I just come to know now that sex worker was HIV positive too one of her friend toled me now and she left message parlour as well.
After 5 months I am still facing rash, and have oral thrush which is so painful and not going away.
I tested 17 times 12 time with duo 4th generation and 5 times insti rapid test result negative. Last test was after 19 weeks.
My symptoms do not let me go back to my life, I have few question if you reply me, it will help me to go back to my life.
1. Is there any other type or subtype of HIV which 4th generation HIV test or Insti rapid test can not pick up.
2. Is HTLV is same like HIV and have same symptoms?
3. Do you think I need to test for HTLV1/2?
4. Do you think if I do PCR DNA test I will look for virus, and can gave me accurate result?
5. Any other test you advise for me?
6. Any other advice which can help me?
Thanks for help me.

Submitted by monicaf on

 

Hi there and thank you for trusting the AIDS Vancouver Helpline with your concern.

First, it is important to note for other people reading that having sex with a sex worker does not necessarily pose a higher risk for the transmission of HIV. HIV does not discriminate between a person's age, race, gender, occupation, sexual orientation etc, so a person does not put you at any higher risk of acquiring HIV; it's the activities that do (such as unprotected sex or sharing needles for drug use). However if you have been explicitly informed that this particular sex worker is HIV+, and you consider the source to be credible, then it is great to hear that you decided to get tested.

It is great that you have been tested, however it's quite unnecessary that it has been done 17 times. Usually we recommend testing after 3 month post-exposure and repeated testing is not required or recommended after that. Given your many negative results, none of the symptoms you are experiencing are due to HIV. Nineteen weeks post-exposure is more than enough to trust your final result. Perhaps try to keep in mind that not all exposures lead to infection. So, even though you may have been exposed to HIV in a high risk situation, that does not mean that you will acquire it. Given all of your negative test results, it is clear that this exposure to HIV did not lead to infection. You do not have HIV based on your very accurate and reliable test results.

To answer your first two questions:

  1. No - there is not any other type or subtype of HIV which 4th generation HIV test or the rapid test can not pick up; the tests are extremely precise and accurate.
  2. HTLV is a human RNA retrovirus that is known to cause a type of cancer, referred to as adult T-cell leukemia and lymphoma, and a demyelinating disease called HTLV-I. Medical researchers used to believe it was related to HIV but now have shown that HIV acts very differently from HTLV, and that it belongs in an entirely different classification. Many people are asymptomatic in early stages of acquiring the virus.
  3. As for the rest of your questions, we are not medical professionals here at AIDS Vancouver and so the best person to speak to would be your doctor. There are blood tests to test for HTLV, but as for whether or not this is something that you require, I do not have the expertise to say.
  4. No, I do not think that you require anymore HIV testing. A PCR DNA test is not necessary because you did not acquire HIV from your experience with an HIV+ sex worker.
  5. If you share your concerns about your symptoms with your medical professional, they should be able to let you know if this is required or not and how best to manage their impact on your life.
  6. I would encourage you to trust your test results and perhaps explore the reasons why you are finding it very difficult to move on with your life. I would encourage you to think about why you have decided to test so many times & ask yourself why it is that you cannot accept the fact that you do not have HIV.

I hope this helps and allows you to move forward.

Take care,
Ruth
AIDS Vancouver Helpline Volunteer

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