Dr. Tan and Partners is one of the few approved Anonymous HIV Testing Centres in Singapore. A detailed write up on our service is available here.

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HIV 4th Generation Test Singapore

The HIV 4th Generation Test is one of the most accurate and fastest way to determine is a person has been infected with HIV or not.

The HIV 4th Generation Test is also called the Combo test or the Duo test.

It tests for both the HIV antibodies as well as the antigens in the blood. It can be done as a rapid test i.e. you can get the results in 20 minutes.

Antibodies are produced by the body when it is infected with the HIV virus. There are many different types of antibodies. The one that is produced the earliest is called the IgM antibody. This can be produced as early as 20 days post exposure. 3rd and 4th Generation HIV tests can detect the IgM antibody.

Antigens are bits of the HIV virus shell that can be found in the blood as early as 14 days post exposure. The 4th Generation test can detect the presence of this antigen.

If the test detects either the presence of HIV antibodies or antigens, it means the patient is most likely infected with HIV. This has to be confirmed with another ELISA test. We always do at least 2 tests before diagnosing a person as HIV +ve.

Officially it is conclusive at 28 days post exposure. However, from current scientific data, we know that when the test is done at 20 days post exposure, it is already as good as 100% accurate. Personally I have tested patients +ve for HIV at only 14 days post exposure with this test.

The US CDC recommends the HIV 4th Generation test for all HIV screening. This is because it is more accurate, has a shorter window period and can pick up rare cases of sero-negative infections (see below).

The HIV 4th Generation test can detect HIV infections in very rare cases of people who are infected with HIV but never produce any anti-bodies. These are called sero-negative infections and happen in about 1 in 1 million people.

At our clinics the HIV 4th Generation test costs $150 (before GST).

You can walk in our clinics at Robertson Walk, Bencoolen Street, Novena Medical Center or Scotts Road anytime during our opening hours for this test. It only requires a finger-prick of blood and 20 minutes to get results.

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If you had a high risk exposure to HIV within the past 72 hours, you can take medicines to reduce your risk of actually contracting HIV. Find out more on HIV PEP Treatment.

 

Related Topics:

Anonymous HIV testing at our Clinics

HIV – Understanding the Window Period

Cost of HIV/STD tests at our Clinics

Condom Broke

Getting HIV from Oral Sex

More on HIV symptoms

How long can HIV live outside the body?


 

We are Open on Saturdays and Sundays.

Click Here for Contact Details, Address and Opening Times.

Feel free to email your queries, feedback and suggestions on what other topics you want to see in the comments section below.

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We are now Open on Weekends.

We have 5 locations conveniently located at Robertson Walk, Bencoolen Street, Novena, Scotts (Pacific Plaza) and Somerset (H&M)

Robertson Walk          6238 7810   map

Bencoolen Street        6884 4119   map

Novena                           6397 2095   map

Scotts                              6694 2348   map

Somerset                       6262 0762   map

Email: [email protected]

About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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791 Comments

  1. Ong Seng

    Hi doctor,I have taken pep for 5days after that I choose to stop pep about 3 days because I taken the sex worker to test for hiv rna and combo-not detected on days5(post exposure).So my question is do I need to complete my pep and get tested on days 28 or I should really stop worrying.If the pep already stop for 3 days does it still work for me?really need your advise,just in your opinion.Thanks Doctor.

    • I do not believe you need to complete PEP given that the partner was tested negative. In the excessively unlikely case that she was in the eclipse period before HIV RNA can be detected (<10 days), then I suppose that risk is still present - if so, stopping PEP for 3 days would mean that is much less effective. Overall, I really would not worry if I were you.

      • Ong Seng

        So doctor,in your opinion.If I stop pep,when should I tested for rule out infection.

  2. Hi Doctor,

    Good day! I had unprotected intercourse at 5th Sept (potential exposure), 3 days later I came down with low-grade fever, sore throat, headache, urticaria that come and go, joint pain. I have done a few tests so far, please refer to below:
    1) 7th day – 4th Gen HIV Ag/Ab – Non reactive (0.75)
    2) 10th day – 4th Gen HIV Ag/Ab & full STDs test – Not detected & all negative
    3) 16th day – Finger prick test HIV (Antibody)- Negative
    4) 41 days – 4th HIV 1 & 2 Ag/Ab (ELISA) – Non-reactive

    Is my test result at 41th day that using 4th Gen HIV 1 & 2 Ag/Ab (ELISA) conclusive?

    What is the difference between 4th Gen Ag/Ab (ELISA) and 4th Gen Combo/DUO?

    Thank you for your time doctor.

  3. Hi doctor,may I know if a patient in eclipse period which is the rna still at not detected level.Can the patient transmit the infection to others?

  4. Kow Chan

    Hi Doctor,I have unprotected sex with sex worker after that I bring her tested hiv rna and combo.The result is Not Detected.Do you think I need to take pep for precaution.

    • I do not believe any PEP is indicated in this situation, unless you are extremely concerned she is still within the window period, which I would find unlikely.

  5. Hi Dr Tan, if the exposure was 6 months ago, if the person is the one u described 1 in a million remain seronegative antibodie and take 4th Generation, will 4th Generation able to rule out hiv since he remain seronegative and P24 disappear after 3 months?

    Kindly advise doc, have a great day!

  6. Hi dr,

    Sorry again but I have 2 questions for you;

    1) how confident are you of a negative 4th gen at 7th week? As there would be a chance that; a period where its too late for antigen p24 yet too early for Igm and Igg to be detected. Please advise.

    2) have you ever came a cross a case where a negative 4th gen rapid test at 7th week turned positive after 3 months?

    Thank you so much for you time.
    Might appreciated.

    Regards
    Mike

    • I am 100% confident of a negative 4th gen test at 7 weeks. There is no period like you described (too late for Ag, too early for Ab) – it just does not work like that. I have never had a case of negative test at 7 weeks turn positive at 3 months.

      • Thank you so much for your reply and advise. Much appreciated.

        God bless you.

  7. Dear Dr,

    I went for a Thai massage and ended up receiving hand job with massage oil. I noticed that she had a lot of reddish open wounds like acne/mosquito marks at the back of her palm. She claims it is from tiger balm allergic reaction.

    Would I be at any form of risk of acquiring HIV from this 15mins exposure? Do I have to go for testing at 28 days ?

    I am really really worried. I’m getting anxiety from the slightest acne breakout, heath rest, red marks on my body and feel like having fever as well.

    This happened 7 days ago.

    Has there be any proven reported case from this form of exposure?

    • There is no risk of HIV from this exposure.

      • Thanks for the clarification doc.

        Here’s the “what if” question…

        1. What if the lesions at the back of the palm is a type of std.. Say syphilis? Does that pose a risk to HIV?

        2. Does presence of oil inactivates the virus?

        Thanks for answering doctor.

  8. Hi doc,

    I had unprotected sex with the girl of unknown status and she is undergoing cancer treatment.After that i had penile rash, swollen lymph nodes, stomach growling and pain, fatigue, numbness of fingers and legs during night.This is still continues after 3 months.i have taken 4th gen duo combo test in sexual health clinic, australia on 67 days and 86 days after exposure. is the test result defintive and conclusive. or i have to take another test in different lab. I am really worried. is there any time both ag / ab undetecable. pls awaiting for your reply

    • Your tests are conclusive, no HIV. If you have symptoms of concern, please get properly assessed by a doctor. They are not caused by HIV.

      • Thank you doc. So no need for further testing at 6 months.my symptoms really worrying me a lot.how accurate is 4th gen combo test.do i need to confirm with NAT ?.please reply me doc

  9. Hi Doctor,May I know what regimen that your clinic use for pep usually.

  10. Dear Doctor,

    I had four test with 4th generation duo test(antigen+antibody) as indicated below.

    25.days, 42.days, 51.days and 63.days all tests are negative. I would like to know that, should I stop having test.?

    Many thanks for your reply..

  11. Hi dr, I did a 4th gen rapid test at 52nd day from the time of exposure. It came back non reactive. How conclusive is that because I realised you said it’s only conclusive AT 28 days and not FROM instead?
    & It has been 2 months since the exposure and I’m having flu and sore throat. Can ars symptoms appear after 2 months? Thank you so much for your time.

  12. Thanks in advance for your response. I had unprotected vaginal sex for 2mins with sex worker.. she performed unprotected oral sex for 5mins as well. I took CMIA 4th Gen test from Dr.Lal Path Labs India at 4weeks , 6weeks & 7 Weeks- all non reactive. Is my result conclusive ? Or further test is required.

  13. Dear sir, After risky exposure taken duo 4g test at 21st day and 31st day results found negative, no symptom was observed till now (63 days) the tests are conclusive, please reply sir worried at the earliest.

  14. gentleman

    hi doc hope you are doing great. i just wanted to know if my 4th generation ELISA NON REACTIVE at 37 days is conclusive. am experiencing all ARS symptoms. many are saying that AT 28 days but heard non saying FROM 28 day. is it that beyond 28 days p24 antigent are not detectable and my antibodies are not enough to be detected thats why got NON REACTIVE results ? am sorry my english is very bad but kindly reply please

  15. Dr. I sucked someone else for about 5 min.
    Not eyaculation in my mouth , not cuts in my mouth.

    Took an hiv duo at a laboratory which came back negative exactly at 30 days. Should I test again?
    Or is it conclusive?

  16. Rahul Sharma

    I had unprotected sex with sex worker in 1st Week August. I have done 4th Gen CMIA duo test at 4weeks , 6 Weeks, 8Weeks all resulted Non Reactive . Do I need further testing or is it conclusive. ? I am suffering from seronegative arthritis. Does it affect the result??

  17. Sir, After risky exposure I took duo 4g test at 21st day and 31st day and found non reactive, is this tests are conclusive please confirm.

  18. Hi Doctor,

    I visited your clinic previously and would like to seek some advice for the following questions:

    1. I did the 4th Gen rapid test which came back with non-reactive results. However, I read that Antigens are easily detected within the first 11 days since exposure. I took the test at 2.2 months since exporsude. Hence, I hope you can advise me if I need to go for another test after 3 months since the Antigens may not be detectable at 2.2 months?

    2. I had a small wound on my finger due to the rapid blood test; had touched the doorknob of the clinic room, which I am quite concerned about contracting HIV as the doorknob may be dirty. Is it possible to contract HIV?

    Could I seek your advice on these questions?

    Thank you very much!

    • The p24 antigen is only detectable from D14 onwards (not first 11 days). The 4th gen test looks for both antigen and antibody, so at 2.2 months if you had an infection, either your antigen or antibody (more likely antibody) would be detectable. You do not need to repeat your test. You cannot get HIV from a doorknob.

  19. I had protected insertive anal and protected oral with SW condom did not break

    I tested at 26 days post exposure 4th Generation DUO

    How conclusive result is?

    Thank you

    • It is fairly conclusive, but officially you would be recommended a test at 28 days or more.

      • Dr.
        Considering the negative result at 26 days what are the possibilities it will change with 3 days?

        In the article above dr Tan states that if test is done 20 days post exposure it is as good as 100%

        Also considering I had protect sex, do i need to worry in the next 3 days?

  20. Micheal Lau

    Hi Doctor,I have taken hiv ab/ag test (eclia)at days 90 and the result is negative.May I know do I need to retest at days 180(6month)?

  21. Das Neri

    Hi Doc Tan

    Good day, I had sex with condom and I got tested after 31 days because i was diagnosed of HPV and the result is NEGATIVE. (method: architect chemilunescent microparticle immunoassay).. they say HPV is skin to skin contact. After that I retest again after 1 week exactly 39 days after the deed and the result is ALL NEGATIVE. VIDAS HIV antigen: 0.03 & DUO ULTRA Antibody 0.06 (method:ELFA 4th GEn.)

    The Hospital said I do not need to retest again because the 4th Gen is good enough.Is this true Doc?

    Regards
    Neri

  22. Hello Dr i had a single exposure for hiv with a sex worker due to a broken condom for about 30 seconds I went to the lab and got a 4th generation duo test 28 days after. A day later got an e-mail result came back non reactive is my test conclusive? Can i move on and stop worrying about it? Or do i need to repeat test at 12 weeks. Thanks by the way the test was done at a lab not a rapid test.

  23. I have did a alere hiv combo test with finger prick blood at days 90 the result is negative.Did my test result conclusive?Do I need to retest at 6 month ?

  24. Hi doc,

    i took an hiv combo test after 67 days.i doesn’t had fever.but i feel fatigue,oral thrush,numb of finger and legs.the doc who did the test said it is conclusive and you have some mental issue and need counselling. pls help me that the combo test after 67 days is conclusive.

    • To add to above comment : it is 4th gen antigen and antibody test i took.

      is this not the correct window period, may be undetecable antigen/antibody.Pls clarify doc. I am soo afraid.

    • Dr Elaine Loh

      I agree with the prevous doctor that your HIV combo test results at 67 days is conclusive. There may be other medical causes for the symptoms that you are experiencing but it is not HIV related. Do visit a doctor to get checked.

      • Thank you doc.is there any period where both antigen/antibody not detected before 90 days.do i need another test or not required.

  25. Doctor,
    About 10 weeks ago I put a bandaid on the finger of an 11 year old boy at a summer camp and remembered while washing my hands that I had a small, shallow cut on my hand that was 24 hours old and no longer bleeding. I don’t recall actually touching this boy’s blood, I know he probably didn’t have any diseases, and that HIV isn’t very transmitable by this sort of blood exposure to begin with. However, I can’t shake the fear that he had HIV via verticle transmission and that I did actually touch his blood. Do you recommend testing? If so, should I wait another couple of weeks to be sure of accuracy?

    • I do not believe you have any risk from this exposure. But if you wish to test for whatever reason, 10 weeks is more than sufficient with a 4th gen combo test kit.

  26. Rainypooh

    Does the p24 antigen levels will remain high enough, say 1 year post exposure to be detected by 4th generation tests in cases of seronegative infections? How will you know if you are a case of seronegative?

    • Theoretically yes. Seronegative cases are exceedingly rare, so trust your doctor that the tests done are appropriate and accurate.

  27. Hello doc. during my session with a sex worker, she sat on my shin(in her underwear), im afraid of getting hiv via scars/wounds/cuts on my shin where she sat.

    How soon should i test?

    • Dr Elaine Loh

      From your description, your risk is negligible. But to be very absolutely certain, you can test at 1 month earliest.

      • Thanks for the reply doctor, what does the negligible means? can you elaborate further?

  28. Hello Dr,

    Does p24 antigen levels remain high enough to be detected by 4th generation tests in cases of seronegative infections? Is there a need to do a PCR test to 100% rule out possibility of Seronegative HIV? Or a 4th gen test is good enough

  29. Dear Dr Jonathan,

    I had protected intercourse with csw and tested negative on both alere rapid and Elisa 4th Gen at 30days.

    Following that had unprotected handjob at 32 Days at a massage parlour. Had sores on my penis and note sure if the masseuse had cuts or blood on her hand. Tested negative on 28days alere combo test post of that exposure.

    Both exposure in Malaysia.

    Been having fever, cough, phlegm and respiratory problems for the last one week. I’m worried that HIV-2 might be a concern as the massage lady was Thai and Alere combo test don’t pick up p24 for HIV-2.

    What is your opinion in this sir? Am I serocomverting?

    Does Elisa HIV1/2 ab/ag picks p24 for HIV 2?

    Your reply is highly appreciated.

  30. Hi Dr .I have done hiv rna test on days 30 and hiv combo test on days 58 both result shown not detected.But until now I still got rash on my body,In your opinion do u think my test is conclusive?

  31. Kareem saba

    Hi doctor
    I have tasted hiv virus after high risk unprotected sex with unknown female , after it i get panic so i get pcr Rna on the 10th & compo test in the 22th day and finally i tasted compo in 30th day and all became negative . Is it the time to not worry and forward my life ! Thank you i appreciate your reply

  32. Hi Doctor,
    I did the following tests:
    1. HIV RNA PCR test on 18th day and the test result came negative.
    2. WESTERN BLOT tests on 39th day and test result came negative.
    3. 4th generation HIV combo test on 39th day and test result came negative.
    Can I consider the tests conclusive?

  33. I had protected anal sex with a guy eith an unknown status who tested positive on rapid test card 2 days ago! We have been having unprotected oral sex but only protected anal sex! I never rimmed him neither he had mouth sores or bleeding gums! We never deep kissed! My mouth hygiene is impeccable. After speaking with the doctor he said this could be false positive since a rapid test can pick abnormalities in the blood and give a positive result! I tested on p24 hivab/ag combo test exactly 11 days after exposure.

    After speaking with a few doctors back in the US they stated hiv combo test with p24 will pick infections post 7 days! How much should I rely on the test or should I take a retest on day 21 when enough antibodies are produced!

  34. Hello, my test result is non reactive. I took my test 13 months after possible exposure. I think the test was 4th generation test. But here the website address and talk about seronegative and I see some people ask also. If someone happen to be seronegative (somehow just doesn’t produce antibody to HIV for some reason), does it mean that the 4th gen test is going to be positive even if the test is done 13 months after exposure? Because it detect the antigen? Is it too late to detect antigens then if the body is somehow not producing antibodies?

    • Your test is conclusive, you do not have to worry. If antibodies were not present in seronegative infection, antigen would be detected. You can move on.

  35. Hi dr.i went to testing center to take a test.51 days after exposure using alere test dont know what generation is.and result NR for both HIV and syphillis.is that conclusive if they only used 3rd generation test.

  36. Worried crazily

    Hi doc,

    I went to dentist for dental cleaning.
    On the 12th day after my visit, i got this gritty sensation in my mouth such as under the tongue, lower gums towards the back, inside cheeks. I noticed very very tiny white spots on the 6-7th day of this grittiness. This gritty feeling lasted for 7 days. I have never experienced this before in my life.

    I am afraid the nurse forgot to change the equipment since when the nurse told me to come in, she directly escorted the previous patient to somewhere else. Not long after the nurse came back and directly did my cleaning.

    I am super worried since i tried to search and many said it was thrush. And many said oral thrush related to Hiv.

    I have never done sex. No drugs as well.

    I got tested using hiv ag ab CMIA test on the 2nd week (14 days) and 5th week 3 days ( 38 days) after the dentist visit, all comes back negative.

    Is my test conclusive? What should i do next?

  37. Hi Doctor,

    I have protected sex with a commercial sex worker in August. I did a test at your clinic 15 days post exposure on 17 August 2017. I think it was the combo test. It was negative and the doctor on site said its 90% conclusive.

    Now, i am 48 days post exposure. If i take another combo test now, would it be 100% conclusive?

    Thanks

  38. Hello dr, using 4th gen duo test my results came back negative on the 15th day, 24th day, 29th day and 45th day. I’ve had a persistent cough the past week, are my results conclusive? should I stop taking the test? Thanks.

  39. Hi Doc I got an 4th generation laboratory test at 3 weeks post exposure (22 days) and then a Alere Determine 4th generation rapid test at 4 weeks post exposure (30 days). Both tests came out negative, are my results considered conclusive. I had protected receptive anal sex with a transgender by the way

  40. Hi Dr Jonathan
    I have tasted pcr quntative real time after 10 days of unprotected sex and the result was negative , after 21 i made compo test and it is negative . Is it counclusive ? Is there any need to retake test? Thank you i will pry to u

  41. I Had intercourse on 15th Aug 2017. Have done HIV DUO IV generation test on 16th Sep 2017 (app. on 30th days) . The result is Non Reactive (0.306). Am i infected with HIV? What does 0,306 means?

  42. Doctor, I have tested with 4th generation CMIA method for HIV at 1 year post exposure. Results is negative however I am concerned about seronegative infections. If I happen to be seronegative, can I say that my HIV test would have turned out positive as well because the antigens would have been detected?

  43. Hi Dr.

    I had a non reactive result with a 4th gen test 53 days after exposure (21 days after pep), would you say it is conclusive?

  44. Doc,

    I did finger prick testing yesterday and touched a door knob of the testing room while I’m still bleeding.

    Assuming there are stains of blood from previous person who took test is positive.

    Am I at risk? Because I believe the still bleeding finger prick is still considered fresh wound?

    My negative result was shortlived until I realised I touched the door with still bleeding finger prick.
    Shivering with fear now

    • No, you will not get HIV from a doorknob.

      • Hi Dr Jonathan,

        Thanks for the reply.

        I literally broke down today crying because of this.

        Is it a 100% assured that I won’t get HIV from a fresh finger prick wound from blood test with another person’s blood on door knob? Even if the stain on door knob is about 10mims old and it’s from someone HIV positive?

        I’m pretty sure my wound had direct contact on the knob from the test centre.

        I know my questions may be irritating but an answer could help me out abit. Also PEP necessary?

        • No, there is no risk at all and you do not need PEP.

          • Thanks for the clarification doc,

            Another crucial question,i had the following test below:

            1.Alere determine 4th generation test – 28 days, 43 days, 52 days – all negative (finger prick test)

            2. 30 days – 4th generation Elisa ab/ab blood drawn lab test – non-reactive

            Have you ever seen anyone turning positive after the 30 days ag/ab test (alere & Elisa)?

            Also is a test at 90 days (3months) recommended?

            Thanks for taking time to answer this doc.

          • No to both questions.

  45. Hi Dr,

    I am a male and I had performed multiple uprotected oral sex (cunnilingus) on a same woman of unaware status, and always condom protected vaginal sex (In a way like this; 2-3 acts per day for 4-5 days-first oral then vaginal). Do you think I am in a risk? Should i get tested?

    • There is extremely low to zero risk from oral sex. There is low risk from any penetrative vaginal sex, as condoms are not 100% protective.

  46. Last test

    Hi dr. Jonathan
    I was tested negative with 4th generation test at 17 days and now ı am tested negative with anti-hiv(chemiluminescence) at 45 days. İs it conclusive sir?

  47. Hi dr.after 28 days of unprotected sex i went to clinic to get tested.but they only used 3rd generation test.i know it is conclusive in 3months but what is the accuracy of this test in this period.thank you dr.

  48. Hi Dr I got a 4th generation hiv 1&2 antibody test 28 days after exposure the result was non ractive is my test conclusive? I’m in the United States and they suggested to test again in moths to ensure a conclusive result. Thanks

  49. Hi doctor
    I asked before about receiving unprotected oral and insertive protected anal with non broken condum i had couple more questions i am not sure if you saw them or not. I will copy them here

    You said “essentially Zero risk” does that mean i dont need to test?
    If i need to test, do i have to wait until the 28 days mark?

    I decided to take the RNA early detiction today at day 10 and will receive the results in 4 days!
    How accurate this test?
    If its negative do i still need to confirm it with 4th generation after 28 days?

    I am overly worried and anxious
    Thank you very much for your help.

  50. Hi Dr Jonathan,I have tested HSV and HIV Combo at days 58 .The result show I infect with HSV-1 but for HIV is negative so I would like to know is my HIV result conclusive or need to retest due to I infect with HSV-1.Hope u can reply me.

    • The HIV result is conclusive; no need for further testing.

    • Worried man

      Hello Doc, first of all i want to thank you for Help so many people with their worries and axiaety like me, second i have to apologize for my medium level english, here is my story, 4 months ago i had an indeterminate hiv result( 1 month after a protected sex with a sex worker), that scared me a lot and i went out of the lab to two more labs to confirm the result, in one lab the test come back negative and in the other come back indeterminate again, the bioanalist told me to no waste more time with 3rd gen and they ran a 4th gen test, it was negative thank god, but that was not enough to me to be completly calm, i repeat a 3rd gen a week after that ( negative), then 6 week after exposure( 3rd gennegative) 8 weeks (3rd gen negative) 12 weeks (3rd gen negative) and finally at 105 days 4th gen and hep C negative both.
      Are my 7 negative test ( including two 4th gen test) conclusive?
      Are a 4th generation test use a confirmatory test when a 3rd gen come back inderteminate or positive?
      Do i have to take another test at six month?
      Thanks for your comments

      • By definition you do not have HIV. Indeterminate tests can occur if there are cross-reactive antibodies such as from other retroviruses (a flu virus can cross-react even). I do not recommend further testing.

        • Worried man

          Thanks for your answer, if i were beggining seroconversion i should test positive in the following 5 test i had right?what are the odds of have a positive result after a 105 day negative 4th gen?
          About the symptoms i am expirience neck and joint pain, i had night sweats but no lymph nodes, no fever, no rash.

          In this country ( Venezuela ) we are lack of medicines and lab are lacks of reactives to run a wester blot, they are using 4th generation test to confirm a positive or inderterminate 3rd gen, is it a valid way to confirm the results?
          Thanks again and God bless you.

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