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More on HIV symptoms

stop aids signI previously wrote an article on early HIV symptoms.

I am still receiving a lot of questions with regards to HIV symptoms so I am writing another article to provide more details.

What is HIV ARS?

When people talk about ‘HIV symptoms’ they are generally referring to the symptoms that appear soon (2 to 6 weeks) after a person is infected with HIV (as opposed to late AIDS symptoms which take years to develop).

These symptoms are a result of the body mounting an immune response to the HIV infection, NOT due to the infection itself. That is why you find similar or identical symptoms with other infections.

It is also commonly known as Acute-Retroviral Syndrome (ARS, ARVS), acute primary HIV illness, acute HIV syndrome and Acute Sero-Conversion Syndrome.

HIV Symptoms are due to the immune system responding to the virus that is why many other infections can cause the same symptoms.

What are the early symptoms of HIV infection?

Because the whole body is reacting to fight off the virus, it is not surprising to find a variety symptoms affecting all bodily systems.

General – Fever, Sweats, Lethargy, Malaise, swollen lymph nodes, weight loss

Skin – Rash, ulcers , Sore throat

Digestive – Nausea, Diarrhea, Loss of Appetite

Neurological – Headache

Musculo-Skeletal – Muscle aches, Joint aches

Not everyone will develop all these symptoms. These symptoms can develop in varying combinations.  The most common symptoms are fever, sore throat, rash and swollen lymph nodes.

Only 40% to 70% of people infected with HIV will develop ARS symptoms

Who gets HIV ARS symptoms?

It is estimated that between 50% to 90% (some say 40% to 70%) of people who have been infected with HIV will develop HIV ARS. There is no way to predict who will develop ARS and who will not.

When do HIV symptoms appear and how long do they last?

HIV symptoms can appear anytime between 2 weeks and 6 weeks after infection. Most people who do develop the symptoms do so at 3 weeks.

Symptoms generally last for at least 2 weeks but have been known to last up to 10 weeks.

‘Flu-like’ is not ‘Cold-like’

HIV ARS symptoms are often described as ‘Flu-Like’. Many people think having a Flu is similar to having a Cold and this has led to a lot of confusion.

Many patients see me for minor cold symptoms such as running nose, sore throat or a mild cough and are worried to death about HIV.  These are Cold symptoms, they are not Flu symptoms.

For those of you who have had the Flu before, you will know what I am talking about. With a Flu, you will be very sick. The fever is high and persistent, the bodyache is very bad and you literally cannot get out of bed.

To be more precise, ARS is also described as mononucleosis-like symptoms.

The HIV ARS Rash

This is a great source of worry for many people I see. I have seen people coming in with literally one tiny red dot on their forearm convinced that it was a HIV rash. It is not.

The HIV rash usually comes on 2 to 3 days after the onset of the fever and lasts for at least 2 weeks. It is a Morbiliform (looks like measles) Exanthem rash consisting of macules and papules up to 1cm in diameter which are pink to red in colour. Each lesion remains discrete and do not become confluent. It is widespread and always (100%) involves the upper thorax and collar region also commonly (60% to 40%) affects the face, arms, scalp, thighs and palms in descending order of frequency.

Basically, the rash is BAD. Your friends and colleagues are going to take one look at you and ask ‘Hey why do you have a rash? Go see a doctor’.  If you have to hunt for individual spots or patches randomly on your skin, it is not a HIV rash.

The HIV ARS Rash looks like Measles

The HIV ARS Fever

Where do I start? I have patients measuring their temperatures hourly and freaking out when it hits 37.1⁰C because they read somewhere that ‘normal body temperature’ is 36.9⁰C and therefore they have a fever and therefore they have HIV. That is paranoia.

The HIV ARS Fever is high, usually above 38.5⁰C when taken from the ear.  The HIV ARS Fever is long, usually lasting for at least 2 weeks most of the time longer. It is usually associated with other symptoms such as lethargy, malaise, muscle aches and joint aches.

The HIV ARS Lymph Nodes

This is another great source of worry. I have seen patients who cannot stop rubbing their necks feeling for lymph nodes and melting into a panic state whenever they feel a lump that they have not felt before.

First of all, you can feel normal non-enlarged lymph nodes especially in thin people. So being able to palpate a lymph node does NOT mean it is enlarged.

Enlarged lymph nodes are about 1cm in diameter. In HIV ARS, there are usually many of such lymph nodes in the neck, groin and underarms. They are usually tender (i.e. painful to touch).

The HIV ARS Sore Throat and Mouth Ulcers

The sore throat associated with HIV ARS is bad. It is not a little discomfort in the throat or the sensation of having to clear your throat. It is painful. If you ever had Strep Throat before, it feels like that.

It is commonly described as an exudative tonsillitis. In other words, you will be able to see white or yellow pus-like substance on the tonsils. The tonsils themselves will be red and swollen. About 20% of the time, there are also ulcers round to oval in shape, 5mm to 10mm in diameter with a white base and red halo on the inside gums, tonsils or roof of the mouth.

Anxiety can frequently cause the muscles around the throat to tighten leading to some throat discomfort. This is NOT HIV.

What other diseases have the same symptoms as HIV ARS?

First of all, the Flu. And by that I mean an Influenza infection, not a cold. See above for details.

HIV ARS symptoms also mimic the symptoms of infectious mononucleosis very closely (also known as Mono or Glandular Fever). HIV ARS symptoms can also be mistaken for an acute Hepatitis A or B infection, Parvovirus infection, Cytomegalovirus infection and Toxoplasmosis. It can even be mistaken for Rubella (German Measles).

Take  home message: Do not assume and do not self-diagnose based on symptoms. Go get tested.

Click here for HIV Testing FAQ

Conclusion

The only way to know for sure if you are infected with HIV or not is to get tested. Until that is done, try not to worry about your symptoms.

If you have to worry, then worry if you fulfil the following criteria:

  1. You have had a high risk exposure 2 to 6 weeks ago
  2. You have a fever above 38.5⁰C that just does not go away
  3. You have multiple small red spots covering your face, neck and upper chest
  4. You have a really bad sore throat with ulcers in your mouth
  5. You have been diagnosed with another STD like Gonorrhea or Chlamydia
Click here to learn about other factors that increase HIV risk

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.

Click here for info on PEP Treatment at Our Clinic

Remember, you are not doing yourself any good by hunting for symptoms. Take a deep breath, calm down and focus on getting the HIV tests done.

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About Dr. Tan
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1,492 Comments

  1. Hi doc, is it possible if the HIV ARS is just one swollen lymph nodes (not painful to touch) and dont have others general symptom like above? Im not sure its swollen lymph nodes or not by the way

    • No. ARS usually presents with multiple tender lymph nodes. If you are concerned, you should get yourself checked by a doctor.

      • Is it possible the lymph nodes a little pain sometimes but not swollen? Or the lymph node is painful if just swollen? Thanks for your answer doc.

        • Lymph node should not be painful if it is not swollen or inflammed.

          • Can i say if armpit is a little pain but not swollen, it is not a lymph node? Maybe muscle, joint or bone? I felt my armpit a little pain sometimes but nothings swollen. Need your opinion doc. Thank you

  2. hellothere

    hello doctor. is it possible that just after 5months after exposure, I would start to get really weak? I’m really really weak right now for about 1month already. my joints hurts, i feel like i have a swollen lymph node? or i dont know maybe beacause i’m always touching my neck? my tongue looks white, and this is the worst case, on my fourth month after the unprotected exposure, I experience like I loss my sense of touch first on my back and now it spread all over my body. It’s really annoying. It feels like I can’t feel my body or my body is feeling tolerance to pain since I can’t feel anything. my questions is 1. is it possible after 4-5 months of exposure, would it affect me already and feel really really weak? 2. is the losing of sense of touch to the whole body a symptoms of hiv? thankyou doctor and more power :)

    • I think you should consult a doctor and get a proper assessment.
      1) Lethargy and feeling weak are symptoms of HIV but it does not mean you have HIV.
      2) Not typically.

  3. paranoidguyhuhu

    hello doctor good day. i’m a bisexual guy from the philippines. my story goes this way. I have a boyfriend for about 7months now so we got in a relationship last november. in that november time span, we already had sex(unprotected sex) and keep on doing it until now. now my concern is that, last month (may 16), I’ve suddenly experienced numbness and weakness of my body, severe headaches, over-fatigue that continues until now. so meaning I’ve neen really feeling weak for about a month now. as i’ve searched for symptoms about what i feeling hiv came out in the google, and i was really really afraid, i started getting paranoid and anxious. i told my boyfriend about this and he just got angry with me and said that we are safe. my issue and worry is that what if he cheated on me and he had a sexual intercourse to other person while we were in a relationship? wjat if that certain person passed the virus on him and my boyfriend passed it on me? now on the positive note, my boyfriend is okay do not feel anything like symptoms of fever or whatsoever. i’m thinking that if the virus is from him, he must be the one who must first feel the symptoms? I’m just really really paranoid I hope you can help me with this issue, also right now(this week) I feel like i have swollen lymph node, I also have white hairy tounge and white patches in the under of my cheeks, I can feel chest pain sometimes severe,I’m overly fatigue like I can’t climb a 3floor building without getting out of breath. I don’t know what I should do with my life. I’m afraid getting test because it’s really embarrasing and my boyfriend don’t want it because he says there’s nothing to worry about.

    • paranoidguyhuhu

      my concern doctor is that am I in high risk on having it? I wanna try the hiv kit that is for sale here in the philippines and they say it’s accurate but I’m really afraid for the result. I’m thinking that my life is over if i tedted and become positive :((((

      • First of all, you have not even decided to get tested but you already are worried about your life after being diagnosed with HIV. Secondly, even if you are tested positive, your life is not over. These days, people with HIV under appropriate treatment have similar life expectancy as anyone else. They live a normal life.

    • Do not feel embarrassed of getting tested. You are responsible for your own health, not anyone else. And it is always better to find out early if you have an illness. Therefore, go get tested if you are worried.

  4. philippine boy

    good day doctor. i’m a bisexual guy from the philippines. I’ve had a boyfriend for about 7months now. he is my first time to have sex with while im not his. for this 7 months span of relationship, I’m feeling very happy and healthy. but last month, of the ,month of may, I started feeling weak, numb, over-fatigue. right now after 1 month, I still feel fatigue, chest pain, i have swollen lymph node(I guess?), i have mouth thrush( also i guess?) and I’ve been really really paranoid. I’ve talked about this to my boyfriend and he just got angry with me. My boyfriend is healthy and seems okay and do not feels any symptoms at all. but i’m really really afraid that I might have hiv. what if my boyfriend was cheating on me and had sex on another person while we were in a relationship? and then he got exposed by it and he passed it on me? The only thing that keeps me holding to positive thought is that my boyfriend is healthy and do not feel anything right now. I just hope he’s telling me the truth cause I’m being very paranoid and my body is really getting weak I can/t even climb a stairs without getting out of breath. I”ve been really really weak for almost 1month now :(( please help me doctor.

    • I would strongly suggest you get yourself tested for HIV if you are worried. If you think your symptoms may be related to HIV, the only way to find out is to get tested!

  5. Paranoidguy

    Hi Dr Tan, i was at orchard towers to buy something from Mamashop, i walked past some of the massage palors and some of the masseuese girls touched me trying to lure me in, am i at risk from catching HIV or STD’s? Please reply im very worried :'(

  6. Hi Docs,

    Is the ARS sore throat painful ?
    Can the sore throat exist on its own only ?
    And my last question is that can ARS symptoms appear earlier than 2 weeks after exposure ?

    Thanks

    • 1) ARS sore throat is extremely painful. It is not like your usual common cold kind of sore throat.
      2) It is possible.
      3) It is possible although it is unusual.

  7. Ram Yadav

    Can ARS symptoms appear within 5 days of possible exposure?

  8. Ram Yadav

    Can ARS symptoms appear after 4 days of possible exposure?

  9. Hi Dr Tan,

    I had protected sex with a prostitute 11 days ago. I recently started to have a mild sore throat with small white patches on the left tonsils only and the sore throat wasn’t the worst I’ve experience. I am still able to swallow food without pain. I also started feeling dizzy during bus and train journeys while traveling. Are these symptoms of HIV ??
    Oh, and for ARS sore throat, it will come together with fever right ? Or is it just sore throat only. ?

    Thanks !

    • Dr Justin Sim

      Very unlikely in the sense that ARS symptoms are very severe. Also it is not advisable to base a diagnosis of HIV on just ARS symptoms since these are not specific. Common things are common so your symptoms are likely due to a mild viral illness but I would advise you to get HIV tested at the right time to be absolutely sure.

      • Hi Dr Sim,

        When will be the best time to test for HIV ?

        Thanks

        • Dr Justin Sim

          The earliest time to get a test would be with a combo test done at 28 days from exposure.

  10. Thompson P

    Hi
    Can a cough with phlegm by itself an ARS symptom?
    i do not have fever, rash, sore throat or swollen nodes.

    • Dr Justin Sim

      A simple cough is not ARS. ARS is described as the worst flu ever. Either way, do not base a diagnosis of HIV on symptoms as this is very very unreliable. Get tested to be sure.

  11. Bambrick

    Hello are there any rashes that are not related to Hiv that would appear on the chest for almost a month I had a rash on my chest that lasted almost 3 to 4 weeks it favored the hiv rash dr told me it was ringworm the rash started disappearing around three weeks.

    • Dr Justin Sim

      Most rashes are not related to HIV at all. There is no rash that favours HIV unless you know that you have HIV or get tested to confirm. Ringworm is much more common and is fungal in nature. Best to see a dcotor again if you are concerned and get tested for HIV if you are worried about that.

  12. hello drs
    went out just now accidently my foot hit the iron,then my foot bleeding,is thr possible to get hiv or hcv?thanks

  13. Hi Doctor, is 3rd gen hiv test negative at 4 months conclusive?

  14. barbara

    hello drs,i just done my blood test at lab。becos i scare of the blood,i didnt see the nurse when she take my blood, I also dunno is she using a new needle or not, is there any risk of HIV? Shall I get test?

  15. barbara

    Drs,i had just done my blood test from lab,becos of scare of the blood,i forgot to see wether the nurse is using a new needle take blood from me。is there any risk on hiv?

    • All needles and syringes used for drawing blood are meant to be sterile and for single use only. There should not be any risk of HIV at all.

  16. Tim McSimmons

    Hello
    Can ars fever come in the evening and go in the day? 2 nights ago I had a fever of 37.2 and last night 37.8 (plus muscle aches) but then during the day it goes back to normal range – 36.6-37.0.

    • Dr Justin Sim

      ARS fevers can occur at any times but do remember that fevers are not specific to HIV and are much ore likely due to something else like a common viral or bacterial infection.

      • Tim McSimmons

        Yes but are the Fevers constant? On this page it says – be worried if you have a fever over 38.5 that doesn’t go away. I’ll ask again – does it sound like ars when you get a temperature of 37.2 one night, then it goes during the day, then that night 37.7, then it goes the following day? No sore throat, no rash, just slight fever at night and muscle ache?

  17. Hi Doctors, i was wondering if urinating in the toilet will it have the chance to get HIV? As one pee into the urinal sometimes it tends to splash back when peeing standing up.

  18. hi dr tan,i had done combo test at ur clinic at bencoolen after my last exposure 30 days,shall i retest at 3 month? thanks

  19. Dear doc,

    Happy to see this post. I have a question for you.

    I had protected sex with social sex worker on 25 May. I cant see any damage to the condom that provided by her. I felt very guilty after the event and worrying about hiv. At that day, I was just got healed from common fever.

    On 5 june, 11 days after the event, i was so paranoid and immediately done hiv Ag/Ab test. The results came out negative. I know it is not 100 accurate considering window period.

    Then start the most worrying time. I got mild fever on 8 june until now. No rash, sore throat, or swallon lymph gland. But i’m encounter night sweats yesterday. Please help me doc. Thanks once again

    • Your test at 11 days is not conclusive. You should repeat the HIV Ag/Ab test after 28 days. Fever could be due to a lot of other reasons. Consult a doctor and get a proper assessment.

  20. Dear doc, I’ve not had sex before but I had foreplay with a very close friend which caused injury to my penis when I rubbed it on her vagina. I’ve had cold after 8 weeks, sore throat, no aches, no swollen lymph, no rashes, very mild headache which has disappeared after three days, no fever, no night sweats. But I’ve been having pains during urination and itching in my urethra. I knew that Hiv could cause flu and site throat. so I asked the girl if she’s had sex before but she told me she’s a virgin. So we are both virgin. Does this sound like Hiv symptoms?

    • If you are both virgin (and HIV negative), it is impossible to pass STD or HIV to each other. Your symptoms are very non-specific. However, painful urination and itching in your urethra are signs of infection. I would suggest you consult a doctor to get yourself checked.

  21. Hi Doctor, yesterday i went to orchard Towers just to eat thai food, not interested in the massage parlors or special services, but while eating i accidentally bit my tongue and it bled abit, im afraid of contracting HIV as i know for a fact that Orchard Towers is not exactly a “clean” place if you know what i mean, am i at risk of infection? Im abit paranoid now about the utensils not clean or the air is unclean, im looking forward to your reply Doctors. :(

  22. Hi Doc Justin,

    I was the patient that you just saw who did the rapid test. Last exposure was on 14 May. So technically speaking its 22 days past last exposure. I suppose this wouldn’t make any difference from the negative results that I got just now?

    Thank you in advance!

  23. Hivfree

    Hi doctors,

    I just had a rapid test done and results is negative. This is 22 days after exposure. However, the recent exposure with a local CSW is not the one that’s worrying me. It’s the others from previous visits in feb March and April.

    Can I consider the negative result gotten today to be conclusive for the exposures I had from feb till march? I know 22 days is not as conclusive as 28 days but it should be at least 90% accurate?

    Thank you for your time!

    • drtan

      It depends on what kind of rapid test you did. Some are conclusive at 28 days some take 3 months some even take 6 months. So as long as you tested after the window period specific to the rapid test you took in raltion to your exposure, you can consider it clear. Again, as for how accurate the rapid test is at 22 days, it also depends on what kind of test it was.

      • Hivfree

        Hi Dr Tan, this was the test that I have done!

        Rapid Fingerprick Blood HIV-1/2 P24 Antigen/Antibody Combo (HIV Duo Test) (4th generation!)

        If I were to refer it to my very first exposure which was in January and the subsequent exposures from Feb to April, I suppose I can consider the negative result to be conclusive? Other than the very last exposure 22 days ago?

        Thank you for your time again!

        • drtan

          Yes that is a combo test conclusive at 28 days. So you are right, it covers all your exposures except for the one 22 days ago. That said, even at 22 days, it is already as good as conclusive.

          • Hivfree

            Hi Dr Tan,

            Thanks for your confirmation!

            Have a great day ahead!

  24. soscared

    hello doc
    i had a high risk exposure insertive vaginal sex. After 8-9 days i dont know if its a fever but i checked my temp its. Around 36-37.9. Went to a clinic in africa they say its malaria they gave mends. After i felt my muscles in my thigh region has pain like tingling sensation. Which led me to go to another clinic after 18-19 days theysay its salmonela i took antibody test i dont know if ist a rapid test or what? Nowat week 6-7 i felt swollen lymph nodes nside mylower jaw lasted for about a month. Night sweats i dunno if i am having it but now o alway feel i have a fever lost appetite weight lost. Is this hiv or severe stress?

    • The only way to tell if this is HIV or not, is to do a HIV test. Since it is 6-7 weeks post exposure, HIV combo test will be conclusive. I would suggest you go to a doctor to get assessed again and do a HIV test if you are concerned.

  25. i got needle prick last two weeks and I have rash in my elbow and I have tonsilitis, fatigue and night sweats Im afraid help me

  26. Hello doc,
    I had protected sex with a prostitute 6 weeks ago. The oral was unprotected and we had deep kissing also…right from day 2, i developed urticaria on my body…it started on palms and spread anywhere on the body..there is itching and red like color appearing which goes away in 1 hour…there r large bumps appearing on my scalp and forehead…its been 6 weeks now and i continue to get then whenever i rub my body anywhere…can u please advise if this is a sign of hiv? What tests do i need to take?

    • No, they do not sound like symptoms of HIV. I would suggest you see a doctor for a consultation. You did put yourself at risk of STDs, therefore you should get a STD testing as well.

  27. Graeme Lowe

    Hi Dr Tan.

    I had potential exposure and 7 days later lost my appetite completely, got nausea, sore esophegus and vomiting after trying to eat then had bad abdominal pains/bowel movement and blood in stools so took rna pcr after 10 days which came back undetected. Since then I have had regular night sweats, mouth ulcers, a jock itch type rash on the groin. The ulcers and jock rash have gone down after 6 days. I have had extreme anxiety over this.

    What are the chances my RNA PCR was false negative? Does this sound to you like ARS?

    • Chances of false negative RNA PCR after 10 days is extremely low. It is difficult to tell if this is ARS, although they are not typical of ARS. You should really consult a doctor for your symptoms, especially if you are having blood in your stool! Also, you should get a full STD screening as well since you had put yourself at risk. Get a repeated HIV test done at 28 days if you are concerned.

    • hi doc. I’m a Medtech intern in a laboratory and i pricked my hand with a needle After 3 days I got rashes in my elbow and in 10 day I have fatigue and tonsilitis and night sweats. what will i do?

      • I would suggest you consult a doctor if you are concerned.

        • but is there a posibility that i have hiv? what are the chances? pls help me.

          • i already consult a doctor he said i only have allergy and tonsilitis. i dont know what to do.. is there a posibility that i have hiv? pls help me

          • You are being paranoid. HIV transmission via needle prick injury is less than 1%. You should have taken PEP within 72 hours after needle prick injury.
            Yours symptoms are not consistent with HIV infection.
            If you are concerned, you should consult a HIV doctor and get a HIV test done. You are welcomed to visit any of our clinics.

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  25. Dr Tan & Partners @ Novena – Infection and Andrology Centre | HIV - […] Analysis of HIV ARS Symptoms […]
  26. STD/HIV Clinic Singapore | HIV - […] Click here for more Detailed Information on HIV Symptoms. Do not worry in vain. Our doctor are …
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  30. STD General Info | STD - […] The common symptoms usually occur about 3 to 4 weeks after exposure. They are fever, sore throat, rash and …
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  37. Common Lumps & Bumps – Molluscum Contagiosum | GP Services - [...] Molluscum lesions do not pose a threat. They are generally self limiting and do not have any risk of …
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  39. Video of Positive Oraquick Advance HIV 1/2 Test | HIV Test in Asia - [...] More on HIV symptoms. [...]
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  48. HIV Symptoms – Early Symptoms of HIV | HIV Test in Asia - [...] For more on HIV symptoms, please click here. [...]

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