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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.

Click here for Info on STD Symptoms in Men
Click here for Info on STD Symptoms in Women
Click here to see the full range of our HIV/STD Services

 

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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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2,218 Comments

  1. Hi doc

    I had sex with a csw with condom last 5 weeks on day 3 i feel like my body is very hot and when i check my temp. It was normal i also had diarrhea and itching of the throat after few days my diarrhea was gone now i have body pains in my arms and shoulders sometimes its gone and again come back the pain is tolerable not severe but i also have clogged nose mild cough for about 2 weeks now and right now my neck hurts do i have hiv? Thanks for your reply much appreciated.

  2. Hi doctor, I had some white discharge after the erection. I had unprotected sex with my partner. Please advise what should I do?

  3. Hiv from injury

    Hi Doctor ,

    I think my question is bit confusing .

    My friend who frequently visits prostitutes for sex , so he was fighting with some person on the street , his hand got scratched with nails just a 3 MM scratch just a tiny amount of blood was coming , so i went to stop him and i got a tiny amount of blood in to my hands ( less than a drop of blood ) and i accidentally put in to my nose , is there any harm of hiv infection from this activity . Do i need to test for hiv , Please help me sir

  4. Mohamad

    HI.i just tested as below :

    1)Pcr rna.@ Day 61+HIV 1.2 ab (negative)
    2)ELISA.@ day 89(HIV 1.2 ab & p24) (negative)
    3)hepatitis B & C @ day 117 + HIV 1.2 ab (negative)
    _______________________________________
    But my tongue is white and I have Linea Alba in my checks and tongue. And so I lost my weight about 10 kg.what should I do. Please help me.

  5. 8 weeks pcr rna test

    Hi Doctor ,

    At 8 weeks i have taken pcr rna test it is not detectable , is this conclusive , and at 6 weeks pcr dna test . what is the difference between pcr rna test and pcr dna test . is both are accurate tests to detect hiv infection.

    Thanks for your service .

  6. Laerti

    Hi Doctor,

    I had a negative RNA test 12 days after a potential exposure, but a week after I experienced a dull ache in my lower left abdomen which lasted almost 6 days. The ache itself was quite subtle and came in random intervals during the day- first days it was more sparse, then peaked in frequency around the middle, and progressively wore off by days 5-6. I experienced no other unusual symptoms, gastrointestinal or otherwise.

    I’ve read that even though some symptoms are more commonly associated with ARS, generally ARS symptoms can take a variety of forms. Could ARS manifest itself as the above? Do you know if its indicative of another, say gastrointestinal condition?

    • Your RNA test is already essentially conclusive. We do not diagnose or exclude HIV through symptoms, or lack thereof. Only testing.

  7. Shared Beer with Hiv positive friend

    hello doctor ,

    I have my friend recently diagnoised with hiv infection just one month ago , just two months back i have shared beer bottle with him as i don’t his disease , can i get the hiv infection from him , i am really scared of it . is i have to get tested for hiv . waiting for your response .

  8. Raven

    Hello doctor,
    About 4 to 5 years ago I gave oral sex to someone I knew immediately after my mouth burned. The burning lasted for a few then went away. I went on vaca 2 weeks later to see him again. We had unprotected sex. Within a week I had a bald spot on my tongue. I was nervous so went to hospital they said it was dehydration. I had been drinking a lot on vaca. They gave me meds and it went away. About 3 yrs ago I had white stuff on my tonsils but no sore throat. Went to urgent care the docs said it was tonsil stones. I had a endoscopy done they diagnosed me with lpr. Just recently I had a tiny bit of a sore throat on one side then the next day the other side. Then it went away and I woke up my uvula looked like it was dipped in white paint. I went to urgent care they said they were tonsil stones and did a cbc. All my numbers were normal. They gave me a mouthwash but it wasn’t magic mouthwash. I only used it once and it went away. The next day I was working in my yard and had an urge to look in my mouth again. The back of my throat around my uvula was covered in white stuff. I used a Qtip and wiped it away it was a bit red under it but no pain. I had some diflucan from a while back and read that it helped thrush. So I took the one pill and in 12 hrs it was gone. I’m really scared about hiv….if i had hiv would the only signs be oral? And does thrush go away that quick. I also quit smoking a year ago and I am an asthmatic that uses advair 2 times a day. Oh and recently for the last few months I can’t stop clearing my throat…. please help…

    • We do not diagnose or exclude HIV from symptoms or lack thereof. The only way you can know is by testing. Advair use can lead to oral thrush, as with any inhaled corticosteroid.

      • Raven

        Ty so much for you reply. I am just wondering if it is likely to have only oral symptoms 4 to 5 years later other then that I feel great. and if hiv causes immediate symptoms like the burning right after oral? I purchased the at home oraquick it’s on the way but I’m scared.

        • HIV can cause any number of symptoms or may not cause any at all 4 or 5 years after transmission, so that question has no straightforward answer. But it definitely will not cause immediate symptoms like burning right after oral sex.

  9. Hiv from salaiva

    Hello doctor ,

    when i was having conversation with my friend accidentally a tiny drop of saliva spitted on my eyes , the thing i am worried is he frequently visits prostitues for sex .

    is iam risk of hiv infection from this incident ?

    Should i get tested for hiv at time should i get tested and i am from india .

    Waiting for your response .

    • Nope, zero risk. No cases ever reported. You can relax.

      • Hiv from saliva

        Thanks doctor for reply , As i am worried as i got marriage within 2 months , can we consider this as zero risk , no testing needed for this exposure . I am bit worried please help .

  10. Hi doctor

    I had a possible exposure 11 days back. at the 9th day I begin to had bad running nose and slight sore throat.day 10 I had fever and visited a GP. prescribe me with normal paracetamol and anti inflammation pill. today is day 11 and fever has subside, no sore throat either. is this ARS? I have read somewhere in your site that ARS only come 2 weeks after infection. is my symptoms too early to consider as ARS symptoms? and is day 14 to go for a 4th Gen test?

    • We do not diagnose or exclude HIV based on symptoms. The only way to know would be HIV testing. Day 14 would be a good indication but it will not be conclusive until day 28.

  11. Hi Doctor,
    2 weeks back I had sex with csw in India and condom was used but I am not sure about its quality, itching and pain was there from first day, on 3rd day I went to visit a urologist due to continuous itching ,pain on penis and itching on testicles and anus. he diagnosed mild balanitis as I have an uncircumcised penis. He gave me medicines and asked me to get regular urine and urine c&s test but reports were absolutely fine. After medicines I got relief but now as I masturbate and from 2-3 days I feel as if those symptoms are coming back.
    Note- I also have constipation problem he told me anus itching could be because of that !

    • Sorry, what is your question? Your symptoms are not related to HIV infection.

      • Sorry Sir,
        MY question is are these all symptoms of any std except hiv ? Should I go for further testing ? Though I will get a test after 3 months for hiv ! But I think I could have some other std infection . Should I visit some other doctor for opinion ?

  12. Conclusive

    Hi Doctor ,

    My condom broken , when having sex with sex worker , after 3 months post exposure that is exactly at 91 days . i have taken ELISA test and tridot test ( INDIA ) is it conclusive is iam free from hiv virus or do i need to retest after 3 months . Thanks sir

  13. PCR TEST

    Hello doctor ,

    In india i had pcr test which is done at 3 months post exposure , it came back negative and performed western blot test also it came negative , can we take this as a conclusive result , when it comes to my exposure , i went to get tested for hiv three months back in one lab and after the test she has given me one white colour spirit to clean my hands i doubt that it would cause an infection if i touched my fingers on my mucous membrane . Please help me sir as i have my marriage in next 4 months . do you have to take one more test . I didn’t had any sex with any one in my life . Just to make sure i am clean of hiv , hep-b,hep-c i went to clinic for getting tested that’s it . Please help me sir

    • You have no actual risk exposure to begin with. And your test is conclusive.

      • PCR TEST

        Thanks doctor for your reply , what if i had touched my hand with that spirit from where she has drawn the blood from my vein puncture , is there any risk from this . Thanks once again for your service you are doing to us

  14. Hi doc. I had the 4th gen test at 27 days & 3rd gen test at 6 weeks. Both results were negative. My exposure was unprotected oral sex and protected vaginal sex. I’m at the 8th week now and I’m having a fever. Should I be worried about it & get tested again?

  15. Hey Doctor, about 6 weeks ago I had oral sex (without condom) and protected vaginal sex with a CSW. During this 6 weeks I haven’t had any symptoms of ARS. Recently I noticed that I could feel 1-2 lymph nodes on the right side of my neck and groin. For the groin, one node can be seen when untouched, but it’s rather small, about 1cm and just slightly raised. I’m not sure if they were always palpable but they don’t seem swollen (Doesn’t buldge out, not painful and only can be felt when pressed). I’ve read your FAQ that lymph nodes can be palpable on the neck and that they are painful during ARS.

    I’d just like to check if there are any symptoms that I should look out for and if my current condition is something I should worry about.

    Cheers!

    • Hi, we are unable to comment on symptoms or signs without a proper consult and examination. HIV is very difficult to identify just with symptoms. Although your exposure sounds fairly low risk, there is still some risk. If you are concerned, please see a doctor and get yourself tested.

  16. Hi Doctor,

    I had unprotected vaginal sex 5 weeks ago with someone of unknown status. He did not ejacutulate inside me but I am aware of pre-cum. I reside in the UK.

    After two weeks they tested negative for HIV. This means in the two weeks before our exposure he could have had another exposure that infected him.

    Ive been panicking about this encounter as I’ve had a white tongue on and off and what feels like a burning tongue. About 10 days after this encounter I also had a sore throat and my left neck and shoulder has ached on and off since. Does this sound like ARS?

    I had a Rapid Alere Determine test 29 days after exposure which returned negative. How likely is it that this a false negative? Are rapid 4th gens tests really accurate at this time? I’ve read research that the p24 part of this test is not reliable at all.

    Please please could you help me?

    • We cannot diagnose HIV through symptoms, so I really can’t comment on that. The Alere Determine test is only conclusive after 3 months post-exposure. It is fairly reassuring that your partner was tested negative 2 weeks after your encounter. I would find it extremely unlikely and unlucky if he had contracted the virus in that short time period prior to meeting you.

      • Thanks Doctor.

        I’m slightly more worried now. So the 4th gen Alere determine combo I took at 29 days has no reliability at this time?

        • Ah, sorry. If it is a Combo antigen/antibody test then it is reliable at 29 days. The Alere Determine antibody only test is conclusive at 3 months.

          • Yes it was the 4th Gen Alere Determine Combo AG/AB test. It was negative. I have also take a 4th gen lab test (waiting for results) but having major anxiety that the results will be different. Should I be concerned?

            Many many thanks for your opinions.

          • I would not be worried if I were you.

  17. I have tested 4th gen test at 3 and 4 weeks. Both are neg.
    Should I continue be worried about the HIV infection?

  18. Hello Doctor,
    Two days back I had sex with 2 prostitutes, but I didn’t release any fluid I couldn’t cum . I wore a condom and after the Sex from past 2 days I have Itching and pain in my penis and my whole body is paining even I have a feeling of vomiting and I can feel rashes around my body. Is this any symptom of STD or HIV or is this symptom that in future I can get this disease. As far as I remember I had my condom on while the contact.
    Note: I didn’t release any fluid.

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