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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
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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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1,185 Comments

  1. Hi i had protected sex and unprotected oral on her lick vegina for less than min with sex worker 21 days ago after 2 weeks i felt sore throat and then some runny nose and gone after week i had no temperature. but my nose still have stuff anyway today im in 4th week tomorrow my last day in week 4 and today i wake up and i found have 2 spot one in both side in my tonuh in the tip looks like mark burn with white around and painless

  2. Hi doc,
    I’ve deep kissing smoothly just about for 20nd and suck gently her breast n lick…no sex activity…just kiss,suck,n lick…but after one week until now (now it’s already 11 weeks after exposured,i’ve rash.Rash just come n go about 1-2 hours,itchy,big pink n red…my question:
    1.Is rash apart of hiv ARS?
    2.Can i get hiv just from doing above..?
    3.should i tes doc
    Thanks doc..sorry my english really bad

    • Dr Elaine Loh

      firstly HIV transmission via deep kissing is close to negligible. Rash that came and went after 1-2 hours definitely does not sound like ARS at all.
      That being said, It will still be advisable to do a check at 4th week with HIV combo just to be very sure. hiv combo

  3. Hey everyone Im new to these boards. I pretty much have no one to talk to so these anxiety boards are all ive got. October 10th like the idiot that I am I had unprotected sex with my friend who i have known for 10+ years. I have had sex with him numerous times before and always came out clean. (hes straight and not a iv drug user that im aware of) But I know he gets girls. And if he doesnt use protection with me chances are he doesnt with other girls either. Before October 10th I had sex with him in July too but I know he could not have had anything then because all stds including HIV came back clean after 6 months which is this month of January. Here is where my nightmare begins. A little over 6 weeks after October 10th I came down with horrible horrible fatigue which continued for weeks, along with dehydration, dry eyes, pimples all over back/chest itchy dry skin, diarrhea, numbing tingling in hands feet legs, constipation some days, my vagina even dryed up. I was also nauseous and dropped like 10 pounds. I looked up these symptoms and thought ***** I bet I contracted HIV. I ***** bricks so at 8 weeks post exposure I bought an oraquick it was negative. I wasnt convinced so at week 9 I took another oraquick also negative. I thought no way I dont trust these tests so I went to my GP and requested an HIV Elisa blood test at 10 weeks post exposure. It came back in 2 days Non Reactive for HIV 1/2 from Questdiagnostics with reflexes. I still was not convinced even though most people who have a normal immune system would of converted by then considering my symptoms started at 6 weeks. But the thing is my CBC blood count was elevated so I totally thougt that means I probably havent converted yet from negative to positive even though Ive always been relatively healthy with no ilnesses or any issues I know of. So my doctor resheduled me to come back for more blood work just to see if my blood count goes back to normal. He never believed it was HIV infact he thinks im nuts. So pretty much I had to wait another 1 month in a nightmare. I cried everyday, quit my job cuz I couldnt focus because my odd symptoms kept persisting, drove all my family and friends crazy, contacted numerous HIV hotlines and even been on all kinds of HIV forums only for people to tell me im negative and to move on. Sotime for my conclusive test on January 22nd which would be around 15 weeks past my sexual exposure. I go get blood drawn for a CBC count and a final HIV test. I was absolutely sure it would come back positive. But to my surpriseI called my doctors office and they said my CBC was normal and my HIV test came back Non Reactive once again 15 weeks past exposure which is over three and a half months. But I am still not convinced due to persisting symptoms. My anxiety and nightmare continues. I still have tingling, numbness, diarrhea, abdominal pains, red burning eyes. I am so tired of living in fear of this disease. I read that although HIV tests are conclusive after 3 months Im scared im one of those people who do not create antibodies to the virus or that I still could be in the process of seroconversion still and although its rare maybe I will convert at 6 months. And the thought of living like this for 2 and a half more months makes me want to drive off a clif. I do not what to do. Pretty much I would have to be the unluckiest person live and my guy friend would have had to contract HIV somewhere from July 11th to October 10th and he would of had to have been in the HIV window period himself and have infected me. I am undeniably depressed and lost all my marbles. Noone will listen anymore. My doctor just keeps telling me that I dont have it and that Im blowing it way out of proportion and my family and friends wont listen and pretty much laugh at me. So pretty much that is how I ended up on these boards. I feel so alone.   

    • I have to say I agree with your doctor, family and friends, You do not have HIV. Just as you are puzzled why no one listens to you, I am equally puzzled why you do not listen to everyone else. To me, it is plain as day that you do not have HIV. If you choose not to believe that, I do not see how anyone can help you. Imagine you take your friend to the park in the middle of the afternoon and tell her that it is daytime. But she insists that it is night time. How can you convince her? You cannot. She has an illogical belief. Just like you have an illogical belief. What you need to to do is to accept the fact that you are not infected with HIV and go find out what is actually causing your symptoms. Until you do that, no one on earth can help you.

    • I understand I’m in your same shoes.I’m at almost ten weeks after. I keep getting negatives. But you are outside the window, so be thankful. It’s stress that is making you sick. I have been down this road before.

  4. uneasy1995

    Doctor, I had a unprotected oral with a prostitute 9 days ago, me being the insertive partner. I have been taking PEP due too my concern and insistence. I know I am in very little risk, but I am already experiencing a mild sore throat.

    • Dr Justin Sim

      ARS symptoms can present as flu-like symptoms (fever, chills, sorethroat etc) but usually present between the 2nd and 4th week after exposure (peak symptoms at week 3). Your symptoms are appearing a little early for ARS. Another point is that you are already on PEP, which is minimising the virus should it be in your system. The last point is, as you mention, your risk is low considering your type of exposure.

      Common things are common and your sore throat is most likely down to a common cold virus, or something in the environment irritating your throat. Either way, continue to monitor your symptoms; if things get worse then it is best to get reviewed by a doctor.

      Getting tested for HIV once you finish PEP will be the only conclusive way to eliminate HIV as a cause but unfortunately requires waiting.

  5. Hi i had protected sex and unprotected oral on her lick vegina for less than min with sex worker 21 days ago after 2 weeks i felt sore throat and then some runny nose and gone in same day and tired im so afraid and scared i had no temperature im on antiputics for 6 days my sore still until now but better but i feel something inside my throat like phlegm but i cant spell it out im really so afraid it now will be week and i didnt get better

  6. Hi
    I have scratched the tissue inside my mouth trying to take some food out of my mouth and it started to bleed severley. I have been touching public surfaces all day and have not had washed my hands. Am i at risk?

  7. Hi Doctor

    Im a 29 years women, I had protected sex but had an “accident” with the condom (it splipped after he ejaculated) I got a flu with 2 days fever 5 weeks after and got very scared.

    I havent had sex since rhen and We both got tested 41 day after with a “combo test”(chimio and p24) both negative… can I consider this conclusive or should I test again?

    Thank u!!

    • By the way I tool this test in a recognized lab, it was not a rapid test.

      • In my opinion your test is already conclusive. Please do not worry.

        • Thank u for your advice Doc!! Saludos desde Mexico.

          • Eres bienvenido! I must admit I got that from Google translate. Literally the only Spanish I know is “Hola soy Dora!”

  8. Hi Dr. Tan

    I had a sexual intercourse with a female sex worker around 6 weeks back. I did used the condom but not sure if it was put rightly. I had some throat infection at the time of the encounter and it did continued for 5 days more. I had took Cefroxime followed by Amoxycillin+Pottasium Culvonate for the same.

    3 weeks after the encounter I have noticed 2 red spots on right side of my stomach and 4 red spots on the chest. these spots are not itching and are flat. 3 of the spots got converted to small bumps but latter became flat. Now its the sixth week and still the red spots on the skin are there.
    I wanted to know can these be a cause of ARS and how long do the rash in seroconverison last.
    Have gone through various web site and am getting confused.

    • What do you mean you were not sure if the condom was put on rightly? In what way can it be put on wrongly? Your rash does not sound like ARS. However, you should still get screened for HIV and STDs.

  9. hi doctor tan my name is steven i am a 19 years old teenager i had protected sex with a sex worker and i bought a rapid kit test for hiv on urine type and blood but came out negative in 42 days of my explosure do u think is it still possible for me to get hiv becuase i have a severe backpain that does not go away do u think it`s a symtom because i am tested negative by a rapid test twice by 42 days from today .

    • The only HIV test approved for home use is the OraQuick test. Even then, it is not 100% accurate. I really cannot comment on the accuracy of urine tests for HIV. I suggest you see a doctor for a proper HIV test and at the same time screen for other STDs.

  10. Hello Dr.

    Typically, how long after ARS a person will test positive? I had a possible exposure eight weeks ago. At 6 week, I had experienced a possible ARS. Then at 7.5 weeks, I had a rapid test done but it came back negative. It’s exactly 10 days after I experienced the symptoms before I had the test. Would the test pick up some thing if what I experienced was ARS ?

    • I don’t know. I don’t think there is any specific data on this. My guess would be 2 weeks give or take. That is purely a guess. Personally I do not take ARS symptoms into account at all when calculating testing window periods. So that is a moot point to me.

      • Thank you. If so, how much should I trust my 7.5 weeks hiv test ?

      • Parker gorley

        About 6 days ago i received oral sex from a sex worker in thailand. I did not ejaculate into her mouth and it was very short period of time. I got home after and cleaned myself with soap. Today I woke up and felt a bit of nausea, had diarrhea and have a rash behind both sides of my knees, and I am slightly fatigue. Should I be getting tested?

        • I do not think what you did put you at risk of HIV. However, it does put you at risk of many other STDs like Herpes, Gonorrhea, Chlamydia etc

  11. Hello Dr,

    I would like to find out if this would sound like ARS to you, 2 weeks ago I had what I remember as protected sex with some who’s status I don’t knw, exactly 2 weeks later I had heartburn and diarrhea and some nausea.. Heartburn lasted only one day, the diarrhea maybe 2 or 3 days.. the nausea is still there though not as strong… Could this be anxiety or would this be some strange symptoms of ARS… Please help

  12. Dear Dr. Tan,
    During the fifth week after the post oral unprotected insertive exposure with a prostitute, I felt burning back and developed a rash on the lower back. It was itchy,the pink area was big with some bump like and disappeared within 12 hours…again appeared the next day with same nature but changing the place and disappeared I had also sore throat and found that the neck was swollen.No fever because i took temperature three times a day.i had night sweat for only one that….i am scared regarding all these symptoms.Are these ARS,doc? I would be really grateful for your kind reply.
    Thank you.

  13. Hello Doc,

    I had possible hiv exposure with a female sex worker. I’m uncircumcised, I used a condom but before I put on the condom we were making love while we were kissing the tip of my penis touched with a vaginal fluid but I didn’t put my penis. The monent I felt my penis touched with viginal fluid I put my the condom on and proceed with vaginal sex. Exactly for weeks later I’ve been having symptoms like low fever 99-100 degree F, light sore throat, nasal congestion. All symptoms bother me mostly at night and the symptoms still going and been more than six weeks since they started. I went to see my doctor but he told that could allergies he gave allergy pill which helps but symptoms still not completely gone. Could that be hiv ARS last that long? I’m scared to death I don’t know if I can live with hiv.

    • What you are describing does not sound like ARS. But you know what I am going to say right? Go get a HIV test.

      • Yesterday I called the female sex worker and asked her if she is hiv positive, she said no but I don’t really believe her. I’m planning to go get an HIV test next month if symptoms still persist. What bother me the most doc is a possibility that my girlfriend can get infected because a week after I had sex with the sex worker, I had unprotected sex with my girlfriend so if I get infected my girlfriend could get infected too.

        Question is hiv rash always multiple can it be just one? Because I had one small black mark on my nose that last for about a couple weeks.

        • Doc,

          Have you seen hiv patients with one tiny hiv rash on nose and itchy face (not the tiny rash) the rash was not itchy.

          Thx,

          Bob

          • Nope. But I don’t see how that is relevant. You still need a HIV test.

  14. rapid test

    Hi Dr.

    I have experienced ARS symptoms after possible exposure 6 weeks after.

    have done rapid test 8 weeks after (venous blood drawn ,results in 30 min). the test came out negative.

    Currently waiting for the combo results and extremely anxious.

    What is the chance to get positive combo after my negative rapid test given that the symptoms were at 6 weeks and lasted for 4 days.

    Thanks a lot

  15. Jessica

    Good afternoon Dr. The article is very helpful but I still have some doubts regarding the symptoms. It has been around 8 weeks since I had a possible exposure with my ex boyfriend. We had a protected anal and viginal intercourse. The condom was intact after he finished. I experienced no symptoms during my 6 weeks and I already tested negative at that time using ELISA test. During my 7 weeks, I experienced some symptoms including fever, diarrhea, slightly headache and abonominal pain. All of the symptoms last only for one day. It went away after I met my doctor. So I want to ask:

    1. In the article, it states ARS occurs between 2-6 weeks after exposure. Is it possible if it occurs at 7 or 8 weeks considering with 3 months window period?

    2. Let’s say it’s possible. Are my symptoms that last only one day and went away after taking some tablet consider ARS?

    • 1. I have never seen or heard of HIV ARS appearing at 7 or 8 weeks. 2. If you say things like “let’s say it’s possible for symptoms to come on at 7 or 8 weeks” then what is stopping you form saying “let’s say it’s possible that symptoms only last 1 day”? It makes the entire question meaningless. Based on what we know scientifically, HIV ARS does not come on after 6 weeks and HIV ARS symptoms last for 1 week to 2 weeks. You cannot pick and choose which facts you want to stick by. A few more facts: Condoms greatly reduce the risk of getting HIV so your risk is low. The 3rd Gen ELISA test at 6 weeks is as good as 100% conclusive except in very very rare cases of sero-negative infections. So it’s time to take a deep breath and calm down Jessica.

      • Jessica

        Thank you Dr. Your further explanation made more sense than the fact I choose to believe. I will try calm down and wait for my 12 weeks test.

  16. Its been 3weeks after unprotected sex n im fine now all of my sysmptoms are gone after 12days if those symptoms were belongs to stds symptoms when i get conclusive result i was using drugs also at that time(cough syrup,cold syrup, nicotine chew gum and i was drunk also at that time )plz suggest me dr.tan

  17. Plz review my messages it could be easy to give answer of my question.

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