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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


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. Hi Doctor, may i ask if the SD Bioline 3rd Gen HIV rapid test is conclusive as at 60 days?

  2. Hi there Doctors,

    Would like to check on something, I did a HIV 4th gen test at around 60+ days after possible exposure, can I say that it is conclusive and do not need to go for another one at 12 weeks/90days?

    Thank you so much

  3. Can ARS appear 3.5-4 months post exposure? I had protected sex with a csw on july and since monday (9 nov) I have been having low grade night fever and a very bad cough. I am concerned because this fever only comes around 5-6pm and the next morning it will be gone. All the times I am completely feeling fine but I can feel the heat in the body so I took note of the temperature taken orally and it ranges between 37.5-37.8. This has happened for 5 consecutive nights. I first had a cough on monday noon and then at night I had fever. From then on the cycle is the same with me being ok in the day and having fever at night (but i feel completely fine). The cough has gotten worse though. What worries me is I have taken my meds like panadol from the polyclinic but the fever just keeps appearing every evening.

    I did take the sd bioline combo rapid test at week 5 6 and 12 weeks (84 days) at your clinic previously and all was negative but its not lab test so maybe its less sensitive?

    Also even if assuming I have such a late ars, will the p24 be extremely high to be detectable from the tests before since antibodies were not formed? Should I test for hiv again?

    Thank you doctor.

    • It is possible. Your symptoms are very non-specific, may not be related to HIV at all.Based on your test results, you do not have HIV. I do not think you need another test. You should see a doctor for your symptoms. They may be due to other illness.

      • It is possible as in it may be HIV ARS? Or are the symptoms definitely not HIV related because of my tests?

        • I do not think it is HIV. Your test results already tell you that you do not have HIV.

          • I was concerned because in the previous reply you said that it was possible. I went to see a doctor for this and he said its a normal virus relating to fever.

  4. Hi dr,

    I seriously think you need to help me to avoid me having depression.
    I think I’m driving my hub crazy for not trusting him.
    We have been together for 9years and within these 9 years no other sex partners.

    I did an employment check for HIV with vdrl 3 years back and the result was negative.
    A year ago, I just given birth and I did HIV test and it was negative too!
    Donated blood cord and result came back with positive HTLVi/ii positive.
    So I was referred to TTSH to do western blot.
    It was negative.

    From there I have been having phobia to have sex.
    I did a rapid prick test last month.
    It’s was 2 months later I have sex after a year giving birth.
    The result was negative.
    Am I safe for HIV based on that?

    Hope you can give me a good answer to ease my anxiety!

    Thank you so much!

    • Sorry! It’s was 2 months later then I do the test!

      • Sorry for spamming! To fill you more!
        I have an yeast infection before.
        Went KKH and they did a VP3 probe test, result normal.
        Urine culture also normal only UTI
        Chest X-ray normal.

      • 2 months after having sex

        • I honestly do not know what you are worried about. You have done so many tests and all of them tell you that you are fine. You do not have HIV or any other infections. You are going through this nightmare just because you had a false positive HTLV test? Hello! It was FALSE POSITIVE! That means you do NOT have HTLV! So why the worry?

          • So meaning I can stop going for anymore test to confirm? I am safe?my hub was so kind also, trying to ease me by telling me he will also go for a check next week. Though a blood test was given to him during my pregnancy from my gynae for HIV and thalassemia was clear! I know I’m too much! This phobia is so scary! I keep thinking I have symptoms. I have sore throat, body ache. And feeling feverish after sex.

          • So I’m also HIV free?
            No need do further test?

          • Yes you are HIV free. Please do not worry unnecessarily.

          • Sorry! I did the $50 prick test. Is it reliable enough?

          • But dr… Now both of us are having sore throat, no fever, so far there’s no rush on us. I’m having small ulcer.

          • Hi dr, is it conclusive enough after all these.
            Cause I’m having mild sore throat, with little dry cough.
            Blocked nose.
            And my husband is having dry cough and just recover lost voice with mild sore throat.

  5. Hi Dr,
    I had an exposure at 66 days ago. And I took PEP (azt+3tc) within 12 hours for 28 days. Then I did test the Eclia 4th generation test (only antibody, without p24 antigen) at 61 days after exposure (31 days after PEP) and got negative result. But my neck still pain from last day of PEP until now (66 days after exposure). So Dr, may I know my test can conclusive or not and what is the possible reason why my neck still pain. But I have no other symptoms.

  6. Can I get HIV from fingering a vagina and licking it? Please i need peace of mind.

  7. Troubled

    Hi doc, is frottage (undergarments to undergarments) considered to be a risk for hiv?

  8. hi dr, i would like to ask if there is a possibility of me contracting HIV when i was contracted with NGU 2 weeks before my 1st test (which shows negative) and 2 weeks after i get tested again, it also shows negative. but currently after more than 6 weeks after the 2nd test, i am starting to have rashes only on my neck area and is also having a sore throat. Could this be ARS symptoms? Can pls tell me to cure my anxiety?

    Thank You.

  9. Johnston

    hi doc,

    had intercourse with 2 different escorts about 3 weeks apart. last one happened about a week ago. had bare blowjob and protected intercourse with condom for both. what is your assessment of risk for both of my situations and would you recommend testing? thanks

  10. Hi doc. Have an exposure ard 7-8 weeks ago and develop pimples like red spots on the small thigh and also throat inflamation. Are these symptoms of HIV? Have taken a combo test at 5th week after exposure. Is the result conclusive and is the test able to pick up the virus if it sero on the 7-8 weeks?

    • Just to add on on the day before, got a oil massage on my leg at bkk. Most of the pimples like spots are on my right small thigh.

      • Hi doc, just to add on that im able to swallow and eat as per normal and the pus in the pimples like spots which are all on the hair pores have diminish and is clearing in less than 1 week after applying some med cream and antibiotics. Are these symptoms and is my result conclusive. Can i move on with life?

        • The test i did was a combo lab test and it came back non reactive. Pls doc reply me. Im dying from anxiety.

    • Dr Justin Sim

      Your result is conclusive meaning you do not have HIV. Pimples are not a sign of HIV.

      • Thx doc. But is the pimples due to bacteria infection? They are widespread on my right small thigh only. In addition, i have throat inflamation which has a white pus like on my right tonsils. But im able to eat and drink normally. These are not hiv symptoms? Is it just a normal infection. They are so alike to the symptoms.

      • Hi doc, sorry for the spam. Jus few qns.
        1) possible for rashes to only widespread on right thigh. Is it 100% invloves upper body?
        2) is the sore throat really bad that u cant even eat or swallow?
        3) do the rashes start to disappear after a week or normally only after 2 weeks. Is the rashes itchy?

        • Dr Justin Sim

          1) Rashes can be anywhere. 2) Typically it can be quite bad. 3) They can appear or reappear at anytime.

          • Thanks doc. I was actually reading the forum and it states that the rashes 100% involves upper collar area and neck and till thigh area to a smaller extent. Mine was on the shin and calf area of right leg only with pus and starts to dry up after antibiotics and cream. These are not hiv rashes right?

          • Dr Justin Sim

            HIV rashes cannot be accurately diagnose anyway because too many other diseases look the same.

          • Appreciate the cooments doc as my exposure was close to 8 weeks ago and i started developing mild throat discomfort and having pimples like red spots with pus on my right calf and shin with onli 4-5 spots on my left shin and calf. All these happens after i came back from bkk and thus wondering if they are symptoms.

  11. Zhong Han

    Hello Doctors,

    I recently had sex with a social escort / freelancer whom I booked through some online forum. She performed oral sex on me without a condom and after that we had sex with a condom on. I shot inside the condom and there is no leakage of semen out from the front (I assume this means there’s no breakage?)
    After sex, the escort said she felt wet below and I told her it was her fluids. Assuming if I had sex with her and tiny amount of fluids got into the condom from my thrusting and all and assuming she’s HIV positive, will I be at risk?

    Please advise me thank you Doctors for your time.

    • Dr Justin Sim

      Yes, I believe you have answered your own question. If any fluids come into contact with your penis then there is a risk and the sex is considered unprotected. The risk is low, however, but you should still get tested at the right time.

      • Zhong Han

        Hi Doctor Sim,

        thanks for your reply.

        May I ask if it’s common for vaginal fluids to get into the condom through the normal movement or it is quite difficult?

        thank you

  12. Good day doctor. I had an encounter last aug 16 2015. We only have deep kissing, oral sex without condom im the receiver, i suck her breast, i fingered her vagina and he performs handjob on me. No sexual intercourse happened. Can i get hiv in that encounter? please i need peace of mind doctor. Thanks.

  13. Jonathan

    Hi doctors,

    I recently procured the services of CSW on 20th Sept and the services of another CSW on 8th Oct.

    For the first service, the CSW did an oral job without a condom and subsequently proceeded for intercourse with a condom on. Ejaculation occurred in the condom and it did not break or slip off during or after intercourse.

    For the second service, the CSW did an oral job with the condom on and subsequently proceeded for intercourse with the same condom. Ejaculation occurred in the condom and it did not break or slip off during or after intercourse.

    With your vast experience, can you advice if I’m classified under low / high risk for HIV?

    Would you recommend me going for a Combo Test and if so, will the results be conclusive at day 21 / 22?

    Thank you and hope to receive a reply from you!

    • Low risk. If you have any concerns, the best thing to do is to get tested for the peace of mind. Combo test is conclusive at 28 days. I suggest you wait for a few more days.

      • Jonathan

        Hi Doctor,

        Thanks for your reply.

        In that case, would you recommend me to go for a combo test between 21-28 days or I can just forgo the test?

        Thank you!

  14. Hello Dr.
    I did a sex with prostitute using two condoms I know its dangerous .after sex I saw the inner condom was as it is & the upper one was slept 25%. condoms didn’t break but after 2 days I had burning on penis doctor prescribed cefixime200 mg after 10 days I developed non itch rash on palm of hands which are still there & these rashes come & go now after 18 days I have diarrhea & pain in stomach simultaneously I am facing a sore throat as well I am so scared. Do these all due to HIV ? Which test I can take now after 20 days please help me

  15. Dear Dr Tan,

    I had a high risk sex as anal receptive partner two weeks ago. And now I have high fever for the past five days. Dengue was ruled out, but my WBC is low well as neutrophil and lymphocyte count. There is no rash and no sore throat although my tonsils are swollen and red. The first few days of fever were with chill and muscle ache. Do you think I have ARS? Is it possible not to develop a rash on this case?

  16. Dear Dr Tan,

    I had a high risk sex as anal receptive partner two weeks ago. And now I have high fever for the past five days. Dengue was ruled out. There is no rash and no sore throat although my tonsils are swollen and red. The first few days of fever were with chill and muscle ache. Do you think I have ARS? Is it possible not to develop a rash on this case?

  17. Good day doctor. I have an encounter last aug 16 2015. We only have deep kissing, next i let here suck my penis without condom, next i suck her breast and also i fingered her vagina. After we done all, she starts to do a handjob on me, im afraid because maybe she touched her vagina and get some fluid then she do a handjob to me. Can i get hiv in that encounter? Thanks i need peace of mind.

  18. Johnson

    Hello Doctor, i was at Park Lane Mall & a CSW from the MP pulled my in and she touched my crotch *Im still having my pants on* & lay down on my to try and get me to have a massage, im afraid that her hands may contain infections or viruses,am i at risk contracting anything?

  19. would like to know if the blood (sample) of few drops are enough to test conclusively?

    the other day went for the test at your clinic and after that, the doctor uses 1 drop of solution? shouldnt it be 4 drops?

    • Dr Justin Sim

      1 drop is enough, 4 drops would overflow the test sample and render it invalid.

      • I am tested negative (combo test prick) after 56 days. Should i be worried that it will come to haunt me in future? conclusive means its 99.9% doctor?

        Before it became antibodies, it is antigen first right?

  20. Hello Doctor,

    How accurate is the Ag/Ab rapid combo test?

    If i’m 2 months after exposure and both are negative, does that i will be negative.

    But how come there are people who antibodies discovered after 3 months? Does that mean the antigen also came late?

  21. i was exposed to hiv by having an unprotected sex a month ago but finished my pep which was started 40 hrs and i have staph too, can i still be infected

    • Until you conclusively test that you are not infected, there is always a chance that you are. For more info on when to test for HIV after PEP, click HERE.

  22. I just wanted to thank you, Dr. Tan, for this informative and level-headed article. Like many of your readers, I found myself in a panic after experiencing a few symptoms ten days after an (admittedly low risk) exposure. Obviously, Google is not your friend in this situation. But this article calmed me down and even made me laugh a bit, and as you suggested, I took a deep breath and focused on getting tested anonymously at your clinic when the window closed. The test was negative. So for everyone out there panicking like I was, just do like Dr. Tan says…calm down, take a deep breath, and focus on getting tested!

  23. Hello Doctor,

    I took the test 18 and 30 days post exposure, and it is negative. Is this conclusive(means i have no HIV?)

    What if the test cant detect the antigen or that the antigen is not in the blood taken in the sample but is somewhere hidden in the body(just 1 virus in the body) ?

    • Dr Justin Sim

      If there is antigen it will be everywhere in the blood and the test will pick it up. THey are very sensitive. If they weren’t then there would be no point using the test, right? Your results are therefore conclusive.

  24. ParanoidGuy

    Hello Doctors, I was at Orchard Towers earlier, i decided to talk a walk around and one of the Massage Parlor Girl went up to grab my hand, she touched me, put her arms around my neck and touched certain parts of me in order to lure me in for a massage, but i dont have any intentions of it at all hence i walked off, am I at risk? I have some Pimple at my neck and shoulder area im afraid her hands might be ‘dirty’ or might have STD’s on it hence i am getting very paranoid! Please reply me Doctor! :'(

  25. ParanoidGuy

    Hello Doctors, I was at Orchard Towers earlier, i decided to talk a walk around and one of the Massage Parlor Girl went up to grab my hand, she touched me, put her arms around my neck and touched certain parts of me in order to lure me in for a massage, but i dont have any intentions of it at all hence i walked off, am I at risk? I have some Pimple at my neck and shoulder area im afraid her hands might be ‘dirty’ or might have STD’s on it hence i am getting very paranoid! Please reply me Doctor! :'(

  26. Hi dr. Let me start by saying I am a worrier. I had a needlestick when giving a subq shot to an 85 year old. I reported it and they tried testing her but after a few failed attempts she refused so I don’t know her status. So since i worry like crazy I decided to go ahead with PEP. At 4 weeks I woke up with a sore throat, cough, runny nose and low temp (99.6 F). I’m getting tested at work at 6 weeks. So I went on my own at 4 weeks but I still have to wait a week for results. Deep down inside I know an 85 y/o lady probably didn’t have HIV, but even with pep I’ve convinced myself I got something from her. I would like a little piece of mind while I wait for results since I’m still feeling sick. Also 4 weeks is enough right?

    • Dr Justin Sim

      You are right, the likelihood of her having HIV is slim. If she did, she probably wouldn’t live to 85 without treatment. Test at 4 weeks and that is enough.

      • Thank you so much for replying doctor! I feel like I knew this already but hearing it from you makes me feel so much better. Thanks again! And thanks for everything you guys do! It really is appreciated!

  27. The CDC does not recommend RAPID 4th gen tests to be conclusive at 28 days, only the lab based tests are conclusive at 28 days. On what scientific basis is the rapid test conclusive at 28 days? I wish to know before testing because if rapid tests isnt conclusive, I would have to wait for the 12 week mark. Please advise as I wish to get a rapid if its conclusive, thank you!

  28. Hii doctor, I did check for an hiv combo test non reactive after 3 months exposure but I seem to have red spots on my chest area and lymph nodes felt under chin.

    Is it possible to be ARS symptoms?

    • Well think about it. Your HIV combo test already proved that you are not infected with HIV. So how can you possibly be having HIV ARS? It is just not logical. Unless you think somehow your Combo test was WRONG. Any reason to think so?

      • Ya I got my test done at the dr tan clinic at robertson walk and dsc, both turn out to be negative. But I having red spot on chest and lymph nodes under chin and I am worried


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