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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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1,848 Comments

  1. Hi Dr Tan, I had unprotected oral sex but protected sex with a lady overseas. There was a split second period where our genitals might have touched prior to sex but it is not penetrative. Shortly on the second day I feel sick with running and blocked nose as well as cough with phlegm. The running nose and block nose is still ongoing for the 3rd day. Are these symptoms of infection?

    • drtan

      You mean of HIV infection? Much too early to be due to HIV. The risk of getting HIV from protected sex is very low but not zero. You should still screen for it after the window period is over. Also condoms do not provide 100% protection from all other STDs. You should screen for those too.

      • Hi Dr Tan, when is the earliest that I can take the test. I’m quite worried. My blocked and running nose has stopped but has developed a slight fever.

  2. Hi Doctor Tan,
    How are you? I would like to ask you about something which such a big doubt in my brain. I hope you would answer me.I am gay and hiv negative versatile (Last hiv check was on 2.4.16) . I have kissed to a positive guy. He told me and i thought kissing is ok.It was on the date of 8.5.14. Trust me i wasn’t comfortable while kissing and all. He is undetectable. Took his medication since 2003. We didn’t fuck or had blow job. Unfortunately, I kissed his nipples and some part of his body. He gave me few seconds rimming in my ass but that wasn’t deep rim too. Also, We didn’t kiss deep throat, however I have a little pimple beside my lip somehow. Currently I jz finished my medication for syphilis a month ago for 28 days by 27.4.16 (doxycline). I am awared that it could get other diseases easily if you have syphilis and mess around. I have stage one syphilis. I couldn’t wait for 3 months no sex period just because I have syphiilis but I always used protection. Always. I have Never missed. I am so worried about this and will I get HIV? I know that kissing won’t get HIV but I am worried about my pimple beside my mouth which might touch or contracted by him unknowingly while kissing. Pimple was almost dry. What should I do? I hope I will get answer and thank you so very much.
    I am carrying such worries. I don’t really have related symptoms but my throat seem painful sometimes. No ulcer. My right neck is painful even before. Maybe too early to tell. should i need PEP? I have never expose or in the risk behaviour no matter what . I am not able to sleep for a week. Please let me know. Thanks once again.
    Pierce,

    • drtan

      I am doing very well. Thank you for asking. Your partner is right. There is no risk of you getting HIV from kissing or rimming. Furthermore, the fact that he is on ART with an undetectable viral load means that he is almost not contagious in the first place. I think your worries are extremely misplaced. You are not at risk of HIV from this.

      • Hi dr Tan,
        Thank you so much for the reply. I am relieved. Just that i have std and that makes me so scared of everything. I will even be extra careful in future. I really appreciate it so much and thank you Dr for your time.
        You have a great day Mr Tan.

        • Hi Doctor Tan,
          I hope that you are having great weekend today. I started my syphilis medication on 2.4.16 and ended on 29.4.16. I went for the Syp Serology. This is what lab reported currently. I am so worried and should i even be worried? RPR is Reactive with 2 DILS, TPHA is Reactive. I am not sure what does this mean? I really thank you for all this replies and help.

          • Hi Dr,
            I hope you are well. Dr, I started my syphilis medication on the date of 2.4.16 and ended on 29.4.16. I went for serology test on the date of 18.5.16 n this is my result. RPR-Reactive 2 Dils, TPHA-Reactive . I am not sure what they are, Do i need to worry?
            Will u Please help me read this doctor? Thanks so much.

          • please see my other reply.

          • It takes months for the syphilis titre to drop. Even if you have been cured, the syphilis antibody will remain as positive. You have taken the blood test too early. Please wait for another 3-6 months to repeat the test.
            It is best to bring the results to a doctor to discuss further.

            http://www.drtanandpartners.com/where-to-find-us/

  3. jason

    hi Doctor, can I know whether ars symptoms would appear after 5/6 months of exposure to oral sex? we didn’t have sex, but we gave oral sex to one another and there was vaginal fluid present in the vagina and I didn’t lick it for more than 2 mins. Recently, I’ve been experiencing diarrhea, mild fever and small painless white dots on the corner of my lips. The oral sex was given at late December 2015

    • drtan

      ARS symptoms do not develop after 6 months. Anyway, ARS symptoms does not depend on how a person is infected.

  4. gave unprotected oral to male. 3-5 days later strep like symptoms. had 4th generation test at 7 weeks negative. i still have a swollen tonsil and one swollen gland the same side which doesn’t hurt. now i have an ear infection. Is this ARS?.is test conclusive as I’ve heard some places it is and some it isn’t? please help .

    • drtan

      Generally speaking the 4th Gen test is conclusive after 4 weeks. Whether or not there is a specific problem with your specific test that affected its accuracy I cannot know and cannot comment. You should see your doctor about possible throat Gonorrhea and Chlamydia.

  5. hi Doctor, I’ve had unprotected oral sex with another girl, we did it to each other during the end of December 2015, I didn’t have any sore throat or high fevers for the past few months, maybe just morning flus, but during the end of April until now, I’m experiencing giddiness, on and off diarrhea, mild fevers and fatigue in the legs, do you think these are the symptoms of HIV? I’ve been worrying a lot nowadays and getting very stressed over it.

    • drtan

      No I do not think these are symptoms of HIV. But I also know that you cannot diagnose HIV based on symptoms. It is still imperative to get tested.

  6. Hi Doctor,

    This was 3 years ago, I had unprotected coitus a couple of times with promiscuous ex who had many sexual partners in the past. I didn’t know this, and when I learned of it, I broke off with him.

    I didn’t suffer from any symptoms, and he didn’t have any. I was wondering, now 3 years on, is it possible that I have HIV? (I know I should have gotten tested, but I was young and foolish)

    Thanks for the advice in advance

    -FL

    • If you are concerned, it is best to get yourself tested for HIV and other STDs. It is not possible for us to comment whether or not you might have HIV.

  7. Paranoia

    I gave a guy a blowjob while having a throat infection . He did not cum in my mouth but he did give me a deepthroat. I had a swollen throat for about 2 weeks before i Bj-ed him and it was going on and off. 2 days after I BJ-ed him, I experienced extreme tiredness and my feet felt hot. But after sleeping it off for one night I felt Ok. However my throat is still swollen and wont go away. Did I get HIV or is my infection just getting for the worse

    • Paranoia

      Also, I smoked for my first time (2 ciggs on the 5th.) could that be a contributing factor too?

      • drtan

        It could also be just a simple matter of your throat being traumatized after the act.

    • drtan

      Your symptoms cannot be due to HIV. HIV symptoms do not come on so quickly. Yes it could be your throat infection worsening. Yes it could be due to your cigarette smoking. You could also have gotten infected with Gonorrhea or Chlamydia in your throat.

  8. Jasonmedina

    If I have a rash and went to a doctor and then a dermatologist and they both say it’s fungal then it can’t be an arms rash? Please help

    • drtan

      The problem with an ARS rash is that it can look like many other types of rashes. That said, fungal rashes also differ greatly in appearance. So if you are asking if a ARS rash can be mistaken for a fungal rash I have to say yes that is possible. However, if you shared your concerns with your doctors, they would have considered the possibility of an ARS rash and would have excluded it already.

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