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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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2,552 Comments

  1. Hi Doctor, I had condom break with my boyfriend and he admitted he wasn’t always faithful. So I went on PEP within 10 hours. He left for a business trip on the day it happened. His last tests two months ago and 5 days after this incident was negative, he claims his always safe but I’m not taking chances. On day 18 of PEP (was too nervous), I got a duo test and it was negative but now on day 21 I’m having a slight runny nose and mild fever, could this be ARS? I plan to retest at day 28 and again at 3 months. Pls advice thank you

  2. hi doctor,

    i have couple of questions that bothering my mind. here is my case:

    yesterday night i went to massage parlour, i got hand job at the end by female theurapist with no condom. she wore a dress while i grabbed her boobs and bottom part. she is on her period hence she was using a menstrual pad.

    1. can i infected by receive hand job with no condom?
    2. i am afraid her menstrual blood goes through/seeping the pad and my finger touch the blood (no wound on my finger as i remember), can i get infected by this scenario
    3. do i need PEP?

    thank you

    • We would not consider this to be a realistic risk for HIV transmission. If you are still concerned and wish to clarify further, please visit us for a consultation and evaluation.

  3. John loong

    Hi Doctor, back in june 2015 had an unProtected sex overseas without condoms, 1 and half months after exposure i went for oraquick test in Sg clinics and came out negative, is my test conclusive? Now in 2018, i had psoriasis on face, scalp, and small water blister bubbles on scalp , legs too plus every night i feel itchy on body, and now worried like hell and cant sleep well thinking bout it…

    • The Oraquick test is an HIV antibody-only test – as such, it is only considered conclusive after 3 months. While your symptoms do not sound suggestive of HIV, if you are still concerned please visit us for a proper consultation and evaluation.

  4. I have HIV and currently on Kivexa, having just switched from Truvada. Do I still take prep if I’m having unprotected sex or is kivexa fine?

    • PrEP is only indicated for pre-exposure prophylaxis, i.e. we do not term your medication PrEP if you already have HIV, but rather HAART (highly active anti-retroviral treatment). Furtherore, Kivexa alone is not recommended as HAART; it should be used in combination with at least one other anti-HIV medication. Please speak to your doctor or come visit us for a proper consultation, to ensure you are on the correct treatment for your condition as well as to reduce the risk of transmission to future partners.

  5. Hi Dr
    Had protected sex with sex worker. Touched her vagina and breasts and then used my hands to hold water to rinse my mouth. Also used same hand to wash my penis. 5days later gums infection at different areas.
    Is it a sign of hiv?

    • This is not a sign of HIV, and there is no realistic risk from the exposure anyway. If you are still concerned, please visit us for a proper consult and evaluation.

  6. Hi Doc,

    I had vaginal sex with a lady back in Dec’16 and since then i have fear of HIV. i felt tired since the day , for like 2-3 weeks with high temp in the evenings. Then i remember i had a bump underneath my armpit somewhere in 2017 also a bad flu 3-4 months from exposure. its been almost 2 years now and im having gastritis issue now for some time and also random red rashes on my body appearing and disappearing. I had done a finger prick hiv test last month and the results are negative. Are these results conclusive, or do i have to do any further checks ? Im still a bit worried. Please help me out doc.

    • Your HIV tests are conclusive. If you have symptoms of concern, please feel free to see us for a regular consultation and evaluation, as there are many other conditions which can cause your symptoms. If you have an issue with anxiety, you may wish to see a psychiatrist.

      • What would be the other conditions so I can get appointments accordingly. Thanks

  7. Dear Dr Tan,

    I had low risk exposure with CSW around 45 days ago, unprotected oral (im a receiver) and protected vaginal sex.

    Did rapid hiv 4th gen, syphilis, and hep b and c on my 29th day, it was negative

    On my 35th day, did hiv 4th gen lab test, also negative.

    What are the chances my hiv seroconvert longer due to coinfection of hiv and hep c?

    Can 4th gen hiv test overcome this i.e detect p24 antigen post 28 days of exposure?

    Is my hiv test conclusive? What about my hep c test? Does my hep c test conclusive also?

    Thank you Doc Tan

    • I would consider your testing conclusive. Even with delayed seroconversion in Hep C coinfection, you would be able to detect the p24 antigen on 4th gen HIV testing.

  8. 29 days after receiving unprotected oral I woke up with severe vertigo/loss of balance, fever (lasted 2 days), fatigue/malaise, and diarrhea (one day). Blood test at hospital confirmed high level of lymphocytes and doctor concluded that I had vestibular neuritis caused by unspecified viral infection; was not concerned. All symptoms were gone by 4th day, except vertigo which required a week of corticosteroids. Could the illness/ vestibular neuritis actually have been ARS? I just made this connection today and am obviously freaking out. I’m getting tested but would appreciate knowing in the meantime if my freak out is warranted.

    • There is really no way to indicate whether you have had ARS symptoms or not, as they are broad and non-specific. You would only know through testing.

  9. Hi Dr,

    I had protected vaginal and unprotected oral with CSW some 25 days ago.

    On 4th day i got mild fever (37-37.5) with rash (chicken pox like rash)

    No fatigue no muscle and join pain no nothing.

    I did 4th gen test on 1st week, turn out negative

    Did another one on my 2nd week, also negative.

    Now waiting for my 4th week to come and do another 4th gen test.

    Im worried to death now.

    Will my symptom be ARS?

    • It is doubtful that your symptoms are due to ARS as it is a fairly low risk exposure. However, if you are still concerned, please visit us for a proper consult and evaluation. There can be other STDs which cause rashes including herpes and syphilis.

  10. Hi doctor, please help me. About 13 weeks ago, I had protected sex with a massage parlour. Lubes were applied inside and outside of condom. But I forgot to press the tip. After sex, i could see the condom is still there. Still holding tightly to my penis. Still covering from base to the tip of penis. Because I did not press the tip, will it be a tiny hole poked out during ejaculation? After 2 days, 2 red bumps appeared on my back. On the second week, i have minor sweat. Third week, sore throat for 1 day. Fourth week, sore throat for 1 day and mouth ulcer lasted 2 days. Fifth week, sore throat for 3 days followed by cold and cough lasted for 4 days. On 7th week, headache lasted for 3 days and followed by neck stiffess lasted for 3 days. Those red bumps still appearing. But the only appear on left side of my back and shoulders. Because i popped them and they left scars. Some have blood and vesicles while some only vesicles. Those bumps come out like 5-7 per week. After applying hydrocortisone and calemine, it seemed better. At 11th week, have minor sneezing. My question is:
    1. Are these seroconversion symptoms or due to anxiety?
    2. Can skin rash only present as seroconversion symptom?
    3. Is it possible a small hole poked out during ejaculation on the condom or it will split wide?

  11. Hi Doctor. I had veginal sex with a sexworker last week. It was with condom but after ejaculation condom slipped off while removing the penise.
    I was effected with minor cold and chillness very next day. I was affried and visited the local physician, on day 3.He gave me medicines for flu aymotoms and informed me STD symptoms are not show up immediately and those are different.( When he checked the temperature it was normal.). Then I was OK within two days.
    On day 6 I had irritation while urinate. I drunk more water and it got settled down with mild abdomen pain.On that night I couldn’t sleep properly because of frequent urination. I had mild sweating at night.
    Hence I went to a hospital on Day 7 and took Urine test. The result is negative. I discussed with doctor he suggested to take the urine test for gonorrhea and chlymydia.On day 8 the results are negative.
    Today I am on day 9. I still have mild cold and mild cough. Morning I am seeing a 2 mm lump on my face. I am really worried and under stress from day 1. Are these ARS symptoms?

  12. Ramnath

    Hi last june 2017 i had exposure for below 30 sec with condam. And i get phobia due to exposure i wend to near by doctor he told to take hiv 1 rna quantitative test after 3 month i take the test he told you dont have hiv.Now 14 months qone i have shoulder pain and i am thinking exposure for last 2 weak i am not concentrating on other work. Pls suggest me i need to take another test. And last 14 month i dont have high feaver.

  13. Hello Doctor,
    I had oral sex with a girl 35 days ago. She hurt my penis with her teeth after that her fluid touched my penis. After 11 days I felt very tired, I was sluggish for 2 days, after that, i think 20 days after the experience, I had pain on my groin and i felt my tonsils swollen especially when i opened my mouth. sometimes i had some pain which last for 4 hours, the pain was temporal, after 25days i had some ulcers on my mouth which are not painful, I also had rush in the evening of the 26 day, this rush came back on 29 days in the morning. after that I had fever which last for 3 hours in the evening and gone.
    I am very anxious, What should I do doctor?
    Thank you

  14. Tested negative 70days of exposure on hiv antibody test. Exposure (finger, Bj, she was trying to insert my Unerected penis.no penetrative sex occur, but on the 70 days from exposure I had a flu, on that 70th day exactly I got tested on hiv antibody but turn negative, is it conclusive or accurate?

    • I would consider your risk very negligible. Your test is not yet conclusive until 3 months post-exposure (as it is a 3rd gen antibody-only test). If you are keen for a conclusive test now, please visit us for a 4th generation combo test (antigen and antibody).

  15. Olga May

    Hello. My child was eating ice cream and there was a red speck of something in her vanilla ice cream. Can hiv virus survive in ice cream? Would its environment most likely make it inactive? Thank you

  16. Jessie Lim

    Hi Doc, i think i had a burn in my tongue after eating hot ramen..and performed oral sex to my boyfriend, was able to spit it and gargle water…is it a risk for hiv

  17. Hi Dr,

    I had sex with a working lady in Singapore on 19th Dec’17 without condom. After don’t know few days, 1 week or more i felt high body temp for some days. Then I had a flu on april-may for few days. And I also remember I had like a small ball like under my armpit during some timeframe, which dissappeared. Recently I’m having irregular bowel movement , like wakes up with stomach pain and going toilet straight. Worries me that I’m hiv positive . Would i be one ? Can you help me ?

    • HIV symptoms are non-specific, and we cannot diagnose or exclude a diagnosis of HIV infection from symptoms alone. If you are concerned, please visit us for a proper consult and testing.

  18. Dear Dr Tan,

    Is there an HIV Risk through licking Belly Button?

    I just finished 5 days of medication from belly button infection that releases white discharge and it was gone and dry after 5 days of using antiboiotics and antibacterial cream.

    I had a casual contact 2 days after finishing the medication. Just kissing but she licked my belly button. Am I at risk? Please enlighten me.

  19. Risk involved : deep kissing with a girl having a wound in my mouth however was fairly recovered 2 days. Fingering without any cut on my fingers.
    Did a rapid combo on week 5 with negative results however had running nose , 37.3 degree temperature and lethargic the next day after the test. Am i at risk?

  20. Omega2018

    Hi doctor.

    How much of a risk would unprotected oral be? I’m make and recieved unprotected oral a month ago. Since then I have been quiet anxious and suffered from muscle ache and joint ache and well as shooting pains in my abdominal area. I don’t think my nodes are swollen but my aches which started after 1 week haven’t stopped and its now 4 weeks post exposure incident.

    I haven’t had a rash or fever.

    Now I’ve read online receptive oral is low risk, neglible risk or even no risk.

    Should I get tested or not?

  21. Terry B

    Hi Dr
    Thank you for this service, I have a question about kissing – I open mouth kissed a girl and 2 days later I had a slightly swollen / tender gland up on the jawline below my teeth, this went away after 2 days, if the girl had blood / open wound in her moth could she have given me an infection that caused the gland to go up – ie if blood was in her mouth and I had a small cut – could this cause HIV infection? How much blood needs to be present to transmit infection ? Is this even possible? Would saliva not kill the infection? What’s you views on kissing and transition – I wouldn’t be concerned but the gland going up for a few days has given me anxiety
    Thank you

  22. James D

    Hi,
    Is it possible to have mitigated ARS symptoms while on PEP but the main symptoms suppressed by the PEP, medication , ie I have runny nose, dry cough, muscle ache but no rash, fever, swollen nodes

    • ARS cannot be diagnosed by symptoms alone – you would have to do testing to be sure in any case. As you are already on PEP, I would advise to complete the course as prescribed by your doctor and get tested at the appropriate time.

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