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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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Need more advice?

Come down to Our Clinics for a discussion with Our Doctors, or call our clinics for more information:

1.) Robertson Walk  (+65 6238 7810)

2.) Bencoolen Street (+65 6884 4119)

3.) Novena Medical Centre (+65 6397 2095)

4.) Scotts Medical Centre (+65 6694 2348)

5.) Somerset – Orchard Building (+65 6262 0762)

6.) Katong – East Coast Road (+65 6635 2551)

Where to find us – here

Selected clinics are open on Saturday and Sunday.

Doctor’s Schedule here

Email: doctor@drtanandpartners.com

All Our Doctors are Fully Certified and Trained to conduct specialised HIV Testing.

For lady patients who prefer female doctors, we have professional certified female Doctors to attend to your medical needs.


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.

HIV Prevention within 72 hours of exposure (PEP) – Click Here
Click Here for Contact Details, Address and Opening Times.

We are Open on Weekends.


 

If you have any questions, visit our free online forum on sexual health, HIV and STDs.

If you need a HIV test visit Our Clinics anytime during our opening hours. You do not need an appointment.

Find out more about Anonymous HIV testing at our clinics.

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Our Andrology and Infection Centre at Novena Medical Center is open.

Call us at 63972095 now to book your appointment.

 

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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2,066 Comments

  1. Herbert

    Hi Dr Tan,

    I did a STI Test at your clinic on 16th Mar 2017 with oral sex exposure on 1st Mar 2017, so are all the test conclusive? Or there is a need to re test? This week considered the 3rd week, right?

  2. Herbert

    Hi Dr Tan,

    I did the 4th Gen at your clinic on 17th Mar, which 17 days and it was neg. On 18th Mar, there was rashes on the arm, body and legs. Consider today is the fifth day, rashes are still there around, but no fever no sore throat and just feel tired. This morning, my hands and toes, seems to be stiffed. Should I return to your clinic?

  3. Anthony

    Dear Doc,
    First let me congratulate you on the great job.
    I need a help from your side.
    Well I was at a party got too drunk and woke up the next day with a cut in my hand and a bit of blood.
    I’m sure nothing sexually happened and wasn’t thinking of it until i learned that hiv can be transmitted through wounds.
    My wound wasn’t one that requires stitches or very deep.
    I had a flu and a fever after 2 weeks of the encounter for almost a week but was going to work.
    I did an Hiv test after a month(33 days) from the encounter(Serology test Hiv 1/2) i think it’s Elisa but don’t really know what it is.
    Then i started having legs muscle aches but my vitamin d is low and it happened previously (especially that i came back to sports 1 week previously)
    After around 5 weeks of the party i had a rash between my legs and back thighs (my doctor said it’s winter eczema) … very small red dots that feel bad when in contact with my jeans or when sitting.
    I’m really panicking over these matters… could these be ARS symptoms ? Should i do the testing once again ? Or this is pure anxiety ?

    • The HIV ELISA test a 33 days is not conclusive. You need to get it done again. Please ask your doctor for details. I cannot say if your symptoms are due to HIV ARS or not. For what it’s worth, from your description, your symptoms do not sound like HIV ARS to me. This is not to say you do not have HIV.

  4. Hi doc,

    I have taken HIV test at one of your clinics 28th day from potential exposure. Your doctor told me my test was conclusive as negative as it is the 4th generation test done and according to my situation.

    I woke up with a sudden rash on parts of my back, with no other std symptoms. Could this rash be because of other causes? As i am currently feeling fine, and it has been 4 months from potential exposure.

    • Hi,
      Your test results are conclusive and your rash is likely from other causes. If you are concerned, you may come down to our clinic for an assessment.

      • Thank you doc. I just had a fever of 38.5 which doesnt has a sore throat, rash and running nose.

        Its already 4months+ pass potential exposure, might it be hiv or im over thinking.

        • If you have had no further exposure since, then you will not have HIV based on your recent tests. Your symptoms are likely from another cause.

  5. I recently met with a man and gave him oral sex he came over the bed sheet and his hands and then shortly after put his fingers inside my bum.
    Before meeting with him I remembered there was some blood when I was cleaning my bum and there was a little bit of blood when cleaning after the meet up.
    I was very worried and 4 days after meeting I started experiencing night sweats along my chest and stomach which have lasted five days. Along with this I had a pain in my gum again after 4 days which on the 8th day I saw was a sore. Looking up both these symptoms I saw these can be a sign of early HIV so again I’m worrying a lot.
    I’ve asked the man several times his status and he says he’s negative but I cant trust people over the Internet.
    If you could let me know the chances of this being hiv please as I said I’m really starting to worry myself.
    Thanks

    • Hi, it sounds unlikely to have transmitted HIV through this way. However, if you are concerned, you may come down to our clinic at Robertson Walk for a consult and/or Anonymous HIV test after a window period of 28 days.

  6. Dear dr Tan,
    I have done rapid combo test at your Robertson Walk clinic on 22Feb (exactly 61days from my last risk – unprotected sex with CSW) in Indonesia. At first i was relieve when the doctor said the negative result and also say its conclusive so i do not need any test for 12 weeks. But now i just having bad flu with the symptoms incl sore throat etc. what i want to ask: 1. Is it possible that my flu is sign for ARS consider i already 2 months from my last exposure? 2. Should i still need to go for test in 12 weeks or combo test in 61 days i already take is conclusive? Thank you

    • Hi,
      The consensus would be that the HIV combo test is conclusive 28 days post-exposure. Therefore, if you had a negative combo test 61 days post-exposure, you do not need to repeat your test at 12 weeks. Your symptoms are likely a viral flu. However, if you still have any concerns, you can always return to the clinic to speak your doctor directly.

  7. Hello doc
    How accurate hiv test using metho 4th generation cmia (ag/ab) on 90 and 130 days after expose if negative? Need i do test again? My activiti just hand job with massage worker.Sory my ingglish no good. I hope you understand.

    • Lee

      In my opinion your tests are very indicative that you are free from hiv.
      officially the testing window period for the 4th generation test is 28 days.
      please note that we are unable to verify the accuracy for your test. for that, please ask the doctor who has done the test for you.

      If you are concerned about the result of the test, I advise that you visit your local doctor so that he could assess you and your partner further to test for HIV and STD as there was unprotected sex.

  8. joan peters

    how i get cure

    • Dear Joan peters
      Unfortunately , there is no cure to HIV. HIV can be treated. Many people living with HIV start taking treatment and stay healthy as a result. Current treatment for HIV is not a cure for HIV, but it can keep HIV under control.

  9. Hi Doc,

    Three days ago, I had an encounter with a ladyboy. She penetrated my ass with condom and gave me oral sex with condom. I gave her oral sex without condom, she ejaculated inside my mouth and I swallowed her semen. I remember that her cock looked fine and there was no visible cut or ulcer. However, I just realised that I might not have recovered fully from my flu symptom, i.e. mild sore throat, and I might have had a little cut on my lip at that time. Am I at high risk of HIV infection? Today, an ulcer appeared on my tongue. I am really concerned. Your advise is deeply appreciated. By the way, she previously mentioned that she was tested one month ago and declared clear of any disease. I am not fully sure though if she is fully honest.

    • Akira
      Your symptoms could be due to other medical conditions .
      However, I recommend you to see a doctor for a consult and getting tested for HIV and STD as you had unprotected sex.

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