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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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1,980 Comments

  1. dear dr Tan
    am working as a seaman and on 1st of november i had a sex with a spa girl in malaysia . its not actually complete sex
    . it was only deep frensh kiss and just scraching her vigina with my penis only from outside and no penteration or cuming happened at all . at the 3rd week after that i feel that the neck lymph nodes below the ear is getting little bigger and smooth pain in addition to pain in the ear ( i actually do not know if its bigger but i feel something wrong in that area with pain in the ear and smooth pain in the throat ) and i always feel iching in my scalp . my quistion is there a possibility to get infecred with hiv if the girl infecter . and if so what is the name of the required hiv test i have to do . pls help me doctor am very afraid specially that am still on board a ship and my next chance to go shore and doing a test is on 18 dec
    that means 48 days after exposure and if the result was negatine is it nessesary to make other test and what is the accurecy percentage
    dear doc. your reply is highly appreciated considering that am on board a ship and have no place to go and test for now
    best regards.

    • If you are being honest with the details of your exposure then I have to say your risk of HIV is negligible. At 7 weeks post exposure I would recommend the HIV 4th Gen Combo test. However, we cannot give medical advice over the internet. You still have to seek the advice of which HIV test to do with the doctor that you will visit on 18th Dec.

  2. Hello,

    I had protected sex with the prostitude 3 weeks ago and my hands are dry and skin peeling off the fingers. No soreness, itchiness or watery stuff. Is this a possible HIV symptom?

    • Your symptoms do not sound like HIV symptoms. However, you cannot diagnose HIV via symptoms. You still need screening. Peeling skin from hands can be symptoms of Syphilis but 3 weeks is much too early for secondary Syphilis symptoms to appear. Either way, you should see a doctor.

  3. Hi doc,

    I had protected seks with a SW 3 weeks ago. Condom was not broken as far i know. I have a cold at this moment,symptoms: running/blocked nose and sneezing. I also have a light red rash on both cheeks and nose ( only on face ) NO Fever. Does this sound like ARS symptoms to you? Can ars rash only appear on the face and not the body? I’m worried a lot.

    • Your symptoms do not sound like ARS. Nevertheless, you need to go for HIV and STD screening.

  4. I had sex with prostitute on October 18 2016.I used condom.Three week after exposure,I found fungus between left thigh and grion.Next two week,new small fungus on my right medial thigh and felt armpit pain without lymphnode enlargement.My GP doctor cannot palpate lymph node enlargement.It may be due to physical strain.I just want to know is these are symptoms of ARS?Percentages of HIV transsmission in protected sex?Can anxiety cause armpit pain?

    • It is already December 1st. That is more than 6 weeks from your exposure. Just get a test and put yourself out of your misery. There is really no point in trying to analyze your symptoms or the risk of transmission. The test will tell you if you are infected or not and that is all you need to know. Honestly, even if I tell you the risk is 0.01% that means nothing to you. Because you may be the lucky 99.99% or you may be the unlucky 0.01%. I know it is hard but the best thing for you to do is to get tested. You’ll be OK.

      • Dear Doctor,very thank to your feedback.Yesterday,I suffered uncomfortable feeling inner left jaw.It is not pain.I cannot palpate any swelling.Today,GP doctor palpate on my jaw.He indicated to take Augmentin and it’s lymph node enlargement.I wanna know is enlarged lymph nodes are palpable or not?I said you above armpit pain.Does my armpit pain related to lymph node enlargement?I known that HIV patients develop lymph node enlargement in many sites.I’m so confused doctor.Can I test HIV antibodies now?It can give me precisely answer.Looking forward to your answer.

  5. Last year i have unprotected oral and protective sex with a SW, then i kindah have flu and neck pain after 5 week of exposure…

    And now during this 1 year i kind of getting repetitive mouth ulcer , itchiness near groin and cold like symptomps…

    Does this include as the 2nd stage of hiv infection doc?

    Thanks… im very worried…

    • What’s the point of worrying? Go get tested. Your symptoms do not sound suspicious.

  6. Hello Doctor,

    thanks for the job you and your colleagues are doing online. 12 days ago I had mutual masturbation with a sex worker (I am male, she was female). I have a case of jock itch which comes and goes with an irritable rash present for as long as I remember. The day I had the contact, it was a normal rash with probably small rash cuts present. The sex worker only gave the masturbation for a few minutes, I did not notice anything on her hands but honestly I did not examine them deeply. Up to this, this would be a more or less low risk scenario, but 6 days afterwards, going onto today, I developed some sort of infection in the mouth with jaw and tooth ache (I can feel the teeth ache and soreness up to my ear) and two non-paniful small ulcers that have since dissappeared (I someties have ulcer problems so it can be non-related, the last time I had an ulcer was in the summer).Is there a reason to worry? I cannot tell whether my lymph gland are swollen because those are things I just am not able to analyze (I can feel them but I think I was always able to since I am quite skinny on the face and neck). I feel a bit tired and sometimes have a headache but it could be the anxiety and also the fact that I am generally tired. Its flu season in this part of Europe by the way. This weekend I had sex with my longtime partner, I had the condom on but without thinking I put it the wrong way up and then flipped it (the same condom). More than afraid for me, I am afraid for my partner and was thinking whether I should tell her the story and get her PEP (which is probably not easy to do here as I’m in Europe and PEP isn’t certified) or whether its just anxiousness. The scenario (I understand unlikely) is that the sex worker had touched her vagina, applying lubrication gel/cream while in the bathroom and she may have thus transported the virus on me (the time between her coming from the shower and the start of the handjob could have been about 2 minutes). Or small cuts on the hand (but nothing bleeding as I probably would have noticed). What do you think? Thank you for your answer.

    • I think you have managed to think up a really convoluted scenario to scare yourself. The fact is you cannot get HIV from hand-genital contact. Regardless of whether or not there was vaginal fluid on her hand and regardless of whether or not you had any cuts. Please stop worrying.

  7. I am currently on PEP and had a high risk exposure back in 5th NOV..
    Took PEP on 6th NOV.. but I’ve developed persistent fever since Friday..(18 NOV)

    I went for 4th gen combo test at AFA to check if it was previous exposure.. and result was negative..

  8. Hi Dr Tan,

    I went to an Asian massage parlor stupidly and ended up having sex with the Chinese masseuse. We wore a condom when we had intercourse and the intercourse only lasted around 3 minutes. After we finished she helped me take off my condom and there seemed to be no leaks or blood from her vagina. What worries me (a lot) is that about an hour before this happened, I used my electric razor to shave some pubic hair and got a couple of tiny nicks on my groin (next to the top of scrotum, not on the penis but close to it) . What is the likelyhood of contracting HIV this way

    This happened about 4-5 weeks ago and last week (the 4th week) I developed a slight sore throat and dry mouth (no ulcers or swollen lymph nodes) and my temperature would range from 98.1-99.4f. My paranoia has made me check my temperature almost every hour, everyday and it has never went close to 100f. I’m hoping these symptoms are because of the changing weather in the US as it is becoming colder and it’s getting into the winter. I also do not see signs of rashes on my upper body and trunk.

    Please let me know what you think of my smyptoms and of this situation Dr.Tan. It is VERY very appreciated. This is the first thing I think about and the last thing I think about everyday.

    • Sorry, but I would also like to add that after I shaved, I noticed some minimal bleeding and and took a shower before I went to the massage parlor. So I guess I somewhat took care of the wounds?

      I am almost certain that by the time I was at the massage parlor, the bleeding had already completely stopped but I’m not sure how much exposure those wounds could cause me.

      Thanks again Dr.

      • I also noticed a tiny sore on the inside of my gum this morning. However, no other symptoms have come up. I’m hoping the sore is caused due to the amount of stress I’ve had thinking about my symptoms. To sum it up, my symptoms are light fever that ranges from 98.1-99.4 that changes very often thoughout the day. And I have a dry throat in the mornings, but no rashes. This has been 4 weeks and 5 days since the incident.

        Much thanks Dr Tan.

        • Your symptoms do not sound typical of HIV ARS. Since it has been already 5 weeks, go get a HIV test and get some peace of mind.

          • Hi Dr Tan,

            I had one more question. I finally mustered the courage to get tested at 52 days post exposure ( a little over 7 weeks) and the results were negative. The type of test I took was a rapid finger prick test where I received my results in less than a couple of minutes. I’m not exactly sure what generation that type of test would be considered, but would you say that my results should be conclusive or is that type of test not reliable?

            Thanks again Doctor, your work and response is very appreciated.

          • Well you do not know what type of test was done for you. I also do not know what kind of test was done for you. So I cannot comment on the accuracy of the test. You had best verify this with the doctor who did the test for you.

  9. Hello Doctor. Last Month I had mutual oral sex (1-2 mins, neither menstruatio nor open wounds) with a spanish prostitute (no drugs customer not drug user). My doctor told me that i must forget it and he didn’t want give me PEP. This last week I had sore throat, cough, mocus (it’s cold time in Spain), but I haven’t had fever, sore, muscle pain or anything like that. I don’t know if I need be tested- What do you think???

    • I agree with your doctor. You do not have HIV. However, you may have throat gonorrhea or chlamydia. You should re-visit your doctor to test and maybe treat for this.

  10. godforgiveme

    Hi Dr

    I have protected sex with prostitute, condom looks normal in whole process but I didn’t check it carefully. And French kiss for about 30s, my tongue has canker,not sure canker in her mouth. Are there any hiv risk in deep kiss? Is condom protected sex 100% safe? I have flu like symptom after two weeks, low fever 37c,soar throat, weary,and rash in neck, Palm sized area rash very small, difficult to find in skin. Now I am very nervous. Hope get your help. Thanks so much!

    • Condoms provide very good protection against HIV but is not 100% safe. You should still get tested.

  11. Hi Dr,

    Had protected sex with a female who’s status is unknown. I came in the condom but did not leave room at the tip. I don’t think the condom broke but when i withdrew there was no visible semen in the condom and my penis was moist. 12 days post exposure I experienced a light rash on both cheeks; Is it possible to develop ARS rash only on the face? No fever i’m aware of. However, 2 days later I had lack of appetite, nausea, vomitting, and fatigue that lasted for 3.5 days. Rash is still there but barely visible after 7 days. I have been stressing about HIV since the encounter and think i’m creating symptoms, what do you think?

  12. Tom short

    Hi dr
    I went to a strip club a few weeks ago
    The stripper was naked, I was fully clothed, at one point she played with her vagina and then tried to put he hand down my pants to grab my penis, I pulled her hand away but I’m concerned her finger may have touched the tip of my penis – if she had vaginal fluid on her finger and then her finger touched the tip of my penis – could I be at risk?
    Thanks

  13. Intheair

    Doctor, I’ve taken the 4th gen duo at 30 days and it came back negative, however 5 weeks have gone by and I still have a few symptoms, the biggest one being the rash around my colour bone.is it possible that I’m taking longer to seroconvert and I possibly have hiv2? At 5 weeks I still have dry mouth/thrush, shortness of breath,rash on colour bone, loose stools and eye flurries.

  14. Hi doc,

    I received my blood test which was done exactly at 28 days after exposure. The results was syphilis serology (modified VDRL): Non-Reactive. HIV Ag/Ab Screening (CMIA): Non-Reactive. HBsAg: Non-Reactive. Herpes Simplex Type I IgG: 0.23. Herpes Simplex Type II IgG: 0.41. Chlamydia IgG: 0.3.

    Could you please direct me which type of HIV test was done as I tried to mail my doctor no reply yet. Can you tell me if the HIV test was conclusive. I am worried as I am still not feeling well.

    Thank you.

    • I do not understand your question. You said the HIV test done for you was the “HIV Ag/Ab Screening (CMIA)”. So what do you mean by “which type of HIV test was done”?

      • Hi Doc,

        Apology for my stupid question but I mean to say which generation test was that. Was it 4th generation test or else. I don’t know much thing about HIV test and just came to know that there are various types of test. I even found that only 4th generation test can detect various as early as 28 days. Therefore could you please tell me in depth about my test that was done as far as your knowledge. Sorry for my bad English.

        Thank you.

  15. Ella wood

    Pls can someone who has a cut in the pussy if licked in the pussy by hiv patient get infevted

  16. Gary Summers

    Doctor, you seem very experienced and thought you could offer advice regarding a recent exposure I had which is causing immense anxiety.

    I had vaginal sex with a woman 3 weeks back and while I did put on the condom, I remember the girl telling me it was not worn properly (I was drunk). I also fingered the girl, and she squirted resulting in a lot of her fluid all over my hands. I do have habit of biting the skin around my thumbs, as such there is broken skin.

    Fast forward, in 3 days I had a chill and from day 4-6 was down with slight fever, very sore throat, loss of appetite and weight loss of 3 kgs. I recovered from the debilitating illness by day 7 although sore throat, fatigue and painful knee joints have persisted. I did start taking the PEP 60 hours after exposure, given I was feeling enlarged glands in my throat and fever of 37.6 at that point.

    I plan to get tested as soon as PEP is finished to set a baseline (I was HIV negative at the start of PEP). I feel certain in my gut that this was HIV symptoms but am not sure why I experienced them so soon. Also, is there even a remote possibility that the symptoms might be due to something else? What might that be (if any)?

    Thank you so much doctor, appreciate it

  17. Hi Doctor,
    How are u? I hope you are well. I have started my PEP on the date of 23.8.2016 exactly at 6pm for first time. then next day i started at 10 am in the morning and till now i am talking this way and never missed. My pills are Lopinavir 200mg+Ritonavir 50mg(keletra), Lamivudine 15omg+Zidovudine 300mg. 1. Should i be taking every 8 hours or every 12 hours?
    2.Can i still be start from tomorrow onwards to 12hrs-12hrs? I know i have to be taken the pills everyday at the same time. I am so sorry for this questions. Would you please let me know? Will there be any less pill’s effectiveness of this Pep treatment if i just switch from 8-8hrs to 12-12hrs now? I m on Pep for 5 days now. Pls help me answer this doctor. I have slight rashes and they were gone for now. My body feels really hot and i am in such worries right now? My doctor will only be available on monday and hence i am looking some answers from you and i hope you would answer me.
    Thanks doctor and i will be waiting to hear from u.

  18. Vincent

    I am worried about drinking drinks with contaminated blood in it. What are the chances of transmission?

    • What? It sounds to me like you need to see a psychiatrist. As a direct answer to your question: there is no risk of getting HIV this way.

  19. Is Sore thoart with shortness of breath and a mild cough signs of HIV or any other STD, I don’t have swollen glands or rash or even being fatigue

    • That is an impossible question to answer. What I can say it that they do not sound like the typical symptoms of HIV or STDs. However, that is not to say you are not infected with HIV or STDs. The only sure way to know if you are infected or not is to get tested.

  20. Worried soldier

    Hi Doctor,

    I have unprotected oral sex (giving and receiving) with a woman later found to be transgender male in Pattaya, Thailand. But I had protected intercourse with her. After having sex when I went to toilet, I spit in the sink and found blood like fluid and when I ask her, she said it was lipstick not her blood. Since then I have been in a really scared state and worried about contracting HIV. It’s been now 2 weeks of my contact. I am having mild fever and chills now and then. I have lost my apetite and my knees started to have mild pain. I do go for run and the knee doesn’t hurt during that period. I have mild itchiness on my neck as well.

    Am I going to have HIV? I have not tested yet as I am really worried. Could you please give me advice on this matter. Thank you.

    • I think what you are looking for is reassurance rather than advice. The advice is simple: go get tested. You had sex with a transgender sex worker in Thailand. I think nobody is going to argue the fact that you are at risk of HIV. You have a multitude of symptoms. Whether or not those are due to HIV nobody knows and no doctor can tell you either. You just need to get tested plain and simple. No amount of worrying will change that fact.

      • Worried soldier

        Hi Doc,

        I have been to the doctor for my HIV test. When I described about my situation and symptoms he just laughed. He said I don’t have any symptoms of HIV. It’s just that I am worrying too much. But I don’t think I got symptoms of HIV due to worry. He even advice no point of taking blood test as I don’t have HIV. But I requested him to take blood test for me.

        I am going to get my results this week. I am really worried about my early symptoms and what my doctor told me. Could you please help on what really going on me?

        Thank you

  21. I had unprotected sex and oral on a female almost 4 weeks ago, and after that started feeling funny, I would get a sore throat only at night it feel like and go aways and also I had trouble breathing at One point but I think it was due to me panicking about getting hiv or an std. Now it’s like I’m ok I have a mild cough but I don’t cough that much. I just got test and waiting on the the result

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