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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
Click here to see the full range of our HIV/STD Services



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

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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. Dear Dr. Tan,

    I have a question regarding HIV testing. I have done 2* 4th generation tests a year after exposure and also 1 (6 persons pooled) RNA NAT 14 months after exposure am I 100% safe?

    Should I look to other causes for my symptoms or is there the slightest posibility that HIV is causing this?

    Thanks in advance for your reply,


  2. Hi there i would like to know understand that flu like symptoms is the natural body response to hiv (if one having it) and its the time for the body to produce antibody. So my question is what if some1 does not have flu like symptoms, which means the body did not produce enough antibody to be able to get picked up by hiv test??

    • You do not need to have symptoms in acute HIV seroconversion. In fact, more than 50% of acute infections can be asymptomatic. They will still be detectable through testing.

  3. PS My throat “tightness” and very mild scratching lasted just half a day. A loose stool just once or twice and then stopped. Thank you again.

  4. Dear Doctor

    My beauty specialist just told all her clients she is HIV positive. She was wearing gloves for most of the procedures but would put cream on my face without gloves. I have some mild acne. Was I at risk? No other risky activities. 3 weeks later after our last procedure, I have upset stomach for a day (loose stool) and my throat feels a bit tight and stratchy (not painful per se, just a bit wierd. It is also not red and it is NOT difficult to swallow food and liquids). I have no fever, no rash as described and no other symptoms. Were I at risk?Does it sound like ARS? I have tested 2 months ago (i do every year because I have HIV phobia) and was negative. Thank you

  5. Victor Corrie ngara

    Thanx have had hiv tests but still worried am in Window period

  6. Hi doctor! Just want to say thank you for this article. It is the most elaborate article detailing the severity and experience of seroconversion symptoms i have read online. Thank you for the work that you do.

  7. Samantha

    Good evening Doctor,

    6 weeks after having oral with a man of own known status, he did not cum, I went to planned parenthood and took their rapid finger prick test and it came back negative. I’m scared and have had a cough for a month now and bloated/gassy gut. How sure can I be that I’m not infected? I will be going again at 12 weeks and get tested again.

    • Dr Elaine Loh

      Please go ahead and get tested again at 12 weeks if you are concerned. Risk of contracting HIV from an oral sex is extremely low.

  8. Hi doc I had protected sex with a prostitute a week ago . And 4 days before I visited a massage parlor where I didn’t have sex but a hand job and rub my penis over her panty . From yesterday I m having one left eyes red . I never have such red eyes before . Is it can be symptom of std or aids . Pls help

    • We cannot make diagnoses over the internet. If you have symptoms of concern, please visit us for a proper consult and assessment. Your exposure risk is very low.

  9. Hello sir I am from nepal .hope you inform as soon as possible and also you will keep it secret . What I want to ask is ……. my friend offered me to have a sex with unknown  girl  two week ago I evan don’t know she is a sex worker or other else . I wore condom during conception and how far I know I had a safe sex bt after 2 hr I shaved my pubic hair bcoz it was smelling bad and the razor made a wound on my pubic hair zone which as a consequence started bleeding .will there be any risk .idont know she is affected with hiv or not bt if she is will there be any risk after the 2 hr of conception .i could nt sleep since last night and also preparing for army training programs pls tell me is there any risk of getting aids … i am in great trouble sirear my problem amf also I am feeling some symptoms like skin rashes and nausea from threedays while my body temperature is about 97.5.is there any risk sir I am a only one son of my family  …any stds risk through here .I showed to the dermatologist he told me that I got some shaving bump .bt I diacharge some white like thing feom my penis amd also having persistent sore throat from 9 days also there is high back and joint pain in every part of body  ……. I am scared of herps and other stds .. I even don’t have financial support to test for it .pls inform me as soon as possible

  10. hiv from tridot kit

    Hello Doctor ,

    I went to a lab for getting tested for hiv ,Lab technician used the tridot kit for testing , so it came negative , he has tested infront of me , by mistake i have touched the tridot kit the inner membrane , and i had put my fingers in my nose and i rubbed my eyes . is it a risky situation , should i get tested for hiv test . please help me doctor . I heard that the inner membrane has hiv antigens plus antibodies . Please help me sir .

    • No, there is no risk here. And no, the test kits do not contain any virus – they just detect it.

      • hiv fromt tridot kit

        thanks sir for your reply , i had minor cut on my fingers which is about 20 minutes fresh , can i get the hiv for touching the tridot kit , Please reply for my answer sir . i am waiting for your reply , as i am dying due to anxiety disorder

  11. Hi Dr someone walk with Sanders slippers in the street all day in the carribean and then the person grab the toothbrush and swipe it with the sandals slides he walk on the street with can I get hiv that way cause I wash it with water then brush my teeth with it can I get hiv that way

  12. Can someone with a cut on mouth infected with HIV, if that person drink using a straw that has fresh HIV blood?

  13. Anonymous

    Hi Doctor,

    Recently I have had protected vaginal sex with a female sex worker, but I received and performed unprotected oral on her as well as our genitals were rubbing against each others at some point. I’m very worried about this can you shed some light on my situation? Still in the window period for testing so I can’t get it checked out yet. My body seems to be itching all over, don’t know if it’s the anxiety or what.

    • Dr Elaine Loh

      Based on your description, risk of HIV is low. However, you are also at risk of other types of STDs. It is best to see a doctor to discuss further.

      You can find us here : Locations

  14. Sir, 6months before I had an unprotected sex with csw, tested for hiv tridot at 3,5months and cmia at 6month, all are negative.during 6months period I was affected with mouth ulcers in every month. After the end of of 6months(after complete of test) I got fever and headache, diarrhoea for 4days and body itching with very tiny red spots coming near fore hand,shoulder and foot. Before two days of cmia test, I took TT injection as I got an injury on my leg due to slip. Will it alter my cmia result.
    Why am I getting these symptoms of hiv after 6 months. Can I go for PCR RNA test now after 6months. Is PCR RNA test is accurate after 6months and during symptoms.

    • Your tests are already conclusive, no repeat testing required. Not affected by any tetanus injection.

      • Thank you sir for reply but I had already given sample for hiv1 pcr RNA qualitative test and today it came non-detected(detectable limit is 66.9copies/ml). I discussed with test center they told if value is less than 66.9 it is considered non detected as their equipment detects that level only. Is after 6 months pcr test is reliable and value is less than 66.9 is ok. But I am getting symptoms such as small itchy red spots and other symptoms such as fever,headache and diarrhea after 6 months. Is my body is responding at late time.kindly help me as I was about to get marry soon

  15. Sir,
    I tested negative by cmia around 175 days, and tridot at 3months. From 180th day I got fever,headache, gastric problem along with diarrhoea for 4 days and from next day observed itching and small red spots on shoulder,arms and foot. Kindly help me.
    Can I go for PCR RNA test after 6months and it is accurate after that time

    • I would consider your tests conclusive already. I do not believe there is any need for an RNA test.

      • Sir ,

        I had unprotected vaginal sex with a CSW lasted for 1 min , thereafter post anxiety was able to get hold of PEP next day but continued it only for a week , 4 weeks post exposure i developed symptoms of Very high fever until 102.5F with diarrhea , nausea , vomiting and headache , for a brief period of 1 day i had rashes all over my palm , neck and back , doctors gave IV antibiotics in hospital post which fever subsided after 5 days during this period i got testing done ( CMIA duo test ) tested non reactive , after my recovery i got another test done at 4 weeks post that symptoms i did again an hiv duo test which again was non reactive , can i consider the same as conclusive , its been now 4 months since the episode , i am worrying about my health status

  16. Dear doctor

    I have tested negative by 4th generation on 101 days result is antibody 0.06 and antigen not detected(cutoff 0.25) taking together. As it was needle exposure I did Hbsag result id 0.01(cut off 0.13). Am I infected wth both? I have donr PCR for Hiv 1.Whether there is schance for hiv 2?I have swelling in armpit anf small pain in groin
    Again thanks.

  17. first i check 3rd gen cmia after 30 days exposure the result negative. After i read on your web that check HIV allere combo test at ur clinic robertson walk can give conclusive result after 28 days, after 37days exposure i tested at ur clinic. The test was negative. Is it conclusive doc? As ur docter said at ur clinic.pls I need ur answer to peace my mind. Tq doc

  18. Sunny Shah

    Sir I am 30 years old man 4 Month ago I performed forttage (penis to penis rubbing) with unknown HIV status. after 48 hours I developed sore throat stomach gas pain lose stools and diarrhea after 10 day itchy isolated rash such symptoms come and go but diarrhea and sore throat continuously. No fever at all time.
    Is this because of HIV?

    What happened if his cum or percum touch my penis tip or any cut
    Please inform me I’m about to dia

  19. hi Doctor,

    I had safe sex with unknown girl on 6th oct, from 14th October onwards I feel mild headache (24 hours) , muscle ache and feeling week. I feel that lost my weight also.
    can I consider all these are HIV symptoms ? That girl doesn’t have any symptoms
    please suggest me on this, thanks

  20. Hi, i had a rash under my armpit, it started small then looks like spreading. it is itchy at sometimes and when im sweating. It has been almost 2-3 wks already
    I went to clinic just yesterday and said its fungal and was prescribed with clotrimazole cream.
    Just worried.
    Than you!

  21. Dear Doctor

    I tested negative at 35 and 77 days and PCR RNA for Hiv 1 at 87 days is not detectable.Then I did test for ab/ag at 101 days.The result is antibody 0.06(cut off value 0.25) and antigen not detected.Sir my question is whether the ideal antibody result should be 0 for hiv negative person and whether there is a chance of Hiv 2 in my case as I have lost 4 kg weight in last 3.5 months and my nerves in chest, leg area are shivering.Kindly help Sir. I had a needle exposure.

  22. Thanks for the knowledge. I have a question regarding symptoms. I understand I had very low risk exposure from recieving oral sex however I feel my body is telling me something.

    After 3 weeks from incident I start to get random shooting pains in arms, elbows, hip area, abdominal region which still happens at 6 weeks post exposure. My toes and fingers feel strange, like a dull ache which has lasted 2-3 weeks. The palms of my hands near my thumbs are always aching. I honestly don’t know what this is. I have read I had no risk from reciving oral sex and maybe it’s my anxiety however have never felt this symptoms before.

  23. Hi doc

    I had a potential exposure condom break. Taken pep . Had on and off symptoms.
    Tested negative fourth gen assay at baseline, 3rd week while on pep, 7 week and
    Two negative rapid test at 9 and 10.2 week

    Is it conclusive sir ?

    Should i test again at 12 week from exposure,will 4 week pep extend window period ?

  24. VeryWorriedMan

    Hi doctor, is a 4th gen HIV test considered conclusive after 28 days of exposure? I’m planning to go get tested.

    When is the best period to test for STDs such as syphillis, gonorrhea, herpes, HPV etc..

    Also I am feeling this slight burning sensation on my penis tip after a visit to a massage parlor & gotten a handjob from there 3 days ago…there is no discharge no pain while urinating just this burning sensation…not sure if it is a irritation to the oil she used or smth…i took a peek with a flashlight into the opening of my penis head and saw this small little red & slighlt yellow mini patch on one side inside but the rest is fine…no discharge nor pain urinating…i even went to try and jerk off but there is no pain during ejaculation also.

    Im just worried i may have contracted an STD and its giving me stress and sleepless nights…please help me doctor im really scared…

    • Your risk from a handjob is essentially zero. If you are keen to check still, come down at 28 days and we will advise you on the rest of the testing available and window periods.


  1. Women STD Symptoms | STD - Dr. Tan & Partners | STD - […] Fever. This symptom is really too general to be useful. In fact, very few STDs aside from HIV actually…

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