What Are the Early Signs and Symptoms of HIV in Men?

HIV — short for human immunodeficiency virus — is a virus that affects the immune system — more specifically, white blood cells known as CD4 cells, or T-cells, that are part of the immune system.

Because HIV attacks the immune system itself, the immune system is not able to mount a defensive response against this virus the way it can for other viruses. It also means that a person with (untreated) HIV is more susceptible to other infections, illnesses, and diseases.

HIV can be transmitted from person to person through contact with blood, semen, or vaginal fluids that contain the virus.

“It is primarily spread through sex, sharing needles, blood transfusion, and mother to baby during delivery,” says Jennifer Veltman, MD, chief of infectious diseases at Loma Linda University Health.

HIV vs. AIDS

HIV is not synonymous with AIDS. Acquired immunodeficiency syndrome (AIDS) is also known as stage 3 HIV. It’s a late stage of HIV when the immune system cells have been so badly damaged that the body is no longer able to fight off infection.

Thanks to modern medicine, with proper treatment, it’s incredibly uncommon for HIV to progress to AIDS. (More on this below).

Before we do a more in-depth discussion about the symptoms of HIV, it’s important to understand that left untreated HIV can progress through the following three stages, each of which has a group of associated symptoms.

• Stage 1: acute illness
• Stage 2: asymptomatic period
• Stage 3: advanced infection

Below, a complete breakdown of the most common symptoms by stage.

Stage 1: Acute illness

Stage 1 of HIV can be considered the “beginning” stage. It’s the stage a person enters when they first contract the virus, and it lasts until the body has created antibodies against the virus.

Antibodies are basically little bodyguards the immune system creates when exposed to foreign invaders.

Somewhere between 66 and 80 percent of people in stage 1 will experience flu-like symptoms within 2 to 4 weeks of transmission.

According to doctoral-prepared nurse practitioner Emily Rymland, AAHIVS-certified HIV specialist and clinical development manager at Nurx, these flu-like symptoms can include:

• fever
• swollen glands
• fatigue
• body rash
• sore throat
• joint pain
• diarrhea
• headaches

Symptoms can also include:

• ulcers in the mouth
• sores on the genitals
• muscle aches
• nausea
• vomiting
• night sweats

“The reason HIV causes joint and muscle pain is because the infection causes inflammation in the body,” says Rymland.

When someone has symptoms, their symptoms can last a few days to several weeks, she says. But not everyone who has come into contact with the virus will experience symptoms.

“It’s common for someone to experience no symptoms that would lead them to question whether or not they’d been exposed to HIV,” explains Rymland.

That’s why anyone who has these symptoms or thinks they may have contracted HIV should consider scheduling an appointment with a healthcare professional to get tested.

“You want to know your status as soon as possible, as early treatment is best for preventing future illness or symptoms,” she says.

Stage 2: Asymptomatic stage

Also known as the clinical latency stage, this stage of HIV is known for its lack of symptoms.

During this stage, the virus exists — and is multiplying — in the body and is beginning to weaken the immune system. But it isn’t (yet) actively causing symptoms.

A person with HIV at this stage may feel and look totally fine. But they can still easily transmit the virus to others.

Stage 3: AIDS

It may take years, even decades, but when left untreated HIV may attack and destroy enough CD4 cells that the body can no longer fight off infection and disease. In short: It breaks down the immune system.

Once this happens, HIV will progress to stage 3, often referred to as AIDS.

A person at this stage has a severely damaged immune system, making them more susceptible to something called “opportunistic infections.”

Opportunistic infections are conditions that the body would normally be able to fight off but can be harmful to people who have HIV.

People living with HIV may notice that they frequently develop colds, flu, and fungal infections.

The symptoms someone with stage 3 HIV might experience include:

• nausea
• vomiting
• persistent diarrhea
• chronic fatigue
• rapid weight loss
• cough
• shortness of breath
• recurring fever, chills, and night sweats
• rashes, sores, or lesions in the mouth or nose, on the genitals, or under the skin
• prolonged swelling of the lymph nodes in the armpits, groin, or neck
• memory loss, confusion, or neurological disorders

“When someone’s CD4 count drops below 200, that’s when someone becomes susceptible to opportunistic infections like pneumocystis pneumonia,” says Rymland.

This may all sound pretty scary, but remember that HIV can be managed with medication called antiretroviral therapy. (More on this below).

No, not really. Symptoms of HIV are generally the same in people of all genders.

One HIV symptom that is unique to people with penises that can occur is an ulcer on the penis. They’re often caused by a concomitant sexually transmitted infection (STI), like syphilis or herpes simplex virus, or chancroid.

Hypogonadism, which is a condition marked by poor production of sex hormones, may develop in people who have HIV that’s not well managed, long-term HIV, or because of aging.

People with all sorts of genitals can develop hypogonadism, but it’s easier to observe the effects in penis owners.

Other symptoms of hypogonadism penis owners may experience include:

• erectile dysfunction
• lower sperm count
• loss of body hair

“HIV is a human disease, meaning anyone can contract it,” says Rymland.

Unfortunately, due to the virus’ early nomenclature as GRID, or Gay Related Immune Deficiency, it’s wrongly assumed to affect only gay men.

Sadly, says Rymland, this pervasive stigma prevents non-gay men, as well as other-gendered individuals, from protecting themselves against HIV transmission or even getting tested for STIs.

“People of all sexual orientations need to be educated about their risk and informed on how to protect themselves,” she says. “And that includes being educated about PrEP, a safe and effective medication for preventing HIV that’s not well known outside of the gay community.”

How common is HIV in men?

Approximately 37.6 million people in the world are HIV-positive, 1.2 million of whom live in the United States.

Globally, men make up about 47 percent of cases. However, research published in 2018 found that men in the United States made up 81 percent of new cases.

There are a number of reasons for this gender disparity. Including:

• systemic homophobia and biphobia
• lack of comprehensive sex education
• lack of education about PrEP and barrier usage

HIV is typically diagnosed with a blood test. Though, it can also be diagnosed with oral fluid or urine.

Most commonly, healthcare professionals will order one of the following tests:

• nucleic acid test (NAT): looks for viral load in blood
• antigen/antibody test: looks for both antibodies and antigens in blood
• antibody test: looks for antibodies in the blood

It typically takes a few days for NAT and antigen/antibody tests to provide results. But there are rapid antibody screening tests and rapid antigen/antibody tests that take 30 minutes or less.

Many medical clinics, community health centers, and substance use programs offer HIV tests.

Another option is to use an at-home HIV test kit. Many of these home tests do not require sending the sample to a lab — a simple oral swab can provide results in 20 to 40 minutes. Regardless of your result, consult with a healthcare professional so that they can confirm with more advanced testing equipment.

Guidelines suggest that everyone between ages 13 and 64 get screened for HIV, as you would be tested for any disease as a regular part of routine medical checkups.

But the right cadence for how often you get tested will vary based on your solo and/or partnered sexual activity, the anatomy of your sexual partner(s) and the type of sex had, and intravenous drug use, says Rymland.

“If someone is in a monogamous relationship with an HIV-negative person, there’s no need for continued testing, unless there is concern for outside play,” she says.

However, if you have had sex with different partners, you should, at a minimum, get tested annually. Ideally, sexually active people with penises who have sex with other people with penises should get tested every 3 to 6 months.

You should also get tested annually if you inject drugs.

“If you have frequent sex with partners of unknown HIV status, then you may consider getting tested every 6 months,” she says.

“If you have had a known exposure to HIV, you should get tested 18 days after that exposure,” explains Rymland.

“And you should immediately start taking the HIV-prevention medication PEP, which you can think of as emergency contraception for HIV,” she says. “It can [help] prevent infection if you begin taking it within 72 hours of exposure.”

First things first: Know your own current STI status.

An estimated 13 percent of people living with HIV do not know that they have it. Knowing your current STI status can help prevent an HIV-positive person from transmitting the virus to others.

To know your most current HIV status, it’s important to get tested if you have any of the aforementioned symptoms or there’s a possibility that you contracted the virus.

If you test HIV-negative, the best way to remain negative is to avoid exposure to bodily fluids that may carry the virus.

These measures can help reduce the risk of contracting HIV:

• Share your current STI and HIV status with any potential partner and ask for theirs. Knowing their status will help you make the most informed decisions.
• Use condoms for any kind of penetrative play (vaginal, oral, anal). When used correctly, condoms are highly effective at protecting against HIV.
• Try not to share or reuse needles. Many cities have needle exchange programs that provide sterile needles.
• Take precautions. Always assume that blood might be infectious. Use latex gloves and other barriers for protection.
• Talk with your healthcare professional about PrEP. PrEP is daily oral ingestible that HIV-negative people can take to reduce their risk of contracting HIV if they’re exposed to the virus.

There’s no cure for HIV. However, getting a prompt diagnosis and early treatment can slow the progression of the disease and significantly improve quality of life.

“HIV is absolutely no longer the death sentence it used to be,” says Rymland. “I have taken care of patients that were diagnosed in the 80s who have been on treatment and have never been sick. They live full lives. Today’s treatment for HIV is easy and effective and, if taken properly, a person can live a long and healthy life and not pass it on to partners.”

Indeed, research shows that people with HIV who start treatment before their immune systems are severely damaged might have a nearly normal life expectancy.

Read this article in Spanish.