Signs and Symptoms of HIV in Men

How HIV Differs From Women by the Stage of Infection

In the United States, males account for around 80% of all new HIV infections each year. Of these, the majority involve men who have sex with men (MSM), while an estimated 10% occur in males who engage exclusively in heterosexual sex.

According the Centers for Disease Control and Prevention (CDC), of the estimated 1.2 million Americans living with HIV, just over 912,000 are male.

While the symptoms of HIV are largely the same whether you are male or female, there are several that affect males specifically due to differences in male reproductive tract, including:

  • Pain with ejaculation
  • Sores or ulcers on the penis
  • Abnormal discharge from the penis
  • Pain in or around the penis, testicles, or the area between the scrotum and anus
  • Erectile dysfunction
  • Abnormal breast growth
  • Reduced facial or body hair
  • Infertility

The article describes why symptoms like these occur in males with HIV, including how they differ during the acute and chronic phases of infection. It also explains how sexually transmitted infections (STIs) that commonly occur with HIV can also trigger distinctive symptoms in males.

Symptoms of Chronic HIV in Men

Verywell / Zoe Hansen

Acute HIV Infection

Acute HIV infection, also known as acute seroconversion or acute retroviral syndrome (ARS), is the initial stage of the disease following exposure to the virus. It is the period during which the body will start producing antibodies to fight the virus. ARS lasts for about 14 days, but the antibodies may be made for much longer.

Though some people will experience symptoms during the acute phase of infection—typically described as flu-like with swollen lymph nodes and occasionally rash—recent studies have suggested that as many as 43% will not have any symptoms at all.

The signs and symptoms of ARS do not vary between men and women. However, the rates of seroconversion differ, wherein heterosexual men are 50% less likely to get infected per sexual act compared to heterosexual women (due to differences in size and porosity of penile mucosal surfaces compared to those of the vagina or rectum).

The biological disparities are one of the main reasons why heterosexual men account for 8% of all new infections in the United States, while women account for 18%.

HIV and STD Co-Infection

Another way that acute HIV differs in men is in the types of symptoms that can develop when there is an accompanying sexually transmitted disease (STD).

HIV transmission is often facilitated by a co-occurring STD. STDs increase the porosity of the penile mucosa and trigger acute inflammation, drawing a high concentration of immune cells to the site of the exposure. Among them are CD4 T-cells, the very cells that HIV preferentially targets and infects.

In such cases, an acute HIV infection may be identified by the signs and symptoms of the STD rather than those of HIV itself.

A 2018 study from the San Francisco Department of Public Health reported that syphilis, gonorrhea, and chlamydia were diagnosed respectively in 66%, 28%, and 15%, of people newly diagnosed with HIV.

Among some of the symptoms commonly seen in men with an HIV/STD co-infection:

  • Penis sores: Syphilis develops in stages, the first of which involves the appearance of a painless, ulcerative sore (called a chancre) at the site of the exposure. In men, the penis, rectum, or mouth can be affected. The break in the skin allows HIV easier access into the body to establish an infection.
  • Pain and burning with urination: This is a common symptom in men with gonorrhea and chlamydia.
  • Testicular pain and swelling: This is another possible sign of chlamydia and gonorrhea in which the epididymis (the tube that stores and transports sperm from the testicle) becomes inflamed. Orchitis (testicular swelling) and/or epididymitis (swelling of the epididymis) can occur.
  • Pain with ejaculation: Also known as dysorgasmia, this is a symptom of gonorrhea, chlamydia, or trichomoniasis in men.

Although the above-listed symptoms are not signs of HIV, they are indicative of an increased risk of HIV. To this end, the CDC recommend that anyone who seeks the diagnosis and treatment of an STD should be screened for HIV as well.

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Chronic HIV Infection

After the immune system produces enough antibodies to bring the acute infection under control, HIV will go into a period of latency when there may be few, if any, notable symptoms.

This chronic stage of infection can persist for years, during which HIV will silently and progressively deplete the number of CD4 T-cells that are part of the body's immune response.

As these immune cells are depleted, the body will become increasingly susceptible to an ever-widening range of opportunistic infections (OIs). These are infections that the body would otherwise be able to control had its immune defenses remained intact.

As the number of CD4 T-cells progressively drop—as measured by the CD4 count—the risk, severity, and range of OIs will increase.

A normal CD4 count ranges from 500 to 1,200 cells per cubic millimeter (cells/mm3) in adults and teens. A value between 250 and 500 cells/mm3 is considered criteria for diagnosis of immunosuppression.

Opportunistic Infections in Men

As opposed to the acute stage of infection, the symptoms of chronic HIV are primarily related to the development of OIs rather than the virus itself.

In men and women, the expression of these OIs remains more or less the same. At CD4 counts of between 250 and 500, common OIs include candidiasis (oral and vaginal thrush), herpes simplex, herpes zoster (shingles), bacterial pneumonia, bacterial and fungal skin infections, tuberculosis, and HIV-associated meningitis.

The differences between sexes, if any, mainly involve those of the anal and genital tracts. In men with chronic HIV infection, these symptoms may include:

  • Chronic or recurrent penile ulcers: Chronic genital ulcers (i.e., those lasting for more than one month) are hallmarks of a severely suppressed immune response. In men with HIV, this can manifest with extensive ulcers on the penis, most often caused by herpes simplex virus type 2 (HSV-2).
  • Anal ulcers: HSV-2 is highly prevalent in MSM with HIV, with some studies suggesting a positivity rate of 80%. Anal ulcers, commonly caused by the transmission of HSV-2 during anal sex, is often the first manifestation of HIV in MSM. Although common in MSM, these painful ulcers can also affect anyone who engages in anal sex.
  • Rectal pain: Rectal inflammation, also known as proctitis, is a symptom also commonly linked to HSV-2 in HIV-positive MSM. In addition to causing pain, proctitis can manifest with anal ulcers, rectal bleeding, mucus discharge, diarrhea, and tenesmus (a feeling that you need to defecate when your bowel is empty).
  • Erectile dysfunction: The prevalence of erectile dysfunction (ED) is high in men with HIV, even those with good viral control. Some studies have suggested that as many as 67% of men with HIV will experience some degree of ED—a rate that exceeds men in the general population by more than three-fold. Causes include anxiety, HIV-associated e level), and HIV-associated lipodystrophy (in which abnormal fat redistribution can impede the ability to achieve an erection).
  • Gynecomastia: The abnormal swelling of breast tissue, called gynecomastia, can also occur in men with HIV-associated hypogonadism. Although hypogonadism tends to affect men with CD4 counts below 100, certain OIs can reduce testosterone levels in men with higher CD4 counts. They do so by indirectly impairing the function of the endocrine system, which regulates the production of male hormones. The loss of libido is also common.


The final stage of HIV infection is commonly referred to as acquired immune deficiency syndrome (AIDS). This is the point where the immune system is said to be severely compromised, increasing the risk of potentially life-threatening opportunistic infections.

By definition, a person with HIV is considered to have progressed to AIDS when:

AIDS-defining conditions include OIs that are rarely seen outside of immunocompromised people as well as common OIs that have recurred or have disseminated (spread) beyond the typical site of infection to distant organs.

If left untreated, HIV can progress to AIDS over the course of months to years, with a median time of approximately 11 years.

Symptoms of AIDS in Men

The symptoms of AIDS are similar for men and women. HSV-2-associated anal ulcers, which can become deep and non-healing with CD4 counts under 100 predominantly affects men.

Kaposi sarcoma (KS), an AIDS-defining cancer, can occur on any part of the body but on rare occasion can manifest with purplish lesions on the penis. Although KS typically occurs when the CD4 count drops below 200, there have been instances when an isolated penile lesion has developed at CD4 counts well over 200.

Non-AIDS-Defining Cancers

In addition to AIDS-defining conditions, people with HIV are at an increased risk of a variety of different cancers. The non-AIDS-defining cancers are thought to be the consequence of chronic inflammation spurred by the infection, which can alter cellular DNA and trigger the development malignant cells.

In men, this can lead to an increased risk of two different types of cancer:

  • Penile cancer: Cancer of the penis is extremely rare in the United States, with an annual incidence of around one case per 100,000. HIV infection increases the risk of penile cancer eight-fold, with 80% of cases directly linked to high-risk strains of the human papillomavirus (HPV).
  • Anal cancer: Anal cancer is also rare in the United States, affecting roughly two of every 100,000 men and women every year. Among HIV-positive MSM, the annual incidence skyrockets by 144-fold, in association with sexual exposure to high-risk HPV strains.

Non-AIDS-defining cancers are the leading cause of death among people with HIV in the developed world, according to research from the ongoing Swiss HIV Cohort Study.

A Word From Verywell

Although certain symptoms may suggest that you have HIV, the absence of symptoms does not mean that you are "in the clear." If you have risk factors for HIV and have not been tested, it may be time to do so.

Currently, the U.S. Preventive Services Task Force recommends at least one time HIV testing for all Americans age 15 to 65 as part of a routine medical exam.

If diagnosed and treated appropriately, people with HIV can live normal to near-normal life expectancy with a lowered risk of HIV-associated illnesses. This is especially important in men, who tend to have significantly lower CD4 counts and higher viral loads at the time of diagnosis compared to women.

Early diagnosis and treatment almost invariably lead to better outcomes.

27 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. HIV and men.

  2. Centers for Disease Control and Prevention. About HIV/AIDS.

  3. Hoenigl M, Green N, Camacho M, et al. Signs or symptoms of acute HIV infection in a cohort undergoing community-based screening. Emerg Infect Dis. 2016 Mar;22(3):532-4. doi:10.3201/eid2203.151607

  4. Scully EP. Sex differences in HIV infection. Curr HIV/AIDS Rep. 2018;15(2):136-46. doi:10.1007/s11904-018-0383-2

  5. Centers for Disease Control and Prevention. HIV in the United States and dependent areas.

  6. Jarvis GA, Chang TL. Modulation of HIV transmission by Neisseria gonorrhoeae: Molecular and immunological aspects. Curr HIV Res. 2012 Apr;10(3):211–7 doi:10.2174/157016212800618138

  7. Chen MJ, Scheer S, Nguyen TQ, Kohn KP, Schwarcz SK. HIV coinfection among persons diagnosed as having sexually transmitted diseases, San Francisco, 2007 to 2014. Sex Transm Dis. 2018 Aug;45(8):563-72. doi:10.1097/OLQ.0000000000000789

  8. Pathela P, Braunstein SL, Blank S, Shepard C. The high risk of an HIV diagnosis following a diagnosis of syphilis: A population-level analysis of New York City men. Clin Infect Dis. 2015 Jul;61(2):281-7. doi:10.1093/cid/civ289

  9. Centers for Disease Control and Prevention. HIV infection: detection, counseling, and referral.

  10. MedlinePlus. CD4 lymphocyte count.

  11. Zanoni BC, Gandhi RT. Update on opportunistic infections in the era of effective antiretroviral therapy. Infect Dis Clin North Am. 2014 Sep;28(3):501–18. doi:10.1016/j.idc.2014.05.002

  12. Kieselova K, Santiago F, Falhas C, et al. Chronic penile ulcer as the first manifestation of HIV infection. BMJ Case Reports 2017;2017:bcr-2017-221604. doi:10.1136/bcr-2017-221604

  13. Sandlin MI, Johnston C, Bowe D, et al. Clinician and patient recognition of anogenital herpes disease in HIV positive men who have sex with men. Sex Transm Dis. 2011 Sep;38(9):833–6. doi:10.1097/OLQ.0b013e31821a5d2c

  14. Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M. The etiology of infectious proctitis in men who have sex with men differs according to HIV status. Sex Trans Dis. 2013 Oct:40(10):768-70. doi:10.1097/OLQ.0000000000000022

  15. De Tubino Scanavino M. Sexual dysfunctions of HIV-positive men: associated factors, pathophysiology issues, and clinical management. Adv Urol. 2011;2011:854792. doi:10.1155/2011/854792

  16. Wong N, Levy M, Stephenson I. Hypogonadism in the HIV-infected man. Curr Treat Options Infect Dis. 2017;9(1):104–16. doi:10.1007/s40506-017-0110-3

  17. U.S. Department of Health and Human Services What Are HIV and AIDS?.

  18. U.S. Department of Health and Human Services. Herpes simplex virus. In: Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV.

  19. Lebari D, Gohil J, Patnaik L, Wasef W. Isolated penile Kaposi's sarcoma in a HIV-positive patient stable on treatment for three years. Int J STD AIDS. 2014 Jul;25(8):607-10. doi:10.1177/0956462413517494

  20. Konan PB, Vodi CC, Dekou AH, Fofana A, Gowe EE, Manzan K. Cancer of the penis associated with HIV: a report of three cases presenting at the CHU Cocody, Ivory Coast. BMC Urol. 2015;15:112. doi:10.1186/s12894-015-0101-y

  21. Engelsgjerd JS, LaGrange CA. Penile cancer. StatPearls.

  22. National Institutes of Health Surveillance, Epidemiology, and End Results (SEER) Program. Anal cancer.

  23. Patel P, Bush T, Kojic EM, et al. Prevalence, incidence, and clearance of anal high-risk human papillomavirus infection among HIV-infected men in the SUN study. J Infect Dis. 2018;217(6):953-963. doi:10.1093/infdis/jix607

  24. Hleyhel M, Belot A, Bouvier A, et al. Risk of AIDS-defining cancers in HIV-1 infected patients (1992-2009): results from FHDH-ANRS CO4J Int AIDS Soci. 2012;15(4):1-2. doi:10.7448/IAS.15.6.18196

  25. U.S. Preventive Services Task Force. Final recommendation statement: human immunodeficiency virus (HIV) infection: screening.

  26. May MT, Gompels M, Delpech V, et al. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapyAIDS. 2014;28(8):1193-202. doi:10.1097/QAD.0000000000000243

  27. Addo MM, Altfeld M. Sex-based differences in HIV type 1 pathogenesis. J Infect Dis. 2014 Jul 15;209(Suppl 3):S86–S92. doi:10.1093/infdis/jiu175

By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.