HIV/AIDS Symptoms How to Know If You Have HIV Knowing the Symptoms, Risks, and Testing Options By James Myhre & Dennis Sifris, MD 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. Learn about our editorial process Updated on April 07, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Anju Goel, MD, MPH Medically reviewed by Anju Goel, MD, MPH LinkedIn Anju Goel, MD, is board-certified in internal medicine. She has over 10 years of experience in the California public health system addressing communicable disease, health policy, and disaster preparedness. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents How HIV Is Transmitted Signs and Symptoms Risk Factors HIV Testing Options Many people who have been infected with HIV are unaware that they have been infected until years after exposure to the virus. According to the U.S. Department of Health and Human Services, of the estimated 1.2 million people living with HIV in the United States, 1 in 7 do not know that they have been infected. There are a number of early signs and symptoms that may suggest you have the virus, but the only way to know if you have HIV is to get an HIV test. Verywell / Danie Drankwalter How HIV Is Transmitted The first step in determining whether you are at risk of HIV is to better understand how the virus is transmitted. HIV thrives in certain body fluids, including blood, semen, vaginal secretions, and breast milk. Most people get infected when exposed to HIV through these fluids. HIV is transmitted through: Anal sex Vaginal sex Shared needles and other drug paraphernalia HIV can also be passed from mother to child during childbirth, although this is less common in the developed world due to advances in prevention and treatment. It is important to note that HIV cannot penetrate intact skin. The virus can enter the body either through porous mucosal tissues (such as those in the vagina or rectum), through breaks in vulnerable tissues (which occurs during intercourse), or directly through the bloodstream. HIV infection can occur with just one exposure, particularly in high-risk individuals. By contrast, HIV does not thrive in saliva, urine, tears, or feces and cannot survive in infectious quantities when exposed to air and environmental conditions. Unlikely Modes of Transmission There are several less common modes of HIV transmission, including: Oral sex Needlestick injury Blood transfusions Female-to-female sex Tattooing and piercing Kissing Dental procedures Biting How HIV Is Transmitted Early Signs and Symptoms Many people do not have any symptoms in the early stage of the infection. However, after HIV transmission, newly-infected people can develop acute signs and symptoms within days of the exposure, including: Fever Chills Headache Fatigue Muscle aches Sore throat Swollen lymph nodes A widespread, non-itchy rash Diarrhea Loss of appetite Night sweats Genital, anal, or mouth ulcers (a sign of a co-occurring sexually transmitted disease) This range of symptoms, typically referred to as acute retroviral syndrome (ARS), generally begin within five days of exposure and usually last for around 14 days (although some cases have been known to last for months). If you have had a recent exposure—such as unprotected sex with a partner of unknown status—these early signs and symptoms strongly suggest the need for immediate HIV testing. With that said, not everyone experiences ARS in the same way. The symptoms are non-specific and often mild and are sometimes attributed to other conditions, such as the common cold or simple exhaustion. According to a 2016 review in Emerging Infectious Diseases, as many as 43% of acute HIV infections are entirely asymptomatic (without symptoms). Less commonly, some people may develop atypical symptoms of HIV soon after exposure, some of which may be serious. These include tonsillitis, meningitis, herpes zoster (shingles), gastric bleeding, and esophageal thrush. How Common Is HIV Today? HIV Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Risk Factors Even though anyone can get HIV, some individuals are at higher risk than others due to risk behaviors. By identifying your personal risk factors for HIV, you can better determine whether you need HIV testing. 7 Top Signs You May Have HIV Sexual Risk Factors Sex is by far the most common mode of HIV transmission. With that said, there are variables that can increase or decrease the risk of infection. These include: Whether you engage in anal and vaginal sex If you are the receptive or insertive partner The viral load of the HIV-positive partner How many sexual partners you have Whether or not there is ejaculation during intercourse Whether or not the male partner is circumcised Sex work or having sex with someone who does sex work Sex with someone who uses IV drugs Anal sex poses the highest risk of transmission with a per-episode risk of roughly 1 in 70 (1.43%) for the receptive partner and 1 in 161 (0.62%) for the insertive partner. Rectal tissues are especially prone to rupture, allowing the virus direct access to vulnerable tissues and cells. Vaginal sex is the second most common mode of transmission with a per-episode risk of 1 in 525 (0.19%) for the female partner and 1 in 1,000 (0.1%) for the male partner. This translates to a higher rate of new infections among women compared to men—18% versus 8%, respectively. Additionally, women have a 1.6-fold greater risk of progression to AIDS. Rather than playing the odds, you can reduce your risk of HIV by using condoms, limiting your number of sex partners, and taking HIV pre-exposure prophylaxis (PrEP) to prevent getting the disease. Undetectable HIV Equals Zero Risk of Transmission Intravenous Drug Use Intravenous drug use is one of the contributing factors to the HIV epidemic in the United States, driven in part by the ongoing opioid crisis. People who inject drugs (PWID) account for around 9% of all new HIV infections, due mainly to the shared use of contaminated syringes and needles. The risk is even higher if you share needles with someone who has a high viral load, inject in non-private places (such as in alleys or parks), or use cocaine and crack cocaine (the drugs of which are associated with drug binges). Additionally, drug use is associated with sex work (which can lead to HIV exposure), as some people who are addicted to drugs engage in sex work to pay for drugs. Injecting crack cocaine or cocaine is associated with a 2.1-fold to 3.7-fold increased risk of HIV transmission. High vs. Low Risk Activities for HIV Transmission Sexually Transmitted Diseases Studies suggest that 1 in 7 people with HIV are co-infected with another sexually transmitted disease (STD) at the time of their diagnosis. These co-infections increase vulnerability to HIV. STD can increase the risk of HIV transmission in three distinctive ways: Ulceration: STDs like syphilis and genital herpes manifest with open, ulcerative sores that can allow the HIV virus greater access to deeper tissues. Inflammation: STDs, including chlamydia and gonorrhea, provoke inflammation, providing immune cells greater access to the site of exposure. Among these are CD4 T-cells that HIV preferentially targets and infects. Viral STDs like herpes simplex and human papillomavirus (HPV) and bacterial STDs like gonorrhea, chlamydia, and syphilis can increase the risk of HIV transmission by up to 300% and 500%, respectively. HIV Stigma HIV remains a highly stigmatized disease. Because it is linked to behaviors that many in society disapprove of—including homosexuality, drug use, sexually active youth, and sexually active females—people living with HIV are frequently discriminated against or "blamed" for the spread of infection. When faced with HIV stigma, some people who might otherwise seek diagnosis and treatment might go into hiding, fearing that the disclosure of their status may cause them harm, abandonment, loss of income, or worse. Feeling of shame, guilt, and fear will often become internalized, leading to depression and an increased risk of isolation, alcohol and substance abuse, and risk-taking behaviors. When paired with homophobia, misogyny, and racism, HIV stigma can exponentially increase the risk of infection. A 2016 study from the Centers for Disease Control and Prevention reported that gay and bisexual Black men, trapped in the crosshairs of homophobia, racism, and poverty, have a 50/50 chance of getting HIV in a lifetime. Why Do Gay Men Have a High Rate of HIV? Youth People under 25 account for 1 in 5 new HIV infections in the United States each year, with the majority occurring through male-to-male sexual contact. Compared to adults, teens and young adults with HIV are more likely to remain undiagnosed and untreated and also fail to achieve an undetectable viral load if they are treated. Young people are also more likely than older people to be homeless, uninsured, recently incarcerated, or living in households with low incomes. Those between the ages of 20 and 24 also have the highest rates of STDs overall, increasing the risk of HIV transmission and infection. High rates of substance abuse also plague younger people, with 2% and 12% of all new infections in young men and young women, respectively, attributed to injecting drug use. The Impact of HIV on Teens and Young Adults HIV Testing Symptoms and risk factors may point you in the direction of HIV testing, but the lack of symptoms or risk factors should not suggest that you are "in the clear." There are several different HIV tests to choose from. Some are more accurate than others, while others are faster, more convenient, or offer greater privacy or confidentiality. The tests can either check for antibodies (defensive proteins that the body produces in response to the virus) or antigens (the part of the virus that triggers the immune response). There are also combination tests that detect both HIV antibodies and antigens as well as nucleic acid tests (NAT) that detect the virus. Different tests require different testing samples. Rapid HIV tests, including at-home and mail-in tests, typically require a saliva sample or drop of blood. Some in-office tests require a sample of blood. Although tests that utilize a blood sample are typically more accurate, newer generation rapid tests are demonstrating higher sensitivity and specificity rates than in years past. Test Type Sample Tests for Turnaround Accuracy At-Home Rapid Test Saliva HIV antibodies 20 minutes Specificity: 99%Sensitivity: 92% Mail-In Test Fingerprick HIV antibodies 2-5 days Specificity: 100%Sensitivity: 83% In-Office Rapid Test Saliva, fingerprick HIV antibodies 20 minutes Specificity: 100%Sensitivity: 98% Standard Antibody Test Blood sample HiV antibodies 2-3 days Specificity: 99%Sensitivity: 95% Combination Antigen-Antibody Test Blood sample HIV antibodies and antigens 2-3 days Specificity: 100%Sensitivity: 99% Nucleic Acid Test (NAT) Blood sample HIV RNA 2-3 days Specificity: 100%Sensitivity: 99% As accurate as these newer-generation tests are, they still have their limitations. Keep in mind that each test has a window period, so it is important that you understand whether you are having the test in the right window to know whether you are infected. Window Period for HIV Testing Because it takes time for the body to produce enough antibodies to reach detectable levels, you may need to wait for three weeks or more—known as the window period—before an antibody test can return an accurate result. Newer combination tests may be able to cut that time to 14 days. A Word From Verywell As scary as an HIV test may seem, the benefits of testing invariably outweigh the risks. Rather than wondering if you "have it or not," your HIV test results will guide your treatment and prevent the virus from undermining your immune defenses. Starting treatment early when your immune system is still intact gives you a better chance of having a normal to near-normal life expectancy. It also slashes the risk of HIV-associated and non-HIV-associated illnesses by more than half compared to starting late. 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