HIV, No Symptoms, Just Swollen Lymph Nodes (Neck, Arm, Elbow)

CarolL72 Asked :

About 2 years ago I was in a serious relationship for about 6 months and I recently discovered that he died of AIDS. At the time he had not mentioned anything about being HIV positive and after contacting his sister, I discovered that he knew his HIV status for many years even before we started dating. I am worried about whether I am positive although we used protection all the time since I was not prepared to use the pill.

I have had none of the early HIV symptoms and I had a finger prick test at work about 18 months ago which was negative. I am terrified about having a test now because I have been feeling like something is wrong for a year or so. I had the flu twice in the past 8 to 9 months, which is rare for me, because I never get the flu. However, I did relocate to a colder part of the country about a year back due to a change in career. I have felt little lumps on my neck, arm and elbows especially, which seems to be swollen lymph nodes and I know that this is a common sign of HIV. Other than that I have no other health problems.

Could I be HIV positive and not showing any signs of symptoms of it? Shouldn’t I be showing some signs and symptoms at this stage?

This question was posted under the First HIV Signs – Early Infection Symptoms, Risks, Other Cause article.

Dr. Chris Answered :

HIV infection is definitely possible but it would be difficult to diagnose without the presence of AIDS-defining illnesses and the relevant tests. While up to 80% of patients will experience the first signs of infection, it is possible that you did have it and just cannot recall or attributed it to the flu or some other illness at the time. It is also possible that you did not show any of these signs (20% of cases).

In most people who are HIV-positive, there is an asymptomatic period which can last for up to 10 years, sometimes longer or shorter. Generalized lymphadenopathy (swollen lymph nodes throughout the body) which is persistent (meaning it lasts for 3 months or more) is one of the common signs in the asymptomatic infection stage. Even if it is not occurring throughout the body, the fact that it is present in at least 2 different sites makes this very relevant. If the enlarged nodes are greater than 1 centimeter (cm) in diameter is another important indicator.

In the 90s in sub-Saharan Africa, where medical resources and testing facilities were limited, the presence of palpable (‘can be felt’) epitrochlear lymph nodes (elbow) along with swollen nodes elsewhere was considered a good indicator of HIV infection.

Many people living with HIV do not experience any significant signs or symptoms for this asymptomatic period, not even the seasonal flu. A lot depends on your lifestyle (diet, exercise and mental/emotional state) during this time. A colder environment, especially if you are not used to it, can result in repeated bouts of a cold or flu even without HIV infection. A career change in addition to relocating is stressful which could have also caused your immune system to dip during that time (not related to HIV infection). Before making any assumptions about your HIV status, rather speak to your doctor or visit a clinic where you are comfortable with the staff and discuss your testing options. An HIV test is definitely necessary in light of what you have discovered about your previous partner.

With regards to your first HIV test, it is possible that you were not infected at the time or you were in the “window period” during this period. It is difficult to assess this based on your account of the events that transpired at the time but from what you say, you were either still seeing your partner or had just ended the relationship. The “window period” can last up to 12 weeks and in very rare cases, up to 6 months. Another possibility is that you are NOT HIV-positive. Hopefully this is the case.

Attempting to diagnose (especially self-diagnosis) HIV infection and contemplating the possibility given the information you now have discovered about your partner can be very stressful. It this type of emotional stress that can impact your current health status if you are HIV-positive or even if you are not, it can be trying. It is better to find out your status at the earliest possible stage to put your mind at rest. If you are HIV-positive, an early diagnosis and evaluation of your CD4 cell count and viral load will allow your doctor to monitor you closely and start with ART (antiretroviral therapy) as soon as it becomes necessary. This could significantly prolong your lifespan.

A point to bear in mind : testing does not change your status – you are either positive or you are not.

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  • Michael.A.S

    This is my symptoms, x3 mo, swollen node R. posterior neck. nodes appear to rise only when I lay down to sleep and on occasion when I feel fatigued from working EMS, I have felt more fatigued and sleepy x6 mo, more so after I noticed swollen nodes. Minor dull pain RUQ which does not radiate, I have had x2 week on occasion a bloody stool, I do eat alot but I do not want to immediately state that is the reason for one or more stools per day. I have neg multiple swollen node sites, x2 (over the past month) night sweats but possibly caused by increased heat in apartment throughout the night, p/c x 4 ext. pos. strong and reg, weight is about 245, height 73″. I have had recent headache almost 5 days out of the week, possibly due to teching in the back of an ambulance for 12 hours a day? neg for yellow or green saliva, c/p or high grade fever. I wasnt feeling to great on one particular day when txp to an SNF and noted by a nursing station a low grade fever of 99.5. My typicaly temp is 96.3 lowest on through 98.6. I have noted mentally that given NY cold weather followed by not wearing a coat and frequently using my body in some sort of anerobic movement or even aerobic given the call or job if you will, i would sweat then be inducted to a warm ambulance or a warm/dry hospital on to the outdoor @ 50 deg. I have never had symptoms as such, PMH of orbital cellulitus 03′ mono, flu. As any individual I has had. I feel if it were any other infection my symptoms would be more pronounced rather than almost “poking at me” for the long ride theyre doing to endeavor with me. E.g. When one attains the flu, or flu like symptoms, generally a high grade fever followed by N/V, chills, fatigue etc. sets in, or even mono. the symptoms are much more progressive and appear and succeed. My symptoms appear very mild and almost as if im able to function my day. CMH, I have a more swollen R. ear w/ occasional retension of possible shower water or some sort of viscous fluid that on occasion has an almost “old water smell” or possible smell of infection, yet as noted it is viscous. I almost have a cracked molar R. Maxilla, which has been such for some years, 2007? until present. Two of these possible factors may suggest an infection, either from or as a result of. However I am in cold weather wearing less clothing to not let my body over heat and sweat which might be causing an upper resp. infect, or some other form of infection I am unaware of. I have had blood work done many years ago, im sure at one point an hiv test was done, but not within the last 3 years. I would appreciate your professional opinion from one medical personell to another. I was noted of what my possibility of this disease could be by a NP, an ER MD stated i”t sounds like you just have a little infection up there, but get it checked out”. I truly dont believe I could have aquired this, but given my oral situation it leaves a gateway for infection. However I have no given an oral stimulant of any recent gfs, not really my thing. it could only be left to kissing.

    • Dr. Chris

      Hi Michael A.S.

      Despite your symptoms, I am going to be bold enough here to say that it may not be due to any infection. In order to confirm this, do a CBC and speak to one of the docs with whom you work with to take a look at the results. This would give some indication of any infection at this point. HIV testing should always be done, whether you are with one or multiple partners, so if you don’t remember doing it, then now is the time to do it irrespective of your signs and symptoms.

      Your weight is a problem unless you are very muscular. If you cannot confirm an infection then look into other conditions that you are at risk of suffering with, given your BMI, age and family history, etc. Poor thermoregulation may be related to a host of causes and the temperatures you report may be related to this, and not an infection. In addition, you are in a stressful job plus at risk of needle-stick injuries, etc so even if you can exclude STD’s, there are other infections to consider like hepatitis (blood-borne transmission) and TB (low immune functioning due to stress despite the lack of pulmonary symptoms).

      Until you do a CBC and relevant blood tests, you will be guessing at best. It is advisable to consult with a physician. Despite your medical background, trying to self-diagnose and have colleagues make uninformed guesses about your condition is only going to be to your detriment in the long run. See an independent doctor.

  • michael.a.s

    Dr Chris,

    I thank you for for your reply, I was discussing thermoregulation with the doctor I shadow. He noted based on how active I am would give me an increased hunger, as well eating prior to sleep. My weight is an issue, I used to be muscular but has lost much of it. My chaloric expenditure being 2,000 plus calories along with less intake would help me loose weight, currently @ 21% body fat. My THR is about 165, which in my opinion is fare but rather hard to maintain unless I built my cardiovascular system to handle such a hr. I do have neg pulmonary symptoms, I was given a tn test x3 mo ago. Result was negative, I ha the oral instant hiv test done downtown yesterday and the result negative. I have not been sexually active the past 3 months. I have never incurred a sharps accident despite multiple ALS rotations, or hospital work. I do have FMH of DM 2/2, CHF, CARDIAC. sebaceous cysts x2 uncles. In 02 I was noted by a cardiologist that I have a minor heart murmur. All PMH may be of no significance however I believe the evidence of a fatty pocket or sebaceous cyst to be scanty given the onset rise and fall of this lump. I could have an abcess in my mouth but I have no pain. I must do a CBC, seems imperative. I had 0.5ml IM antiflu today @ 1400. I suppose 3 weeks after antibodies accumulate ill see if symptoms reside. I went through depth because health insurance is not available to me at work until the next fiscal year. I’m going to try vitamin d and c, ibuprofen and try best to stay warm and maintain body temp and note progress.

  • michael.a.s

    Sorry for spelling mistakes,my touch phone is freezing. I have no symptoms now except for lump.

    thank you sir

    • Dr. Chris

      No problem Michael. Good luck. Once you get your CBC results and if inconclusive, consider doing an ANF, etc as part of an autoimmune screen. But let’s not get ahead of ourselves. CBC first.

    • Dr. Chris

      Sorry Michael, meant to also say “Please speak to your doctor before undertaking any advice offered on this platform.”

  • chux

    hello doc.

    some months ago, i had a little sweeling around my anus and it stayed for up to a month. and i had casual unprotected sex within that period. what do you think is wrong.

    thank you

    • Dr. Chris

      Hi Chux

      Would be impossible to say. May not even be related to an STD (sexually transmitted disease). But since you admit to risky behavior, it would be wise to see a doctor about it. Not sure what exactly you mean by swelling around the anus – whether you are referring to the skin or anus itself. Could be tortuous vessels in teh area which was the start of hemorrhoids. Anyway, you will need to have a doctor examine it.

  • chux

    thanks doc for your response, i meant a lump, very tiny though just at the open of my anus. though its gone now after using an anti-inflammatory/anti-bacteria cream. but i am still worried because of the risky behaviour as i mentioned earlier. also the second time i exposed myself to danger with the same person i noticed a blister that later formed a sore almost immediately after sex. i know i shld see my doc soon, but any informationa from you will help;



    • Dr. Chris

      Hi Chux

      Advising you any further may mean that you will delay testing. Please see your doctor. A gonorrhea, syphilis, chlamydia tests are necessary. HIV should also be conducted simultaneously. Do not waste time by trying to self-diagnose or self-medicate without your doctor’s supervision and relevant STD testing. You could do more harm to yourself in the long run.

  • aahmad69

    Hi doctor, about 20 months ago I had a 2 way oral se.x (giving and receiving) with my girlfriend. We tested after 3 weeks(rapid test) and both negative, I tested 2 weeks later and finally I tested after 5 and 1 week after my oral se.x all was negative. But since that time I had lots of symptoms and more important 2 swollen lymph nodes In my neck about 13mm in diameter and I feel I have them till now.symptoms :
    1. Itchy skin( with hives that they dissappear in 20 minutes.)
    2. From June I had about 10 sweating in sleep( during night or day) my hair and chest get wet and a little my clothes.
    3. Feverish feeling sometimes no fever and also after I took anti anxiety and anti depression medicine last year for 2 months I feel better now.
    4. Sometimes loose stool (watery just 2 times during this 2 years) for one week( doctors said it’s IBS)
    5. In My mouth after eating dry foods like dry bread or chips I see 1 or 2 little scars that they healed in just 4 to 5 hours.
    6. Frequent aphthous( on back of my lips, 1 on my tongue and one on my upper gum) one in every 2 months but even the large ones disappeared in 10 days.

    • Hi Aahmad. The question now is whether these symptoms are related to the activity with your girlfriend or not. It could be a sexually transmitted infection. Apart from HIV testing, you should discuss these symptoms with your doctor and get tested for other diseases. But you could have also picked up an infection from these activities or even elsewhere. It does sound like an infectious disease from what you describe. Do not be too hasty to immediately associate it with your sexual activity, although this is reasonable concern. Autoimmune diseases, endocrine diseases and so on could also account for these symptoms that may have nothing to do with an infection. You have to speak to your doctor about it and possibly get a referral to a specialist physician.

      • aahmad69

        Thanks doctor but if you see my question again you’ll see that I didnt have fever ever, what about it? And what is your final opinion about HIV? Should I go for another test or not?

        • Aahmad, you should discuss these symptoms with your doctor. Looking for answers online may be delaying a possible diagnosis of something serious. A regular HIV test is always advisable if you are sexually active. But let your doctor assess your case and decide accordingly.

  • geryzimi

    Hello Dr.
    I had a sexual intercourse last 2 years. I used condom. But, when she took it off, her vaginal secretion touch my mucosa of penis a little. I had a pin point injury at my mucosa of penis.
    Can hiv transmit such a condition?
    After 3-4 weeks, I suffered fever, sore throat and lymph nodes enlargement near ears, neck and groin areas.
    Although fever and sore throat disappeared, my lymph nodes are still enlarge. They are not painful.
    I was so scared. I did my hiv 3rd generation ab test after 5, 7, 9 and 12 months.
    All tests are negative.
    But, whenever I feel my lymph nodes, I become so anxious.
    Please help me. Are my tests sure that I am 100% hiv negative?
    Do I need further testing?

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