HIV Symptoms in Women

Human immunodeficiency virus (HIV) is the virus that causes HIV infection. Spread through certain bodily fluids, HIV destroys the immune system and, if not treated, advances to AIDS. The first symptoms of HIV most commonly appear soon after infection, going away in a short amount of time. These initial HIV symptoms are flu-like in nature and are similar across all genders (HIV.gov, 2022).

But HIV symptoms in women tend to be different after the initial infection. From changes in menstrual cycles to an increase in vaginal infections, HIV can affect the body in ways that lead to symptoms unique to women.

The first signs of HIV for two-thirds of people are flu-like symptoms such as fever, chills, and fatigue. These symptoms are the body's natural response to infection and develop within two to four weeks after exposure. This is known as acute HIV infection and can last anywhere from a few days to several weeks (HIV.gov, 2022).

In this phase, HIV quickly multiplies and spreads throughout the body. Other HIV symptoms in women—and any other person—during this time include: (HIV.gov, 2022)

Rash
Night sweats
Muscle aches
Sore throat
Swollen lymph nodes
Mouth ulcers

After this acute HIV infection, you enter the stage of the virus known as chronic HIV infection. During this time, HIV continues to multiply but at lower levels. Without treatment, the stage can last about 10 years before progressing to AIDS.

Chronic HIV infection is also known as asymptomatic HIV infection because it is possible that you don't feel sick or have any symptoms (HIV.gov, 2021). More severe HIV symptoms, such as a weakened immune system, take longer to develop (HIV.gov, 2021).

It is during chronic HIV infection when women might experience health changes different from anyone else. While it is possible to not experience any complications for quite some time, they can eventually develop—and there are several HIV-related health changes during chronic HIV infection that are specific to women.

Menstrual cycle changes

You may notice changes to your menstrual cycle if you have HIV. Women with HIV might miss periods. They might also have lighter or heavier bleeding than they did before they were infected (HIV.gov, 2022).

Women with HIV are also more likely to have more severe symptoms of premenstrual syndrome (PMS) (HIV.gov, 2022). Symptoms of PMS include: (Office on Women's Health, 2021)

Swollen or tender breasts
Constipation or diarrhea
Bloating or a gassy feeling
Cramps
Headache or backache
Irritability
Sleeping too much or too little
Changes in appetite

An increase in vaginal infections

Women with HIV are more likely to get vaginal yeast infections or bacterial vaginosis(BV) than women without HIV (HIV.gov, 2022).

Yeast infections that happen at least four times a year, meaning they are recurring, are more common among women with advanced HIV (HIV.gov, 2022). Symptoms of a vaginal yeast infection include: (Office on Women's Health, 2021)

Itchiness in and around the vagina
Burning, redness, and swelling of the vagina and vulva
Pain when urinating or having sex
Soreness
A thick, white, odorless vaginal discharge

Women with HIV are also at higher risk for BV, a condition where the normal balance of bacteria in the vagina is disrupted (HIV.gov, 2022). Symptoms of BV include: (CDC, 2022)

A thin white or gray discharge from the vagina
Pain, itching, or burning in the vagina
A strong fish-like odor, especially after sex
Burning when urinating
Itching around the outside of the vagina

These yeast infections and cases of BV might not only happen more often, but they might also be harder to treat than usual (HIV.gov, 2022).

Recurring STIs

If you have HIV, you're not just at higher risk for contracting certain sexually transmitted infections (STIs) like genital herpes and pelvic inflammatory disease. You're also at greater risk for experiencing more symptoms of these diseases. If you have HIV, STIs may also be harder to treat (HIV.gov, 2022).

Early menopause

Menopause is considered to have been reached when your period has not come for 12 months. The average age for menopause in the US is 52 years old (Office on Women's Health, 2021). Women with HIV tend to enter menopause sooner, though (HIV.gov, 2022).

The transitionary time leading up to menopause and menopause itself are marked by a variety of changes, including the onset of hot flashes. A hot flash is when you suddenly feel heat in the upper part or all of your body. The sensation can last anywhere from 30 seconds to 10 minutes and can happen at varying frequencies (Office on Women's Health, 2021). But women with HIV typically have more severe hot flashes compared with those without the virus (HIV.gov, 2022).

Faster bone loss

People with HIV experience faster bone loss than those without HIV. However, that is especially true for women with HIV. Even without HIV, women tend to lose bone faster than men because of the hormonal changes that happen after menopause. So having HIV can affect women's bone loss more so (HIVinfo.nih.gov, 2021).

Increased cervical cancer risk

Women with HIV are at higher risk for cervical cancer, a cancer that begins in the cervix. This is because human papillomavirus (HPV) is the most common cause of the cancer, and women with HIV are more likely to have the cancer-causing types of HPV (HIV.gov, 2022).

Because of this increased risk, it is recommended that women with HIV discuss the ideal Pap smear screening schedule with a healthcare provider. For example, some guidance recommends having two pap smears in the first year after diagnosis with one Pap smear done every year after if the first two screenings were normal (Chen, 2013).

There are also some populations of women, such as those who are pregnant or breastfeeding and those who are taking HIV medication, that may need to take certain precautions. That's because these women have to keep in mind certain potential complications.

Transmission to child

HIV can be passed from mother to child during pregnancy, birth, and breastfeeding. Because of this, women who are pregnant or recently had a baby need to take special precautions. For example, because HIV transmission might be more likely with a vaginal delivery, a provider might recommend that women with HIV have a Cesarean (MedlinePlus, 2020).

Pregnant people with HIV—and their babies once they are born—need to take medication to reduce the risk of transmission. It is also suggested that women with HIV use formula instead of breastfeed since HIV can be passed through breastmilk (MedlinePlus, 2020).

If proper precautions are taken, the risk of passing HIV to an infant can be less than 1% (HIV.gov, 2022).

HIV medicine interactions

People with HIV can take antiretroviral therapy (ART) to bring and keep their HIV at undetectable levels. That means that they can live life with fewer complications and not pass HIV to others.

In general, women who are taking HIV medication may have different—sometimes more severe— side effects from the medication (MedlinePlus, 2020). For instance, research has shown that certain HIV treatments may cause some women to have rashes, nausea, and vomiting at higher rates than men (Office on Women's Health, 2021).

Some HIV medicines can also interact with hormonal birth control, increasing your risk for unintended pregnancy. That means that while you can use any form of birth control when you have HIV, you might need a secondary form of protection if you typically use hormonal methods like the shot, pills, or implants. If you're on HIV medications, talk with your doctor about which birth control option is best for you (HIV.gov, 2022).

If you suspect you've been exposed to HIV and have flu-like symptoms, see a healthcare provider or go to a clinic to be tested. These early symptoms can be caused by any number of illnesses and don't necessarily mean you have HIV, but the only way to know for sure is to get tested.

Some people who've been exposed to HIV never develop symptoms. So if you think you've been exposed to HIV and don't have flu-like symptoms, you should get tested, as well. That's especially true if you engage in behavior that is considered higher risk for contracting HIV, including injecting intravenous drugs or having unprotected sex with multiple people.

The sooner you get tested, the sooner you can start medication to bring and keep your HIV at undetectable levels.

Once you have a confirmed HIV diagnosis, it's important to stay in close contact with healthcare providers. Reach out if you notice any changes to your health, including seemingly unrelated or minor things like menstrual cycle changes or an increase in UTIs.

Since HIV puts you at increased risk of complications from infection, talk to a healthcare provider about what to do if there is a change in your health, such as if you get the flu or are exposed to Salmonella (HIV.gov, 2021) (HIV.gov, 2022).

HIV symptoms in women can start out like those of anybody else. Night sweats, muscle aches, a sore throat, and other flu-like symptoms that develop within two to four weeks after exposure and last between a few days to several weeks can be the first sign of HIV.

After that, it's possible to not have any other symptoms. But women can experience complications from HIV different from anyone else with the virus. Women can have reproductive health effects like menstrual cycle changes, early menopause, and more frequent vaginal infections. They're also at higher risk for cervical cancer and bone loss. And even if they take ART, women can still have medication side effects different from others, such as interactions with hormonal birth control.

To avoid those complications and their side effects, it's important to get tested if you think you've been exposed to HIV. Testing is the only way to know for certain whether you have HIV. The sooner you know you have it, the sooner you can begin ART so that you can bring and keep the HIV at undetectable levels.

Sources:

HIV. gov. How Can You Tell If You Have HIV?
HIV.gov. The Stages of HIV Infection.
HIV.gov. HIV and AIDS: The Basics.
HIV.gov. How Does HIV Affect Women Differently?
Office on Women's Health. Premenstrual syndrome (PMS).
Office on Women's Health. Vaginal yeast infections.
Centers for Disease Control and Prevention. Bacterial Vaginosis – CDC Basic Fact Sheet.
Office on Women's Health. Menopause Basics.
HIVinfo.nih.gov. HIV and Osteoporosis.
Chen Y, Liu H, Li C, et al. Low Papanicolaou Smear Screening Rate of Women with HIV Infection: A Nationwide Population-Based Study in Taiwan, 2000–2010. J Womens Health (Larchmt). 2013;22(12):1016–1022. doi:10.1089/jwh.2012.4127
MedlinePlus. HIV/AIDS and Pregnancy.
MedlinePlus. HIV/AIDS in Women.
Office on Women's Health. HIV and Women's Health.
HIV.gov. Are People with HIV at High Risk for Serious Flu Illness?
HIV. gov. What Are Opportunistic Infections?

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