- Mononucleosis: Management and Treatment
- Signs and Symptoms
- What Causes It?
- Who’s Most At Risk?
- What to Expect at Your Doctor’s Office
- Treatment Options
- Treatment Plan
- Drug Therapies
- Surgical and Other Procedures
- Complementary and Alternative Therapies
- Prognosis and Possible Complications
- Supporting Research
- About Epstein-Barr Virus (EBV)
- Prevention & Treatment
Mononucleosis: Management and Treatment
How is mononucleosis treated?
There are no medications that can treat mononucleosis, because antibiotics and antiviral drugs are not effective against the virus. If you are diagnosed with mononucleosis, here are some suggestions for how to deal with it:
- Get lots of rest, preferably bed rest, especially the first week or two.
- Drink plenty of water and other fluids.
- Take nonprescription pain relievers, such as ibuprofen (or
acetaminophen, if you cannot take ibuprofen) to help relieve the fever and
muscle aches that are common symptoms.
- To help soothe a painful sore throat, use throat lozenges, drink cold
beverages, or eat frozen desserts, such as popsicles.
- Gargle with salt water several times a day if your throat feels sore.
Prepare the salt water solution by dissolving about one-half teaspoon of
salt in 8 ounces of warm water.
- Avoid any strenuous physical activity, such as exercise, heavy lifting, or contact sports, for at least 4 to 6 weeks after being diagnosed with mononucleosis. This is to prevent rupture of the spleen, which is fragile during mononucleosis.
Share Facebook Twitter LinkedIn Email Get useful, helpful and relevant health + wellness information enews
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
0 shares 2 min
Mononucleosis, or more properly, infectious mononucleosis, is caused by the Epstein Barr virus, a herpes virus related to the agents that cause cold sores and chicken pox. Most people get mono at some point in their lives, usually during childhood and, usually, the disease is so mild that youngsters don’t even know they’re infected. The virus then stays in the body for life, usually causing no further trouble. It seems that the older you are when you first catch mono, the worse your symptoms can become. Some people, who are run down or whose immune systems are depressed, can get quite sick with mono.
Symptoms typically include fever, sore throat, swollen lymph nodes and exhaustion. The fatigue often can be overwhelming, keeping people in bed for several weeks.
The best treatment is rest, at least for the duration of the fatigue – usually a week or two. To relieve the sore throat, drink lots of fluids, gargle with salt water and take Tylenol — not aspirin. Because of the risk of Reye’s Syndrome, children and teens with fever should not be given aspirin. (If your throat is so sore that you can’t talk, your doctor may prescribe a syrupy lidocaine gargle.) I would also suggest taking astragalus (Astragalus membranceous), a traditional treatment in Chinese medicine for colds and flu with immune-boosting effects. Take two capsules twice a day unless the product directs otherwise. Echinacea (Echinacea purpera) can also help – the dose is a teaspoon of tincture in water four times a day or two capsules of freeze-dried extract four times a day until symptoms disappear.
In addition to treatment, be sure to wash the dishes and utensils used by people with mono – and don’t share food with them. The virus is passed through saliva, which is how mono earned its nickname “the kissing disease.”
As for continuing to work if you have mono – that depends on the severity of your symptoms. You may recall that speed skater Chris Witty won a Gold Medal at the 2002 Olympics despite having mono. Of course, most people don’t have the motivation and stamina of Olympic athletes and it is best to avoid sports, exercise and other physical activities for about 3 to 4 weeks after infection starts. Moving around too much puts you at risk of rupturing your spleen so wait until you get the go-ahead from your doctor before resuming physical activities.
I don’t advise pushing through viral fatigue in order to work, because you’ll probably just prolong your recovery. You would be better off resting until the fatigue ebbs and your energy returns.
Andrew Weil, M.D.
Signs and Symptoms
Also listed as:
|Table of Contents > Conditions > Mononucleosis|
|Signs and Symptoms||What Causes It?||Who’s Most At Risk?||What to Expect at Your Doctor’s Office||Treatment Options||Prognosis and Possible Complications||Supporting Research|
Infectious mononucleosis, or mono, is often called “the kissing disease” because that’s one of the ways you can get it. It’s caused by the Epstein-Barr virus (EBV), spread through saliva. Symptoms include:
- Sore throat
- Swollen glands
Mono can also be spread by sharing eating utensils or glasses. A person is contagious several days before symptoms appear and for some time after. Symptoms usually resolve within 2 to 6 weeks.
- Sore throat, often severe
- Swollen tonsils
- Swollen lymph nodes in the neck
- Enlargement of the spleen
- Enlargement of the liver
Symptoms may not show up until 4 to 7 weeks after you’ve been exposed to the virus. Symptoms may last only a few days or as long as several months. In most cases, they go away in 2 to 6 weeks.
What Causes It?
The Epstein-Barr virus (EBV) causes mono. Direct contact with saliva that’s infected with the virus, mainly through kissing, can pass the virus on. You can also get mono through transfusions with infected blood products.
Mono affects about 45 out of 100,000 people, mostly teens and young adults. It usually isn’t a serious disease. But it can cause fatigue and weakness that interfere with daily life.
About 90% of adults have been exposed to EBV and have antibodies, meaning they are immune to the virus.
Who’s Most At Risk?
The following factors can raise your risk for developing mono:
- Age. Mono is most common among people ages 15 to 24. After age 35, the rate is low.
- Blood transfusion.
- Weakened immune system.
What to Expect at Your Doctor’s Office
Your doctor will do a physical examination, checking for fever, sore throat, swollen glands, and swelling of your spleen or liver. Your doctor may also do a blood test to confirm the diagnosis.
Someone who has mono doesn’t need to be isolated because the virus isn’t usually spread through the air. Family members or college roommates have only a slight risk of being infected, unless they kiss the person. It’s best not to share eating utensils or toothbrushes.
Treatment for mono includes bed rest and plenty of fluids. You may feel so tired and weak that you can hardly get out of bed for about a week. Symptoms typically begin to improve after about 2 weeks. People with mono should avoid contact sports and heavy lifting for 2 months due to the risk of rupturing the spleen.
There is no cure for mono, but your health care provider may prescribe the following medications to treat your symptoms:
- Pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil) for fever. DO NOT give over-the-counter pain relievers to children without talking to your doctor first. Children under the age of 18 should not take aspirin because of the risk of developing Reye syndrome, a rare condition that can affect the liver, brain, and other organs.
- Antibiotics don’t work against mono, but your doctor may prescribe them to treat strep throat.
Surgical and Other Procedures
In the case of a ruptured spleen, you may need surgery to remove it.
Complementary and Alternative Therapies
Several studies report that stress and relaxation affect our immune systems. Stress can make your body more vulnerable to infection. So reducing stress may help prevent infection with viruses such as EBV.
While no herbs or supplements treat mono specifically, some may help reduce the long-term effects of EBV infection and complications linked to EBV.
Always tell your doctor about any herbs and supplements you are using or considering using.
Nutrition and Supplements
These nutritional tips may help reduce symptoms and strengthen your immune system:
- Eat more antioxidant-rich foods, such as green, leafy vegetables and peppers, and fruits, such as blueberries, tomatoes, and cherries.
- Avoid refined foods, such as white breads and sugar.
- Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
- Use healthy oils, such as olive oil and coconut oil.
- Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid caffeine, alcohol, and tobacco.
- Drink plenty of water daily.
- Gargling with warm salt water may help soothe a sore throat.
These supplements may also help:
- Omega-3 fatty acids, such as fish oil, to help reduce inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources. Fish oil may increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
- Probiotic supplement (containing Lactobacillus acidophilus), for gastrointestinal and immune health. Taking antibiotics can upset the balance between good and bad bacteria in your gut and cause diarrhea. Taking probiotics, or “friendly” bacteria, may help restore the right balance. If you take drugs to suppress your immune system, or have a weakened immune system, ask your doctor before taking probiotics.
Herbs are a way to strengthen and tone the body’s systems. As with any therapy, you should work with your health care provider before starting treatment.
The following herbs have not been studied for treating mono, but they are sometimes suggested because they strengthen the immune system:
- Green tea (Camellia sinensis). For antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also make teas from the leaf of this herb.
- Echinacea (Echinacea purpurea). To strengthen the immune system. DO NOT give echinacea to a child without talking to your doctor first. People with autoimmune diseases, such as rheumatoid arthritis, should not take echinacea. People who have ragweed allergies should be extra cautious since they may be allergic to Echinacea as well.
- Astragalus (Astragalus membranaceus). Has not been studied for mono, but it does seem to kill viruses, at least in test tube studies. Researchers don’t know whether it would work against the EBV. People who have autoimmune diseases, such as rheumatoid arthritis, or who take anticoagulants (blood-thinners), diuretics (water pills), lithium, cyclophosphamide (Cytoxan), medication for high blood pressure, or medication to lower blood sugar should not take astragalus without talking to their doctor first.
- Cranberry (Vaccinium macrocarpon). Appears to fight viruses, although no one knows whether it works against the EBV. Cranberry may increase the risk of bleeding, especially if you also take blood thinners. People who are allergic to aspirin should not take cranberry supplements or drink large amounts of cranberry juice.
Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for mono based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
The following remedies may be effective for fever related to EBV:
- Belladonna. For early stages of mononucleosis with sudden onset of fever.
- Ferrum phosphoricum. For individuals with the early stages of a fever accompanied by a painful cough and sore chest.
- Kali muriaticum. Typically used for individuals with extremely swollen tonsils, but may also be useful for treating infectious mononucleosis when administered in conjunction with Ferrum phosphoricum.
Professional homeopaths may also recommend the following remedies:
- Mercurius. For individuals with a fever accompanied by profuse sweating, alternating hot and cold body temperature, weakness in the limbs and painful, aching bones, a bluish-red throat with a constant desire to swallow, excessive salivation, teeth marks around the edges of a swollen tongue, and tremendous thirst.
- Phytolacca. For pain caused by throat inflammation that radiates to the ears upon swallowing.
Other helpful remedies include Lachesis, Conium, Hepar sulphuricum, and Baryta carbonica.
Research also suggests that a combination of homeopathy and traditional Chinese medicine (TCM) may effectively improve symptoms of mononucleosis. The most common homeopathic remedies used with TCM include Lycopodium, Silicea, Phosphorous, Sulphur, Mercurius, Nux vomica, Sepia, and Pulsatilla.
Although no scientific studies have reviewed the use of acupuncture for mono, it may help reduce symptoms, improve immune function, and relieve congestion (blockage of qi, or energy flow) of the liver, spleen, and lymph.
Traditional Chinese Medicine
Studies show that people with EBV have fewer symptoms when given a combination of homeopathic remedies noted in the section on homeopathy and TCM remedies including Atractylodes alba, Glycyrrhiza recens, Rehmannia preparata, Bupleurum, Cortex magnolia, Phragmites, Belamcanda, Sophora, subprostrata, Siler, Angelica dahurica, Paeonia alba, Dendrobium, Polygonatum officinal, and Cnidium. Chinese herbs are prescribed on an individual basis. They may have side effects and can interact with many medications, and with other herbs and supplements. You should not take herbs without the supervision of a practitioner trained in TCM.
Prognosis and Possible Complications
Most people with mono recover fully, and can return to school or work in a few weeks. A small number of people may experience fatigue for several months. Severe complications are uncommon. They may include anemia, problems with the central nervous system or liver, rupture of the spleen, or inflammation of the heart. People who have had mononucleosis are at incresed risk of developing multiple sclerosis (MS).
Bope ET, Kellerman RD, eds. Conn’s Current Therapy 2017. 1st ed. Philadelphia, PA: Elsevier; 2017.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea–a review. J Am Coll Nutr. 2006;25(2):79-99.
Chiang LC, Ng LT, Cheng PW, Chiang W, Lin CC. Antiviral activities of extracts and selected pure constituents of Ocimum basilicum. Clin Exp Pharmacol Physiol. 2005;32(10):811-816.
Clancy RL, Gleeson M, Cox A, et al. Reversal in fatigued athletes of a defect in interferon gamma secretion after administration of Lactobacillus acidophilus. Br J Sports Med. 2006;40(4):351-354.
Ferri FF, ed. Ferri’s Clinical Advisor 2017. 1st ed. Philadelphia, PA: Elsevier; 2017.
Mayer KE, Myers RP, Lee SS. Silymarin treatment of viral hepatitis: a systematic review. J Viral Hepat. 2005;12(6):559-567.
Porter RS, Kaplan JL, eds. The Merck Manual of Diagnosis and Therapy. 19th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2011:chap 11.
Ramagopalan SV, Giovannoni G, Yeates DG, Seagroatt V, Goldacre MJ. Sex ratio of infectious mononucleosis and possible relevance to multiple sclerosis. Mult Scler. 2013;19(3):359-361.
Reiche EM, Morimoto HK, Nunes SM. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int Rev Psychiatry. 2005;17(6):515-527.
Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-247.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-2119.
Review Date: 1/1/2017
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Mononucleosis, or “mono,” has a wide range of symptoms, which can make it hard to diagnose. You’ll need to see your doctor to find out if you have it.
Your doctor will give you a complete physical exam. You may get a throat culture to rule out strep throat, which has symptoms that are similar to mono. Your doctor may also take a sample of blood to check for abnormal white blood cells.
You may also get a heterophile antibody test. It checks your blood for special antibodies that your body makes to fight off a viral infection. But it’s not specific to mono. This test isn’t always accurate, especially in younger children, and it takes several days for it to show the presence of the antibodies after a child starts to feel ill. The “monospot” is one test that checks for heterophile antibodies.
The results of these tests are not always clear, so you may need even more tests.
You may also get an EBV test if you don’t seem to have a typical case of mono. This blood test checks for Epstein Barr virus. Doctors usually don’t need EBV test results to diagnose mono. But it can help them find out if the Epstein Barr virus is to blame. It’s a common virus, and although it can cause mono, you could have the virus and not be sick.
About Epstein-Barr Virus (EBV)
On This Page
- Prevention & Treatment
Epstein-Barr virus (EBV), also known as human herpesvirus 4, is a member of the herpes virus family. It is one of the most common human viruses. EBV is found all over the world. Most people get infected with EBV at some point in their lives. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis, also called mono, and other illnesses.
Symptoms of EBV infection can include
- inflamed throat
- swollen lymph nodes in the neck
- enlarged spleen
- swollen liver
Many people become infected with EBV in childhood. EBV infections in children usually do not cause symptoms, or the symptoms are not distinguishable from other mild, brief childhood illnesses. People who get symptoms from EBV infection, usually teenagers or adults, get better in two to four weeks. However, some people may feel fatigued for several weeks or even months.
After you get an EBV infection, the virus becomes latent (inactive) in your body. In some cases, the virus may reactivate. This does not always cause symptoms, but people with weakened immune systems are more likely to develop symptoms if EBV reactivates.
EBV Spreads Easily
EBV is spread by saliva through:
- sharing drinks and food
- using the same cups, eating utensils, or toothbrushes
- having contact with toys that children have drooled on
EBV spreads most commonly through bodily fluids, especially saliva. However, EBV can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations.
EBV can be spread by using objects, such as a toothbrush or drinking glass, that an infected person recently used. The virus probably survives on an object at least as long as the object remains moist.
The first time you get infected with EBV (primary EBV infection) you can spread the virus for weeks and even before you have symptoms. Once the virus is in your body, it stays there in a latent (inactive) state. If the virus reactivates, you can potentially spread EBV to others no matter how much time has passed since the initial infection.
Diagnosing EBV infection can be challenging because the symptoms are similar to other illnesses. EBV infection can be confirmed with a blood test that detects antibodies. About nine out of ten of adults have antibodies that show that they have a current or past EBV infection.
For more information, see Laboratory Testing.
Prevention & Treatment
There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.
There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including
- drinking fluids to stay hydrated
- getting plenty of rest
- taking over-the-counter medications for pain and fever
Top of Page Related Pages