How to get mono

What’s Mono?

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Have you ever heard of the “kissing disease”? If you said that it’s mono, you’re right!

Infectious mononucleosis, called mono for short, is usually caused by the Epstein-Barr virus (EBV). EBV is one of the most common viruses around. Most people will get infected with it at some point in their life. Babies and young kids who get infected with EBV often don’t feel any symptoms, or sometimes they have mild symptoms that feel like a common cold.

But older kids and teenagers who get infected with EBV are likely to feel symptoms such as fever and a very sore throat.

How Do Kids Get Mono?

Mono is contagious, which means someone who has it can spread the virus to other people. Even though it’s called the kissing disease, there are other ways you can get mono. They usually involve contact with saliva (spit). So sharing straws, toothbrushes, or food from the same plate can spread mono.

At first, people don’t feel sick after getting infected with the EBV virus. The symptoms come a month or two later. And some people don’t get any symptoms at all. So they can spread the virus and not even know it. That’s why it’s important not to share things like forks, straws, water bottles, or lip gloss at school.

What Are the Signs of Mono?

Mono can cause you to feel really, really tired, but you may have other symptoms, too. These include:

  • sore throat
  • swollen lymph glands in your neck
  • headaches
  • sore muscles
  • belly pain with enlarged swollen liver or spleen (organs in the upper part of your belly)
  • loss of appetite

It may seem like you have the flu or strep throat because the symptoms are so much alike. The only way to tell for sure if you have mono is to go to a doctor, who will do an exam to see if you have mono. Sometimes the doctor will do a blood test to be sure.

What If I Have Mono?

If you have mono, you probably will need plenty of rest. This might mean no school for a while, no sports, and no running outside playing with friends or even wrestling with your little brother.

While you’re resting, drink plenty of water and other fluids. You can ask your mom or dad to give you a pain reliever if you have a fever, sore throat, or aching muscles. Don’t take any aspirin, though, because that can put you at risk for a condition called Reye syndrome, which can be dangerous.

Some kids with mono might not feel very sick at all. But it’s very important to listen to your body. A kid who has mono should tell a parent if he or she starts feeling worse. And if the kid feels tired and run down, it’s the body’s way of saying more rest is needed.

Kids who play contact sports (like football or basketball) need to skip them for about a month after the illness, especially if their spleen is swollen. Your doctor will let you know when it’s safe for you to get back in the game.

Mono usually goes away after a few weeks, even though you’ll have to take it easy for a bit. Make sure you wash your hands after you cough or sneeze. Keep your straws, forks, and toothbrushes to yourself, and… no kissing for a few months!

Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: January 2020

Infectious mono: More than the ‘kissing disease’

Infectious mononucleosis, or mono, is often called the “kissing disease” because the virus can be easily transmitted by kissing.

While the most common way for the virus to spread is, indeed, through saliva, you don’t have to kiss someone with an active strain of it in order to contract it. It can also be transmitted by activities like sharing drinks and using another person’s utensils, or through blood and other bodily fluids.

Being exposed to mono does not guarantee an onset of symptoms, especially if you are exposed as a child. “Many people have the virus in their system throughout their lives without any symptoms,” says Rob Danoff, DO, an osteopathic family physician. “This is especially true in young children as fever (often persistent) may be the only symptom. We can only confirm if they were exposed and had the virus in them through a blood test.”

Many people have the Epstein-Barr virus in their system throughout their lives without any symptoms.

In fact, most people have been exposed to the virus by the time they reach middle age, with the majority acquiring the infection during childhood and severe symptoms more typical during the teen years. Mono is caused by the Epstein-Barr virus (EBV), which is a type of herpes virus and one of the most common human viruses. Other viruses in the herpes family cause cold sores and illnesses like chickenpox.

Epstein-Barr signs, symptoms

Sometimes the first indication that a person may have mono is a rash that develops after taking the antibiotics amoxicillin or ampicillin. These antibiotics are used for bacterial ailments and are frequently incorporated into treatment when a bacterial cause of a sore throat is suspected prior to a diagnosis.

Unusual fatigue is a very common early symptom of mono. “Often the person says ‘Doc, I am sleeping a lot but still tired and don’t feel like I am doing too much’,” Dr. Danoff says. Sometimes mono can be confused with the flu or strep throat because the symptoms are so similar, but with mono, the fatigue and other symptoms can go on for weeks or even months before an individual fully recovers.

Once a person is infected with the Epstein-Barr virus there is a lag time, or incubation period, during which the virus is multiplying in the body. This can last for several weeks and the patient can be asymptomatic the entire time though still able to spread the virus to others. People who get symptoms from EBV can expect them to last from two to four weeks, though some can feel fatigued for several weeks or months.

Once the virus is in your body, it remains there in an inactive state. If it reactivates, you can potentially spread it to others regardless of how much time has passed since the initial infection.

Symptoms of mono may include:

  • Increased fatigue
  • Unexplained fever (often between 101-104 degrees)
  • Sore throat that may look like strep throat
  • Enlarged liver or spleen (typically with pain or discomfort in the upper left side of the abdomen)
  • Headaches
  • Swollen lymph nodes, particularly on the sides of the neck, underarms or groin
  • Swollen tonsils
  • Decreased appetite

Treatment and prevention

There is no specific treatment for EBV other than relieving symptoms by staying hydrated, getting lots of rest and taking over-the-counter medications for pain and fever.

There is also no vaccine to protect against EBV infection, but there are ways to decrease your risk of mono, according to Dr. Danoff, who is program director of the Family Medicine Residency and the combined Family Medicine/Emergency Medicine Residency programs at Jefferson Health Northeast in Philadelphia. He believes in a preventive approach to medicine and encourages his patients to take charge of their health.

Ways to decrease the risk of mono:

  • Don’t intimately kiss a person who is sick.
  • Don’t share utensils, glasses, straws of a person who is sick.
  • Don’t donate blood if you have mono.
  • If you’ve been exposed to someone with Epstein-Barr virus, try not to touch your eyes, nose or mouth as the virus can live on moist surfaces for many hours.
  • Keep your immune system strong through regular physical activity, a healthy diet and regular sleep (6-8 hours per night for adults; 8-10 hours for children).

Focusing on preventive care, Doctors of Osteopathic Medicine, or DOs, consider how environmental and lifestyle factors impact your health. They also partner with their patients to help them get healthy and stay well.

How You Get Mono — Plus Everything You Should Know About Avoiding Infection

EBV Can Cause Other Diseases, Too — Including Some Cancers

EBV infects humans and a few other primate species. (6) It is one of the group of viruses known as human herpesviruses. Specifically, EBV is human herpesvirus 4. (2) Oral and genital herpes are caused by the herpesviruses 1 and 2. Chickenpox and shingles are caused by the human herpesvirus 3, and there are other human herpesviruses that also cause disease.

Dr. Deresinski explained, “All herpes viruses establish latency, a state of relative dormancy, within infected cells. The mechanisms by which this occurs remain incompletely understood.”

Like other human herpesvirus infections, EBV can remain latent for the life of the person. EBV can also reactivate, and it is sometimes infectious to others, even if the person with the reactivated virus does not show symptoms. (6)

Most people can get mononucleosis from EBV only once. (6,7) If the virus reactivates, it usually does not cause mono symptoms to reactivate.

There has long been a suspected link between EBV and some autoimmune diseases, and a study published in April 2018 in the journal Nature Genetics identified various genes associated with those autoimmune diseases that bind with EBV proteins, offering some pretty convincing evidence that EBV plays a role in those chronic problems — including lupus, multiple sclerosis (MS), type 1 diabetes, juvenile idiopathic arthritis, and celiac disease. (8)

EBV has also been linked to Hodgkin lymphoma, non-Hodgkin lymphoma, and Burkitt’s lymphoma. This has been reported in Africa, alongside malaria infections. (6)

Additionally, EBV infection has been reported to cause chronic active EBV infection (CAEBV) in rare cases. (4) Someone with CAEBV has symptoms of mono-like fever, lymph node swelling, and liver and spleen swelling for a prolonged period of time.

Some people have speculated about a link between chronic fatigue syndrome and EBV, but this link has yet to be proven. (4)

Mononucleosis (Mono)

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What Is Mononucleosis?

Mononucleosis (mono) is a viral infection that causes a sore throat and fever. Cases often happen in teens and young adults. It goes away on its own after a few weeks of rest.

What Causes Mono?

Mononucleosis (pronounced: mah-no-noo-klee-OH-sus), or infectious mononucleosis, usually is caused by the Epstein-Barr virus (EBV). Most of us are exposed to EBV at some point while we’re growing up. Infants and young kids infected with EBV usually have very mild symptoms or none at all. But infected teens and young adults often develop the symptoms that define mono.

What Are the Signs & Symptoms of Mononucleosis?

Signs of mono usually show up about 1–2 months after someone is infected with the virus. Its most common symptoms are sometimes mistaken for strep throat or the flu. These include:

  • fever
  • sore throat with swollen tonsils that may have white patches
  • swollen lymph nodes (glands) in the neck
  • being very tired

A person also can have:

  • headaches
  • sore muscles
  • weakness
  • belly pain with a larger-than-normal liver or spleen (an organ in the upper left part of the belly)
  • skin rash
  • loss of appetite

Is Mono Contagious?

Mono is contagious. It spreads from person to person through contact with saliva (spit). It’s nicknamed “the kissing disease” because it can spread through kissing. It also spreads through coughing and sneezing, or when people share something with spit on it (like a straw, drinking glass, eating utensil, or toothbrush).

Mono can also spread through sexual intercourse and blood transfusions, but this is much less common.

People who’ve been infected carry the virus for life, even after symptoms stop and even if they had no symptoms. The virus is then “dormant,” or inactive. Sometimes the dormant virus “wakes up” and finds its way into a person’s saliva. This means that they can be contagious from time to time over the course of their life, even when they have no symptoms.

How Is Mono Diagnosed?

To diagnose mono, doctors do an exam to check for things like swollen tonsils and an enlarged liver or spleen, common signs of the infection. Sometimes the doctor will do a blood test.

How Is Mono Treated?

The best treatment for mono is plenty of rest and fluids, especially early in the illness when symptoms are most severe. For fever and aching muscles, try taking acetaminophen or ibuprofen. Don’t take aspirin unless your doctor tells you to. Aspirin has been linked to a serious disease in kids and teens called Reye syndrome, which can lead to liver failure and death.

How Long Does Mono Last?

Mono symptoms usually go away within 2 to 4 weeks. In some teens, though, the tiredness and weakness can last for months.

When you start feeling better, take it slow and don’t overdo it. Although you can return to school after your fever is gone, you may still feel tired. Your body will tell you when it’s time to rest — listen to it. By taking good care of yourself and resting as much as you need to, you will soon be back to normal, usually within a few weeks.

Can Mono Be Prevented?

There is no vaccine to protect against the Epstein-Barr virus. But you can help protect yourself by avoiding close contact with anyone who has it.

If you have mono, don’t share the virus with your friends and family as you recover. Wash your hands well and often, sneeze or cough into a tissue or your elbow (not your hands), and keep your drinks and eating utensils to yourself. This is one time when your friends and family will thank you for being selfish.

What Else Should I Know?

Mono can make the spleen swell for a few weeks or longer. An enlarged spleen can rupture, causing pain and bleeding inside the belly, and needs emergency surgery. So doctors recommend that teens who have mono avoid contact sports for at least a month after symptoms are gone. Don’t do any strenuous activities until your doctor says it’s OK.

In most cases, mono symptoms go away in a matter of weeks with plenty of rest and fluids. If they seem to linger or get worse, or if you have any other questions, call your doctor.

Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: January 2020

I Feel Sick!

What’s Mono?

Pucker up! Have you ever heard of the “kissing disease”? If you said that it’s mono, you’re absolutely correct.

But you don’t get mono only from kissing. Infectious mononucleosis, called mono for short, is caused by the Epstein-Barr virus (EBV), which is a type of herpes virus. Other viruses in the herpes family cause cold sores and illnesses like chickenpox.

Most people who get mono are between the ages of 15 and 25, but younger kids can get it, too. The mono virus affects the lymph nodes, throat, salivary glands, liver, spleen, and blood, and it can make a person feel tired and achy all over. It can also make you lose your appetite.

You probably know what your lymph nodes are, and you probably guessed that your salivary glands are inside of your mouth. But what about your spleen? It’s located on the left side of your abdomen, just under the ribcage, and it helps cleanse your blood of bacteria and viruses.

Mono is contagious, which means you can spread the virus to other people who haven’t had mono before. Even though you can get mono from kissing someone infected with EBV, there are other ways you can get it, but they all involve contact with saliva. Sharing straws, toothbrushes, or food from the same plate can also spread mono.

At first, people usually don’t feel sick after getting infected with the EBV virus. So someone could be infected — and be spreading mono — and not even know it. That’s why it’s important not to share things like forks, straws, water bottles, or lip gloss at school.

Mono can cause you to feel really, really tired, but you may have other symptoms, too. These include:

  • fever
  • sore throat
  • swollen lymph nodes (the infection-fighting glands in your neck, underarms, groin, and elsewhere throughout your body)
  • headaches
  • sore muscles
  • enlarged liver or spleen

Sometimes, it may seem like you have the flu or maybe strep throat because the symptoms are so much alike. The only way to tell for sure if you have mono is to go to a doctor, who will examine you and draw blood for tests (one test is called the Monospot) to see if you have mono.

Usually with mono you will need plenty of rest. This might mean no school for a while, no sports, and no running outside playing with friends or even wrestling with your little brother. While you’re resting, it’s a good idea to drink plenty of water and other fluids. You can ask your mom or dad to give you a pain reliever if you have a fever or if your muscles are sore. Don’t take any aspirin, though, because that can put you at risk for a condition called Reye syndrome, which can be dangerous.

Other kids might not feel very sick at all, so a lot of bed rest isn’t necessarily for everyone. But it’s very important to listen to your body. Someone who has mono should tell a parent if he or she starts feeling worse. And if the person feels tired and run down, it’s the body’s way of saying more rest is needed.

If you play contact sports, such as football and basketball, you will probably need to avoid them while you’re sick and for about a month after the illness — especially if your spleen is enlarged. Your doctor will let you know when it’s safe for you to get back in the game.

You’ll probably be happy to hear that mono usually goes away after a few weeks, even though you’ll have to take it easy for awhile. Make sure you wash your hands after you cough or sneeze. Keep your straws, forks, and toothbrushes to yourself, and . . . no kissing for a few months!

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: March 2013

Mononucleosis

What is mononucleosis?

Mononucleosis, also known as “mono,” is an infectious disease that is usually caused by the Epstein-Barr virus (a herpes virus). Other viruses can also cause mononucleosis. Mononucleosis is not considered a serious illness, but its symptoms may be severe enough to prevent a person from engaging in normal activities for several weeks. The classic symptoms of this illness tend to occur more frequently among teenagers, especially those 15 to 17 years old, and in adults in their 20s.

How common is mononucleosis?

The Epstein-Barr virus is a very common virus. About 85% to 90% of American adults have developed antibodies to the Epstein-Barr virus by the time they are 40 years old, which means that they have been infected with the virus at some point in their lives. Most individuals are infected with this virus early in life (before the adolescent years), and most of these children have no or very mild symptoms from it. Adolescents, especially teens 15 to 17 years of age, and young adults who become infected with this virus are most likely to develop the classic symptoms of mononucleosis.

How is mononucleosis spread?

Mononucleosis is usually acquired by contact with the saliva or mucus of a person who is infected with or is carrying the virus. (Mononucleosis is also known as the “kissing disease,” because it can be acquired through kissing.) Occasionally, it can be spread by coughing or sneezing, or when an infected person shares food or tableware with another person.

What are the symptoms of mononucleosis?

The most common symptoms of mononucleosis are fever, sore throat, and swollen lymph glands in the neck, under the arms, and in the groin area. Other symptoms include the following:

  • Fatigue
  • Muscle aches or weakness
  • White patches in the throat
  • Skin rash
  • Headache
  • Loss of appetite

In addition to these symptoms, the spleen (an abdominal organ that stores and filters blood) may become enlarged. About half of those who have mononucleosis have enlargement of the spleen sometime during the course of their illness.

The incubation period—the time it takes symptoms to appear after a person becomes infected with the virus—can be 4 to 6 weeks. Symptoms of mononucleosis usually last for 1 to 4 weeks, but it might take as long as 2 months before you feel well enough to resume all of your normal activities.

Are there any symptoms of mononucleosis that require medical attention?

If you have an unusually painful or persistent sore throat or have difficulty breathing or swallowing because your tonsils are swollen, see a healthcare professional. Your doctor may perform a throat culture to see if you have a streptococcus infection (strep throat), which is not uncommon when you have mononucleosis, and which can be treated with antibiotics. You can also develop airway difficulties from enlarged tonsils.

If you have mononucleosis and feel a sudden, sharp, severe pain in your left side in the upper abdomen, go to a hospital or call 9-1-1. The pain may be a sign of a ruptured spleen, which is a very rare complication of mononucleosis.

Symptoms lasting longer than 4-6 weeks are very rarely due to the effects of mononucleosis.

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