Overview

What is mononucleosis (mono)?

Mononucleosis is an illness that commonly affects teenagers and young adults, but can affect children as well. Viruses, most commonly Epstein-Barr Virus (EBV), and certain infections cause the illness. Mono is sometimes called “the kissing disease” because it spreads easily through bodily fluids like saliva.

For most people, mono isn’t serious, and it improves without treatment. Still, extreme fatigue, body aches and other symptoms can interfere with school, work and daily life. With mono, you might feel sick for about a month.

How common is mononucleosis (mono)?

The Epstein-Barr virus (EBV) that causes mono is extremely common. Around 90% of Americans are infected with it by age 35. Not everyone who has the virus develops mono symptoms — some people only carry the virus.

Who might get mononucleosis (mono)?

There are often two peaks when people acquire EBV: early school age children and again around adolescence/young adulthood. Young children are often asymptomatic, whereas teenagers and people in their 20s are most likely to get mono. About one in four people in this age group who get EBV come down with mono, but anyone can get it, no matter their age.

Is mono a sexually transmitted infection?

Epstein-Barr is a type of herpes virus. It’s different than the herpes simplex virus (HSV) that causes genital and oral herpes. Both viruses can be sexually transmitted. However, EBV is more likely to spread through other means like sharing drinks or kissing.

Is mononucleosis (mono) contagious?

Viruses that cause mono are very contagious. You can pick them up through contact with an infected person’s bodily fluids, including saliva. These viruses spread through:

Blood transfusions.
Coughing or sneezing.
Kissing.
Sexual contact.
Sharing food, drinks or eating utensils.
Organ transplants.

Can you get mononucleosis (mono) more than once?

The Epstein-Barr virus stays in your body in an inactive form even after mono symptoms go away. But most people develop mono only once.

If EBV reactivates, it rarely causes symptoms. However, you may unknowingly spread the reactivated virus to others. And people with weakened immune systems may develop mono symptoms more than once.

Symptoms and Causes

What causes mononucleosis (mono)?

Over 90% of mono cases are caused by the Epstein-Barr virus. Other viruses and certain infections may also bring on the illness. The symptoms can develop because of:

Adenovirus.
Cytomegalovirus (CMV).
Hepatitis A, Hepatitis B and Hepatitis C.
Herpes simplex virus (HSV).
Human immunodeficiency virus (HIV).
Rubella.
Toxoplasmosis.

What are the symptoms of mononucleosis (mono)?

Symptoms of mono vary, and they can be mild or severe. They tend to come on gradually. If you get sick with mono, it will probably happen four to six weeks after you come in contact with EBV. These symptoms may last for four weeks or longer:

Enlarged spleen or liver.
Extreme fatigue.
Fever.
Headaches.
Loss of appetite.
Muscle aches or weakness.
Rash.
Sore throat.
Swollen lymph nodes in the neck, armpits or groin.

Diagnosis and Tests

How is mononucleosis (mono) diagnosed?

Your healthcare provider will assess your symptoms to make a diagnosis. They will especially check for swollen lymph nodes in your neck and signs of an enlarged spleen or liver.

Blood tests detects antibodies that your body makes to fight the Epstein-Barr virus. Your doctor may also check for a high number of white blood cells (lymphocytes) that indicate infection.

Management and Treatment

How is mononucleosis (mono) managed or treated?

There isn’t a vaccine or cure for mono. Antibiotics to fight bacterial infection and antiviral medications to kill other viruses don’t work against mono. Instead, treatments focus on helping you feel better by relieving symptoms. Your care might include:

Rest: Mono makes you very tired. Sleep helps your body fight infection.
Hydration: Drink plenty of fluids to prevent dehydration.
Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) ease fever, inflammation, headaches and muscle aches. These drugs include ibuprofen (Advil®) and naproxen (Aleve®). Acetaminophen (Tylenol®) also works.
Sore throat soothers: You can gargle with salt water and use throat lozenges.
Avoiding sports: Physical activity can put too much pressure on an enlarged spleen, increasing the risk of rupture. You should avoid contact sports and strenuous exercise while you’re sick and for up to four weeks afterward.

What are the complications of mononucleosis (mono)?

Mono symptoms tend to gradually improve in about four weeks. Feelings of fatigue can linger for months. Some people miss some school or work as they recover.

An enlarged spleen that ruptures (bursts) is the biggest concern with mono in previously healthy individuals. This gland in the upper left abdomen (belly) helps filter blood. If your spleen bursts, it can bleed into your abdomen. Internal bleeding from a ruptured spleen can be life-threatening and requires emergency surgery. Your healthcare provider may tell you to avoid strenuous exercise, contact sports and heavy lifting until you feel better.

Prevention

How can I prevent mononucleosis (mono)?

There’s no vaccine for mono. The best way to prevent getting the viruses that cause mono is by practicing good hygiene. Don’t share foods, drinks or bodily fluids with someone who has mono or any signs of viral illness, like fever, cough, sore throat or fatigue.

How does mononucleosis (mono) affect pregnancy?

Expectant moms who develop mono from EBV typically have healthy pregnancies. Call your healthcare provider if you develop a fever, which can increase the risk of miscarriage and premature labor. While there’s a slight chance you may pass the Epstein-Barr virus to your baby during pregnancy or after childbirth while breastfeeding, most babies don’t develop mono symptoms. If mono was caused by a CMV infection during pregnancy there is a chance your infant may be affected and you should discuss this with your obstetrician.

Outlook / Prognosis

What is the prognosis (outlook) for people with mononucleosis (mono)?

Mono symptoms can be severe. They may temporarily affect your ability to lead an active life. Fortunately, these symptoms gradually improve with at-home treatments.

You may experience lingering fatigue for several months. You’ll need to protect your health by getting enough rest and fluids during this time. You should also avoid strenuous activities to prevent a ruptured spleen.

Living With

When should I call the doctor?

You should call your healthcare provider if you have mono and you experience:

Difficulty breathing or swallowing.
Dizziness or fainting.
Extreme muscle weakness in arms or legs.
Intense body aches.
Persistent high fever.
Severe headaches.
Sharp pain in the upper left abdomen.

What questions should I ask my doctor?

If you have mono, you may want to ask your healthcare provider:

What are the best treatments for mono symptoms?
How long am I contagious?
What steps can I take to prevent infecting others with this virus?
How long will it take to recover from mono?
When can I go back to work or school?
When can I get back to exercise and physical activity?
Can I get mono again?
Should I look out for signs of complications?

A note from Cleveland Clinic

Most cases of mononucleosis (mono) don’t cause serious problems. However, symptoms like extreme fatigue, sore throat and body aches can disrupt school, work and life. Your healthcare provider can provide suggestions for finding relief. Rest and over-the-counter medications are often the best ways to ease symptoms. It’s also important to avoid strenuous physical activity that may rupture an enlarged spleen.

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Mononucleosis