Post-Viral Syndrome

“Post-viral syndrome” (PVS) is a catch-all name for long-lasting conditions or symptoms that can start after a viral infection. Other names include post-viral pain syndrome (PVPS) or post-viral fatigue syndrome (PVFS). For some people, it’s the early stage of chronic fatigue syndrome (CFS).

Many viral infections can lead to post-viral syndrome. For some of those infections, experts understand the connection a little better. But for others, they don’t fully understand the link (if there is one). That’s why post-viral syndrome can apply to more than one condition or cluster of symptoms.

Symptoms of post-viral syndrome

PVS can cause many symptoms, including:

• Autonomic symptoms, like low blood pressure and/or fast heart rate when you stand up too fast
• Depression-like symptoms
• Difficulty sleeping or not feeling rested after sleep
• Fatigue or extreme tiredness, especially after being active
• Feeling too tired for your usual activities or routine
• Headaches
• Irregular heart rhythms
• Joint pain or musculoskeletal pain that isn’t focused in one place
• Fever
• Muscle weakness
• Sensitivity to light, sound, smell, etc.
• Shortness of breath or trouble breathing
• Sore throat
• Swollen or tender lymph nodes
• Trouble concentrating or remembering things

How long you have these symptoms is also important. You can get a PVS or post-infectious fatigue diagnosis if you’ve had symptoms for at least two weeks. A diagnosis of chronic fatigue syndrome is possible once you have symptoms for at least six months.

Post-viral syndrome causes

Experts don’t fully understand how and why PVS happens. One possible explanation is that a viral infection triggers an immune response. But that immune response malfunctions and leads to long-lasting inflammation. That inflammation is what causes post-viral syndrome symptoms and effects.

Research links several viral infections as possible triggers or causes. These include:

• Dengue fever
• Epstein-Barr virus (the virus that causes mononucleosis)
• HIV
• Influenza
• SARS-CoV-2 (the virus that causes COVID-19)
• Mononucleosis
• Varicella zoster virus (which causes shingles)
• Viral hepatitis
• West Nile virus
• Coxsackie virus
• Ross River virus
• Q fever

Other post-viral syndromes or related conditions

Researchers already recognize other conditions that could be a form of PVS or likely work similarly. Some examples include fibromyalgia and long COVID. And between 10% and 35% of people with PVS will meet the criteria for chronic fatigue syndrome after six months.

And while they aren’t viral infections, a few other types of infections also behave like PVS. Those include bacterial infections, like Lyme disease, or parasitic infections, like giardiasis.

Complications of post-viral syndrome

Complications of PVS often revolve around pain and mental health. Some examples of complications include:

• Allodynia
• Anxiety
• Central pain syndrome
• Depression
• Hyperalgesia
• PTSD

How doctors diagnose post-viral syndrome

Healthcare providers can diagnose PVS based on your symptoms and by asking you questions about what you’ve experienced.

There are also many lab tests your healthcare provider may recommend. These won’t diagnose PVS, but they can rule out conditions that cause similar symptoms — and diagnosing PVS requires ruling out those other conditions.

Tests that are used

Some tests providers might recommend include:

• Blood or urine tests to check your liver, kidneys, thyroid and immune system
• Imaging tests to rule out nervous system conditions or cancer
• PCR testing to look for a current or recent infection
• Physical and neurological exams
• Sleep studies to rule out other sleep disorders

How is post-viral syndrome treated?

There’s no cure for PVS and no way to treat it directly. Instead, healthcare providers try to help manage your symptoms and limit the effects on your body.

Some examples of treatments include:

• Complementary therapies: Treatments like acupuncture or massage therapy may help with symptoms like pain or fatigue.
• Exercise programs: These help you gradually build up the level of activity your body can handle. There’s evidence these can help with fatigue and other symptoms. (You should only do these if your provider recommends them.)
• Medications: These range from antivirals, like acyclovir, to immune support drugs, like IV immunoglobulin. But research is mixed on their benefits, and none have U.S. Food & Drug Administration (FDA) approval specifically for PVS.
• Mental healthcare: Research shows post-viral syndromes are likely to affect mental health. Treatments like cognitive behavioral therapy may help you manage related anxiety and depression. Mental healthcare may also help you manage symptoms like pain or other effects.

Other treatments may help, depending on the symptoms or complications you have. Your healthcare provider can tell you more about specific treatment options for your needs.

When should I see my healthcare provider?

If you have ongoing symptoms for more than two to four weeks after a viral infection, call a healthcare provider for an appointment. That’s especially true if you have multiple symptoms or the symptoms are interfering with your usual activities.

What can I expect if I have post-viral syndrome?

If you have PVS, it’s hard to predict what you can expect. That’s partly because multiple conditions can cause or contribute to it. Your health history is a factor, too. And PVS can look very different from person to person. There’s also still a long way to go before researchers can explain how and why these conditions happen.

Because there are many considerations, your healthcare provider is the best person to tell you more about what to expect. They can also tell you what you might be able to do to help yourself recover.

How long can post-viral syndrome last?

PVS can last weeks, months or even years. It varies widely. In general, you should talk to your healthcare provider if you still have symptoms after three weeks.