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Mononucleosis, or 'mono', is an extremely common viral infection caused by the Epstein-Barr virus (EBV). Most people will be infected at some time in their lives.  Mono frequently affects adolescents and young adults, especially when residing, studying and socializing in crowded settings, such as with the university lifestyle.  Mono can be spread through contact with saliva, including eating or drinking after an infected person, or through kissing a contagious person. In the past, mono was called “the kissing disease” but kissing is only one way mono is spread.  It is typically difficult to accurately determine when or from whom you caught mono. It generally takes 4–6 weeks for the first symptoms to appear, and once someone has mono, they are likely to remain contagious for many weeks; perhaps off and on for much of their life. Infection in early childhood is often asymptomatic, or with mild symptoms which may go unnoticed at that age. Children with mono are likely to have full or partial immunity to later mono illness, should they be exposed to the virus.

Typical Mononucleosis Symptoms 

  • Fever (100.4 F / 38 C or greater)
  • Fatigue generally lasting 4–6 weeks. If fatigue continues longer than 3 months, schedule a follow up appointment at the IU Health Center
  • Sore throat usually with swollen tonsils coated with white or grey-green material
  • Swollen lymph glands in the front or sides of the neck
  • Headache
  • Loss of appetite
  • Jaundice (yellowing of the skin or whites of the eyes)
  • Rash

You should contact the IU Health Center Medical Clinic if you experience any of these more serious symptoms:

  • Tonsil or throat swelling that causes difficulty swallowing or breathing
  • Pain in either side of the upper abdomen
  • Jaundice (yellowing of the skin or whites of the eye)
  • Chest pain
  • Unusual weakness in arms or legs
  • Severe headache
  • Stiff neck

Mononucleosis Prevention

Since mono is spread in saliva, avoid eating, drinking or smoking from the same glasses, dishes or utensils of friends or strangers and at parties. Wash your hands regularly, especially before putting food in your mouth.  Avoid sick people.

Mononucleosis Treatment

Mono can usually be quickly diagnosed in the IU Health Center Laboratory while you wait. A simple blood test is required. Occasionally, the test can be negative early in the illness even if symptoms are suspicious for mono, and a follow up test several days to a week later may be required to confirm the diagnosis of mono. The IU Health Center Medical Clinic will also sometimes perform a throat swab to rule out strep throat, as both strep and mono have symptoms that closely overlap, and some persons have both infections.

Avoid Strenuous Activity

You should avoid sports, lifting, straining, or other physical exertion for about 4 weeks. That's because mono affects the spleen to some extent in about 50% to 60% of people with mono. An enlarged spleen is more vulnerable to rupture, and a ruptured spleen is a medical emergency. You should get medical clearance before you resume your regular activities.

Abstain From Alcohol

Mononucleosis often inflames the liver and alcohol makes this inflammation worse. Mono patients should not use alcohol for two months after the onset of symptoms.

Self Care

Mono is a virus, so it has to run its course. These is no cure and antibiotics do not help.  Antibiotics only treat bacterial infections.  Taking some antibiotics in mono can cause a rash.  Acute symptoms can last 7–10 days. Here's what you can do to feel better:

  • Get plenty of rest to avoid prolonging or relapsing your illness.
  • Take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, etc.) for fever or pain. Acetaminophen (Tylenol) is broken down by the liver. Thus it is important to closely follow the dosing instructions or your Health Care Provider’s instructions to safely take this medication.
  • Throat lozenges or spray containing benzocaine (such as Cepacol) may provide temporary relief from throat pain.
  • Gargle with warm salt water for a sore throat (use 1/2 teaspoon of salt in 8 ounces of warm water).
  • Feeling ill often causes a loss of appetite. This is normal, and usually improves as the infection improves. It is important, even if you have no appetite, to drink an adequate amount of fluids. You are drinking adequate fluids if your urine is a pale yellow color.

Even the common symptoms of mono are frequently severe enough to warrant medical examination, and at times require prescription medication for relief during the acute phase. If you have any concerns regarding the possibility of illness due to mono, feel free to schedule an appointment with an IU Health Center medical provider.