Mono throat pain is a common symptom of infectious mononucleosis, an infection caused by the Epstein-Barr virus (EBV). However, other infectious diseases can cause mononucleosis-like syndromes. Although EBV is primarily an infection of the immune system, the infection typically starts in the salivary glands and the back of the throat. That’s why throat pain is such a common symptom. Nearly everyone is infected with EBV, but the first exposure can cause a symptomatic infection, especially in adolescents, college students, and young adults. The majority of young children first infected with EBV have no symptoms when first infected.
For those with symptoms, that first infection is not a pleasant experience. Besides throat pain, most people with infectious mononucleosis have a fever and swollen lymph nodes in the neck, armpits, groin, or all three sites. If the nodes in the neck swell too much, breathing may become difficult. In that initial infection, some people are overwhelmed with fatigue, significantly affecting their ability to function throughout the day. Many people spend much of the day asleep. Symptoms of mono may also include muscle aches, body aches, headaches, coughs, red tonsils, and nausea. Unfortunately, there is little to do to decrease mono throat pain. The viral infection has to run its course as there is no treatment.The only treatment options are for symptom relief.
Sore throat is a common symptom that may be caused by infectious mononucleosis.
Typically, mono throat pain does not require immediate medical attention unless breathing or swallowing is difficult.
Mono throat pain generally does not require treatment. It typically resolves without treatment within two to four weeks but rarely lingers for months.
T0 help decrease sore throat pain rest, hydration, over-the-counter throat lozenges or sprays, salt water gargling, and over-the-counter pain relievers can help.
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There are many causes of sore throat. A sore throat can be a bacterial infection like streptococcus, requiring an antibiotic, or a viral infection, like Epstein-Barr viral infection (EBV). Other viruses, such as cytomegalovirus (CMV), hepatitis A, and HIV, can cause mononucleosis-like syndromes. Symptoms are similar but not identical. Only 7% of people with a primary CMV infection complain of sore throat compared to 95% of people with EBV infectious mononucleosis.
Infectious mononucleosis is unpleasant, but the infection eventually resolves without lasting complications in most cases. Additionally, healthcare professionals are limited in their treatment options. Even so, there are good reasons to see a healthcare provider and get a medical diagnosis:
The throat pain may be due to a condition such as strep throat, which requires antibiotics.
A diagnosis will help you take appropriate measures to prevent its spread to loved ones, family members, and friends
Because swollen lymph nodes can block the throat, if you have difficulty breathing or swallowing, seek emergent care or call 911.
Rarely infectious mononucleosis can cause enlargement of the spleen. Contact sports or vigorous lifting should be avoided for four weeks after diagnosis. Even more rarely, the spleen can spontaneously rupture without provocation.
A healthcare professional can prescribe symptom relief medications such as lidocaine viscous that can effectively relieve mono throat pain
Mono throat pain typically does not require emergency treatment unless breathing or swallowing is difficult. This is due to lymph node swelling in the neck, which may compromise breathing. If breathing or swallowing is hard to do, get immediate medical attention.
Healthcare professionals diagnose infectious mononucleosis from blood tests. Before performing any blood tests, the clinician will perform a history and an exam.
The classic symptoms of mononucleosis are sore throat, fever, and swollen neck lymph nodes. Other common symptoms include:
Swollen lymph nodes in the armpits or groin
Tiredness
The clinician will also carefully examine the throat to ensure that swelling or some other issue does not compromise breathing. Airway obstruction can occur fast and will require emergent treatment.
The clinician will also palpate the abdomen. The spleen sits under the left ribs and usually cannot be felt. Most people with infectious mononucleosis will have an enlarged spleen which may mean curtailing certain activities, as vigorous activity can precipitate the spleen to rupture. Splenic rupture can rarely also occur at rest.
The diagnosis is confirmed by looking for abnormal blood cell counts. The word “mononucleosis” is used because lymphocytes, a type of white blood cell, are greater in number than usual, a condition called lymphocytosis. The clinician will also test for antibodies to Epstein-Barr virus in the blood.
Sometimes, the clinician may perform other tests to rule out similar conditions like cytomegalovirus or toxoplasmosis, particularly in pregnant women. These infections can mimic infectious mononucleosis, but they are both more problematic during pregnancy.
Diagnosis will make very little, if any, difference in treatment. The prescribed treatment usually includes pain relievers, rest, and waiting out the infection.
RELATED: Mononucleosis treatments and medications
Mononucleosis is contagious during both its incubation period and the symptomatic period. The virus is spread through saliva. While the virus reproduces, it sheds viral particles and DNA into the mouth. Saliva from an infected person is transferred to someone else’s mouth through kissing, sharing food, sharing eating utensils, sneezing, or coughing. Once inside another person’s mouth, the virus first infects the salivary glands and the back of the throat, starting a new infection.
To avoid getting mononucleosis, take a few precautions around people who have mono:
Avoid kissing
Do not share food or drinks
Do not share eating utensils, plates, or drinking straws
Do not share toothbrushes or other oral care products
Mono throat pain typically resolves within four weeks but could hold on longer in some people. Most people can expect to feel better before a month has passed. In an older study tracking mono symptoms, approximately 3 out of 4 participants experienced throat pain during the initial symptomatic period, and 16% still had sore throat four weeks later. At two months, 11% still complained about a sore throat. Those people were still having problems with sore throats six months later.
RELATED: How long does mono last? Duration and stages of mono
Infectious mononucleosis cannot be cured but resolves spontaneously in a few weeks. Most symptoms, such as throat pain, should clear up in four weeks, but other symptoms, such as fatigue, headache, and sore muscles, could linger for several months.
Treatment consists of rest, hydration, and symptom medications. Acetaminophen and NSAIDs such as ibuprofen can help with mono throat pain, fever, headache, and other body aches. Do not use aspirin in pediatric patients <18 years who have or are recovering from a viral illness due to the association with Reye syndrome, a potentially devastating inflammatory condition. Use ibuprofen or naproxen instead.
Other treatment options for mono throat pain include over-the-counter lozenges, sprays, salt water gargling, or sucking on ice. In some cases, a healthcare professional may prescribe a lidocaine viscous 2% mucosal solution. Lidocaine is a topical anesthetic that will deaden the nerves in the throat. Lidocaine can have serious side effects when too much of it is swallowed, so patients will be told to space out doses by at least three hours.
Prescription medications such as antibiotics, antivirals, and corticosteroids do not help reduce the duration of symptoms. However, corticosteroids may be prescribed if swelling in the neck blocks a person’s ability to breathe.
RELATED: What parents should know about Reye’s syndrome
The bad news is that there’s no treatment for infectious mononucleosis. Patients will have to tough it out until symptoms go away. Even so, there are a few home remedies that can help mono throat pain:
Drink plenty of fluids
Get plenty of rest
Take an over-the-counter pain reliever, but do not administer aspirin to anyone < 18 years of age
Use over-the-counter throat anesthetics with phenol, menthol, or benzocaine—of the three, benzocaine-containing lozenges or throat sprays have the highest satisfaction rate
Gargle with salt water
Suck on a popsicle or ice chips to numb the throat
Eat soft foods to avoid irritating the throat more
RELATED: 24 sore throat remedies
Admittedly, there is little healthcare professionals can do to treat mono. Still, it’s important to get medical care to determine exactly what is causing the throat pain, what can be done to ease the pain, prevent potentially serious complications, and prevent spreading the disease to friends and loved ones.
Sore throat is a common symptom of the initial symptomatic stage of infectious mononucleosis. Mono throat pain usually resolves in two weeks to a month, but approximately 1 in 10 patients will continue complaining about a sore throat six months later. Older adults with infectious mononucleosis are less likely to experience a sore throat.
Mono is not a sexually-transmitted disease (STD). Although mono is nicknamed the “kissing disease,” it is not spread through genital contact. Mononucleosis is spread through saliva and initially infects the salivary glands and the back of the throat.
Mono is spread through the exchange of saliva. During the infectious stage, virus particles are shed into the saliva. If saliva with virus particles enters another person’s mouth, the virus can infect the tissues in that person’s throat. The most common cause is kissing, but sharing anything with spit on it can spread the virus. Sneezing or coughing can also be a cause if enough saliva gets into the mouth or throat.
About infectious mononucleosis, Centers for Disease Control and Prevention (CDC)
Epstein-Barr virus, StatPearls
Epstein-Barr virus infectious mononucleosis, American Family Physician
Laboratory testing, Centers for Disease Control and Prevention (CDC)
Mononucleosis, StatPearls
Epstein-Barr virus infectious mononucleosis, American Family Physician
Mononucleosis, StatPearls
Mononucleosis treatments and medications, SingleCare
Prospective study of the natural history of mononucleosis caused by Epstein-Barr virus, Journal of the American Board of Family Medicine
Strep throat treatments and medications, SingleCare
What parents should know about Reye’s syndrome, SingleCare
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