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They call mono the “kissing disease.” Despite its reputation, not all people contract mononucleosis (mono) from kissing, but from activities like sharing a straw, using someone else’s toothbrush, or just standing in the way of someone else’s sneeze. Unfortunately, once mono has taken hold, there is no cure. The only real treatment is to ride it out while the body fights the infection, but supportive care can make it easier to live with.
What is mononucleosis?
Infectious mononucleosis is a contagious viral syndrome presenting asfever, sore throat, extreme fatigue, swollen lymph nodes, and/or swollen tonsils. Several different viruses cause mononucleosis, but nine out of 10 cases are caused by the Epstein-Barr virus (EBV), a type of herpesvirus. Other cases are caused by cytomegalovirus (CMV), but rubella, adenovirus, hepatitis A, and others are also behind some infections.
The virus is primarily spread through saliva. Sharing plates, glasses, food, eating utensils, or toothbrushes are common ways to catch the virus, but kissing is the most common route, which is why it’s often called the “kissing disease.” Sneezing and coughing can also spread the virus. Not only are people contagious when they’re showing symptoms, but they can also spread the disease for up to six months after the first appearance of symptoms. The virus can also be spread through semen and, in rare cases, blood transfusions or organ transplants.
About six weeks after exposure to the virus, the infection causes symptoms such as fever, sore throat, and fatigue that typically last for two to four weeks but may hold on for as long as six months. However, young children rarely show symptoms and about one in ten young adults will have no symptoms at all. There is no cure for infectious mononucleosis. It is treated with supportive care, such as rest, fluids, and symptom relief.
Epstein-Barr virus infection is very common. About 95% of the world’s adult population has been infected at some point in their lives. Once infected, people carry the virus in a dormant stage for the remainder of their life and it usually does not reactivate. Infectious mononucleosis is most common among people never exposed to the virus, mainly teenagers, college students, and young adults.
Also called glandular fever, infectious mononucleosis initially infects cells in the top of the mouth and throat and spreads to the salivary glands (tonsils). From there, the virus enters into B lymphocytes, a type of white blood cell responsible for fighting infections. The infected B lymphocytes can travel throughout the lymphatic system to other lymphoid tissues; lymph nodes, adenoids, and, more dangerously, the spleen. While mono seems to be a throat infection, it is actually an infection of the body’s immune system.
While most cases resolve on their own in a few weeks, the infection can cause serious and potentially life-threatening complications. Fortunately, complications are rare. Chief among them is airway obstruction caused by swollen tonsils, making it hard to breathe. A ruptured spleen is another serious complication, a risk primarily to patients active in contact sports.
How is mononucleosis diagnosed?
Mononucleosis is diagnosed from the symptoms and blood tests. With a Monospot blood test, a general practitioner can arrive at a diagnosis in minutes.
The common symptoms of infectious mononucleosis are fever, sore throat, swollen glands, and fatigue. Patients frequently describe the sore throat as the worst they’ve ever experienced.
Other possible mono symptoms include:
- Malaise (feeling bad)
- Tiredness
- Headache
- Body aches
- Weakness
- Enlarged spleen or liver
- Rash
- Brown or red spots on the upper part of the mouth (the palate)
All these symptoms can be caused by other infections, so a definitive diagnosis can only be made with blood tests. Most doctors will use the Monospot test (heterophile antibody test) as a quick way to test for the Epstein-Barr virus. Taking a blood sample usually from a pinprick, the Monospot test can verify an Epstein-Barr infection in about one hour.
For a variety of reasons, the Monospot test may yield false negatives, especially in young children. If a Monospot test comes back negative but clinical suspicion remains high, blood counts and other laboratory antibody tests will be used to make the final diagnosis. Blood tests may also be performed to identify possible complications, such as a rupture of the spleen.
Mononucleosis treatment options
Supportive care—rest, fluids, and over-the-counter pain medications—is the standard treatment for mononucleosis. There are no drugs that fight off the virus itself. Complications such as airway obstruction or ruptured spleen may require hospitalization.
Supportive care
Mononucleosis is treated with rest, fluids, and over-the-counter medications that provide symptom relief. Over-the-counter pain relievers can help reduce fever, sore throat, and body aches. Over-the-counter throat lozenges can help with the sore throat.
Airway obstruction
About one in twenty people will experience difficulty breathing because of airway obstruction, mostly young children. When infectious mononucleosis severely compromises breathing, corticosteroids are the treatment of choice for reducing swelling in the throat and airways.
Mononucleosis medications
Mononucleosis is treated with medications that reduce fever, pain, and sore throat. Antiviral medications have no significant effect on the infection. Corticosteroids, however, may be used when swelling in the throat severely compromises breathing.
Pain relievers
Acetaminophen is the most commonly advised pain reliever for mononucleosis, but (nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, naproxen, or aspirin can also be used. Because of the risk of Reye’s syndrome, a potentially fatal drug reaction, aspirin should never be given to children or teenagers with a viral infection.
If pain killers do not completely reduce sore throat pain, saltwater, over-the-counter throat lozenges, sore throat syrups, hard candy, herbal teas, herbal sprays, or herbal lozenges may provide relief. Because of the risk of choking, children under five should not be given lozenges or hard candy.
Corticosteroids
Airway obstruction is a potentially hazardous complication of infectious mononucleosis. A corticosteroid injection, usually dexamethasone, rapidly reduces the swelling blocking the throat.
What is the best medication for mononucleosis?
Medications are used only to treat the symptoms of mononucleosis: fever, sore throat, and pain. Because people react differently to various drugs, there is no “best” medication for mononucleosis, only drugs that work best for the individual case.
| Best medications for mononucleosis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Tylenol (acetaminophen) | Analgesic | Oral | Two 325 mg tablets every four hours | Nausea, stomach pain, loss of appetite |
| Advil (ibuprofen) | NSAID | Oral | One 200 mg tablet every four to six hours | Nausea, bleeding, stomach pain |
| Aleve (naproxen) | NSAID | Oral | One 220 mg tablet taken with food or water every eight to 12 hours | Nausea, bleeding, stomach pain |
| Aspirin | NSAID | Oral | One or two 325 mg capsules or tablets with water every four hours | Upset stomach, heartburn, bleeding |
| Dexamethasone | Corticosteroid | Intravenous injection | Dose depends on weight | Fluid retention, difficulty sleeping, mood and behavior changes |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of mononucleosis medication?
Infectious mononucleosis medications have many side effects that vary depending on the type of medication. This is not a complete list of their possible side effects. If you have concerns about your specific situation, please consult with a healthcare professional.
Acetaminophen and NSAIDs are safe medications when taken over a limited period. The most serious side effect of acetaminophen is overdose, a potentially life-threatening condition. Use only as directed and for a limited time.
NSAIDs interfere with blood clotting and the digestive system’s ability to protect itself against corrosive stomach acid. The most common side effects, then, are stomach problems, stomach pain, gastrointestinal bleeding, bruising, and bleeding problems.
Most people with infectious mononucleosis will be given only one or two corticosteroid injections when airway obstruction becomes a potential hazard. Corticosteroid side effects, then, may be minimal. Patients may experience a rise in blood pressure, increased appetite, or mood changes.
What is the best home remedy for mononucleosis?
The best home remedies for mononucleosis are rest, fluids, and managing pain and sore throat with medications or alternative remedies.
Rest
Your body will fight off the infection, so give it plenty of rest.
Drink fluids
Water and fruit juices both fight off fever and help relieve a sore throat. Because swallowing might be painful, drink several small glasses a day.
Take over-the-counter pain relievers
Over-the-counter pain relievers, throat lozenges, hard candy, and herbal teas can help relieve symptoms. For over-the-counter pain and fever relief, acetaminophen is your best choice followed by ibuprofen or naproxen.
Gargle with saltwater
For sore throat, the most effective remedy is to gargle with warm salt water every two or three hours. For natural sore throat remedies, try chamomile or peppermint tea. Over-the-counter herbal throat lozenges are also effective but don’t give them to children under five.
Moisturize the air you breathe
A vaporizer, humidifier, or simply taking a steamy shower helps to calm a sore throat.
Frequently asked questions about mononucleosis
How can I get rid of mono fast?
There is no cure for infectious mononucleosis other than giving the body time to fight off the infection.
How long is a person contagious with mono?
A person with symptoms can spread mononucleosis. Symptoms typically persist for two to four weeks. Once symptoms go away, however, the person can spread the infection for up to six months.
How long does it take to heal from mononucleosis? / What is the best treatment for mononucleosis?
For most people with infectious mononucleosis, symptoms resolve in two to four weeks, but many people may still feel the effects for many more weeks. Some people might take months to get over their symptoms.
There is no medical cure for infectious mononucleosis. The only effective treatments are supportive care such as rest, fluids, and symptom relief. Severe complications, such as ruptured spleen or difficulty breathing, will need immediate medical or surgical treatment.
How serious is mono?
Infectious mononucleosis usually resolves in a few weeks without doing any lasting damage. In rare cases, however, mono can cause life-threatening complications such as ruptured spleen, airway obstruction, or liver damage. In extremely rare cases, an Epstein-Barr virus infection may become chronic, leading to long-term struggles with low white blood cells (neutropenia), liver damage, nerve damage, and pneumonia.
How do you treat Mono naturally?
There is currently no medical cure for infectious mononucleosis. It is treated by giving the body rest so that it can naturally fight off the infection.
How does mononucleosis affect the body?
The viruses responsible for infectious mononucleosis first infect the top of the throat (from the back of the mouth to the base of the tongue) and then the salivary glands (tonsils). From there, the virus infects white blood cells and relocates to the lymphatic system, causing swelling and transmission in the tonsils, adenoids, lymph nodes, and spleen. The virus also enters the bloodstream where it can cause problems in other parts of the body, such as the liver.
How do you get rid of a mono rash?
Mono rash is usually caused by taking antibiotics, such as amoxicillin, in the setting of infectious mononucleosis. Although antibiotics do not help with viral infections such as mono, they are used to treat bacterial infections, such as strep throat, that often occur along with the EBV infection. Mono rash typically resolves as the person recovers from the infection.
What should you not do when you have mono?
One of the most hazardous complications of infectious mononucleosis is rupture of the spleen. People diagnosed with infectious mononucleosis should not participate in contact sports for at least three weeks after the first appearance of symptoms.
What should you eat when you have mono?
No foods will help “cure” or treat infectious mononucleosis. The best diet for mononucleosis is one that is rich in nutritious foods.
Can mono be dangerous?
In most cases, infectious mononucleosis passes in a few weeks without doing lasting harm. However, the infection can lead to serious complications. Tonsil inflammation could be severe enough to make breathing difficult. A swollen spleen could tear, a serious medical condition called splenic rupture that requires emergency medical treatment. Permanent liver damage and even liver failure have resulted from a mono infection.
Does ice cream help with mono?
A sore throat caused by mononucleosis can be a real pain to live with. Swallowing and even breathing can be a chore. Gargling with salt water or baking soda water are the best remedies, but occasionally try a spoonful of ice cream, instead. It tastes a whole lot better and the cold temporarily overwhelms the pain.
Does mono go away on its own?
In nearly all cases, infectious mononucleosis goes away on its own, typically in two to four weeks. The body’s immune system regains control, and the virus continues to live in the body in a dormant stage. In extremely rare cases, however, a virus infection might become chronic, a condition known as chronic active Epstein-Barr virus disease (CAEBV). It is treated with immune-suppressing drugs to relieve symptoms, and, in extreme cases, bone marrow transplantation.