The Epstein-Barr virus (EBV) is so prevalent that as many as 95 percent of Americans between 35 and 40 years old have been infected at some time in their life, according to the Centers for Disease Prevention and Control (CDC). If it's so common, why have so few people heard of it?

In many cases, symptoms are so mild or indistinguishable that it is often overlooked or passed off as the common cold, but unlike the common cold, an Epstein-Barr infection can have lasting effects and long-term repercussions. When EBV occurs in adolescents, it causes infectious mononucleosis, or mono, 35 to 50 percent of the time. Here is an overview of how EBV spreads, its symptoms, and how to treat and prevent it.


What causes Epstein-Barr is unclear; however, it is known that Epstein-Barr can cause a litany of other health related problems. Primarily, EBV causes infectious mononucleosis, which is passed through the saliva of an infected person. Although mono isn't as infectious as some other illnesses, such as the common cold, it can be transmitted through a cough or a sneeze, sharing a glass, or kissing-hence the term "kissing disease."


EBV is usually asymptomatic, which is why many people don't know they're infected. Infectious mononucleosis, on the other hand, has a number of symptoms that can cause severe discomfort, including:

  • Severe fatigue;
  • Headache;
  • Fever;
  • Sore throat;
  • Swollen lymph glands;
  • Swollen spleen or liver;
  • Weakness;
  • Loss of appetite;
  • Night sweats.

Although a person with mononucleosis may not experience all symptoms, fatigue, fever, sore throat, and swollen glands are common. The symptoms of infectious mononucleosis last between four to eight weeks; however, dormant EBV cells can remain in a person's immune system for a lifetime.


To diagnose mono, a doctor will perform both a physical exam and a blood test. A clinical diagnosis is often made when the symptoms of fever, enlarged lymph nodes, and sore throat are present for one to four weeks. After the clinical diagnosis is made, most doctors will conduct blood tests to confirm the diagnosis. They'll look for the following two things.

  • White blood cell count. A physician will commonly look for an elevated number of white blood cells or abnormal-looking white blood cells. Although this does not definitively confirm mono, white blood cell abnormalities are a strong indicator of the infection.
  • Antibodies. A heterophile antibody test--also often called a "monospot"--is used to confirm the diagnosis. Heterophile antibodies are often associated with mono. Often several EBV-associated antigens will be tested simultaneously to prevent a false-positive or a false-negative result.


There is no one specific treatment for an EBV infection or infectious mononucleosis. Antibiotics are usually not commonly used to treat mono because it is most often caused by a virus. However, a doctor may prescribe an antibiotic in the rare case that it is caused by a bacterial infection. In this case, a doctor may prescribe an antibiotic.

The foremost method to treat mono is to relieve the symptoms. The American Academy of Family Physicians recommends the following steps:

  • Get lots of rest-returning to sports or intense activity too soon can cause a relapse;
  • Drink plenty of fluids;
  • Gargle with saltwater, or suck on throat lozenges or popsicles to relieve a sore throat;
  • Take acetaminophen or ibuprofen to alleviate pain and fever. Aspirin should not be given to children.

Occasionally, bacterial infections will accompany infectious mononucleosis, resulting in strep throat, sinus infections, or rashes. See a doctor if you suspect an infection has developed. Ultimately, time is the only cure for mono, and in most instances, mono goes away in four weeks.


There is no vaccine to prevent the spread of EBV or infectious mononucleosis. If you are infected, you should not kiss others or share glasses, dishes and utensils until your symptoms have completely subsided. Epstein-Barr can remain in your saliva for sometime after the symptoms ease, so being cautious is the best way to avoid infecting others.

Complications and Long-Term Effects

Although symptoms are often manageable, complications can arise in rare but serious cases. Among the serious issues is the possibility of a ruptured spleen due to enlargement, causing sharp pain on the upper left side of the abdomen. If such pain occurs, seek medical attention immediately. Surgery may be needed.

Liver inflammation and yellowing of the skin (jaundice) are other uncommon complications that also will require medical attention.

Heart problems and issues concerning the central nervous system are virtually non-existent, and infectious mononucleosis is rarely fatal. Due to Epstein-Barr's ability to lay dormant in the immune system, it is unlikely but possible that Burkitt's lymphoma and nasopharyngeal carcinoma will materialize. Although experts believe that EBV seems to play a role in these malignancies, it is not the sole cause of the disease.