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Mononucleosis, or 'mono', is a common viral infection in college students.  Epstein-Barr virus (EBV) is the most common cause of mononucleosis.  Most people will be infected with EBV at some time in their lives.  Mono frequently affects adolescents and young adults, especially when residing, studying, and socializing in crowded settings, such as a university.  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 difficult to accurately determine when or from whom a person caught mono. It generally takes 4–8 weeks for the first symptoms to appear.  Once someone has mono, they are likely to remain contagious for many weeks and may continue to be contagious intermittently for decades.  Infection in early childhood is often asymptomatic or have only mild symptoms, which may go unnoticed at that age.

Typical Mononucleosis Symptoms 

  • Swollen lymph glands in the front, sides, or back of the neck
  • Fever (100.4 F / 38 C or greater)
  • Sore throat, usually with swollen tonsils that can be coated with white or gray-green material
  • Fatigue
  • Headache
  • Loss of appetite
  • 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
  • Vision problems

Mononucleosis Prevention

Since mono is spread in saliva, avoid eating or drinking from the same glasses, dishes, or utensils of friends or strangers.  Do not share personal items or smoking products (but we advise everyone not to smoke).  Wash hands regularly, especially before eating.  Avoid sick people.  There is no medication or vaccine to prevent mono.

Mononucleosis Diagnosis

Mono can usually be diagnosed by an IU Health Center medical provider with an examination and a rapid blood test in the IU Health Center Laboratory. 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.  A small percentage of people with mono continue to test negative.  

Mononucleosis Treatment

Mono is a virus, so there is no cure for it.  Acute symptoms of mono can last 7–14 days or longer and improvement is gradual.  Antiviral and antibiotic medications do not help.  Antibiotics are only used to treat bacterial infections.  Taking some antibiotics with mono can cause a rash. 

Treatment consists of self-care and these things can help for feeling better:

  • Get plenty of rest.
  • Take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, etc.) for fever or pain. Taking more acetaminophen (Tylenol) than recommended can cause liver damage. Thus it is important to closely follow the dosing instructions or the health care provider’s instructions to safely take this medication.  Check all medications for acetaminophen because it is often combined with other ingredients in multi-symptom medications.
  • Throat lozenges or sprays containing benzocaine (such as Cepacol) may provide temporary relief from throat pain.
  • Gargle, then spit out, 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 no appetite, to drink an adequate amount of fluids. The urine will be a pale yellow when drinking enough fluids.

In addition to self-care, it is important to avoid strenuous activity and abstain from alcohol:

Avoid Strenuous Activity

People with mono should avoid sports, lifting, exercising, falls, and any potential injury to the abdomen for about 4 weeks. That is 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 either spontaneously or from trauma to the abdomen.  A ruptured spleen is a medical emergency. Anyone with mono should get medical clearance before resuming physical activities.

Abstain From Alcohol

Mononucleosis often inflames the liver and alcohol can make this inflammation worse. Mono patients should not use alcohol while they are ill or until a provider tells them it is safe.

Even the common symptoms of mono are frequently severe enough to warrant prescription medication for pain relief during the acute phase. If any concerns regarding the possibility of mono or complications from mono, call or schedule an appointment with an IU Health Center medical provider.