MEDARVA: With This Kiss ...

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Just like a teen romance, mono usually goes away by itself.

By Helen Adams, MD
Henrico Monthly
August 2014

Does mononucleosis live up to its reputation as the “kissing disease”? Actually, sometimes it does. 

Mononucleosis, usually just called mono, is often seen in young people who are just exploring their worlds, starting to date and finding their way into first relationships. While kissing may not be the only cause, mono most often occurs in teens between 15 and 17 years of age, just when they are starting to spread their wings and becoming aware of their attraction to others.

Mono is a viral infection usually caused by the Epstein-Barr virus (EBV), one of the most commonly found viruses in the world. Most adults in the U.S. have had an EBV infection of one kind or another during childhood or adolescence and have developed an immunity. 

Mono is almost always self-limiting, meaning that it will eventually go away by itself. Any treatment is meant to make the patient feel better, since viral infections don’t respond to antibiotics.

EBV lives in the body fluids, including saliva, urine, blood and tears. It’s transmitted by contact with these fluids, such as by kissing or sharing utensils. Health care workers are less likely to develop mono even though they deal with bodily fluids all of the time; most have already developed immunity. In the few who haven’t (about 5 percent), mono may occur and follow the same course it does in teens.

The incubation period is fairly long, about four to eight weeks. Contagion risk is probably highest during the first weeks after infection, but studies have shown that some mono patients may still be able to spread the virus for many months after the disease is gone.

In adolescents and young adults, mono starts with three major conditions, which can be called the “mono diagnostic triad”:

• Fever lasting 10 to 14 days, usually mild.

• Sore throat, which is severe for the first three to five days and is resolved in about two weeks.

• Sore, swollen glands in the neck and occasionally elsewhere in the body.

Some patients will experience fatigue, body aches and just not feel well for a week or so before showing the triad. Others get sick abruptly. The way the disease starts is not related to how long it will last nor how severe it will be.

As most people know, there are other signs and symptoms commonly seen with mono. There is a characteristic feeling of exhaustion or fatigue, and most have headaches. Abdominal pain with nausea and vomiting may occur, with slight enlargement of the liver and spleen. Jaundice, or yellowing of the skin and whites of the eyes, will occasionally occur.

The sore throat can be very uncomfortable. Tonsils may be infected and sometimes pus is seen, similar to that found in strep throat. 

Diagnosis is fairly simple once the triad of symptoms has appeared, but some tests are performed to rule out more serious conditions:

• Blood smears to look under the microscope for the characteristic cells giving the disease its name.

• Monospot test, a rapid test to see if there are antibodies present; while this test is not 100 percent accurate, it can come pretty close when the symptom triad is present as well.

• Testing for immunoglobulins (proteins which react to infection) in the blood.

• Blood tests to look for an elevation in liver enzymes.

As noted before, mono goes away by itself. It is usually treated symptomatically, meaning medications are given to help the patient feel better, not to try to eliminate the virus.

Below are some suggested treatments for someone with mono:

• Take NSAIDs for fever or pain.

• Gargle saltwater for sore throat.

• Drink plenty of fluids to remain hydrated.

• Rest in bed if needed, but the patient should do whatever activities he/she can comfortably do.

• Return to normal activities gradually as the acute phase of the disease stops and the energy level starts to rise; this will usually happen over a period of several weeks to several months.

• Avoid contact sports for several weeks or until the doctor says any spleen enlargement has subsided.

• Remember that a person may still be contagious for weeks to months after becoming well.

When should a doctor be contacted? Since most cases of mono don’t cause serious problems except for feeling lousy, constant medical care isn’t needed. In the unusual situation of a severe case or a complication, a doctor will do further testing and treat with antivirals and other medications. 

Doctors do want to hear from someone, however, if he/she has:

• Sharp or sudden abdominal pain.

• Difficulty breathing.

• Fever persistently higher than 101.5 degrees.

• Worsening headache.

• Leg or arm weakness.

• Severe difficulty swallowing.

• Stiff neck or severe weakness.

Happily, the vast majority of mononucleosis (more than 95 percent) spontaneously disappears, leaving a lifetime of immunity behind as a parting gift.

Dr. Helen Adams is a family practice specialist at Innsbrook Primary Care, part of Virginia Physicians Inc. in Richmond.