Infectious mononucleosis, commonly known as mono, is a disease most frequently caused by the Epstein-Barr Virus (EBV). EBV is a common herpesvirus that is often mild or asymptomatic in young children. However, it can lead to more noticeable and severe symptoms when contracted by adolescents and young adults. The illness earned its nickname, “the kissing disease,” because of its primary transmission route, but this focus often causes confusion about other activities that may spread the virus.
How the Epstein-Barr Virus Spreads Through Saliva
The Epstein-Barr Virus (EBV) is transmitted primarily through direct contact with infected saliva. Any intimate exchange of oral fluids carries a risk of transmission, including deep kissing, which is the most common form of spread. The virus can also be transferred through sharing drinking glasses, eating utensils, or toothbrushes.
The virus can be present in saliva even when an infected person has no symptoms, a phenomenon known as viral shedding. EBV has been confirmed in genital secretions, including semen and cervical fluids. When the virus is present in saliva, oral sex facilitates the direct contact necessary for transmission via mucous membranes.
While the risk is generally considered lower than with deep kissing, any activity that increases the exchange of saliva, including oral-genital contact, presents a possibility for EBV transmission. The virus can be shed into the mouth for months after a person has recovered from the initial illness, and sometimes intermittently for years. This long-term shedding means a person can unwittingly pass on the virus.
Common Symptoms and Incubation Period
The time between initial exposure and the onset of noticeable symptoms, known as the incubation period, typically lasts four to six weeks. During this silent phase, the virus multiplies, and the infected person can be contagious without being aware of it. While the infection is often mild or asymptomatic, in teenagers and young adults, it frequently leads to infectious mononucleosis.
Once the acute stage begins, the characteristic triad of symptoms includes a persistent high fever, a severe sore throat, and swollen lymph nodes, especially in the neck and armpits. Extreme fatigue often represents the most debilitating and longest-lasting symptom, frequently persisting for weeks or even months after other signs have faded.
Mononucleosis can cause less common but serious complications. These include an enlarged spleen (splenomegaly), which may occur in the second or third week of the illness. Mild inflammation of the liver (hepatitis) may also develop, sometimes leading to temporary jaundice. If the spleen becomes significantly swollen, there is a risk of rupture, which is a life-threatening medical emergency.
Reducing Transmission and When to Seek Medical Attention
Since EBV is spread through saliva, the most effective way to reduce transmission is by avoiding close contact, such as kissing and oral sex, with an infected person. Simple hygiene practices are also important, including refraining from sharing personal items like lip balm, eating utensils, or drinking containers. Because the virus can remain in the saliva for many months following recovery, these precautions should be maintained even after symptoms disappear.
There is no specific cure or antiviral medication for mononucleosis, so treatment focuses entirely on supportive care. This involves getting sufficient rest, which is the most important factor for recovery, and staying well-hydrated. Over-the-counter pain relievers can help manage the fever and discomfort of the sore throat.
Seek medical attention if symptoms are severe, such as a persistent high fever that does not improve or significant difficulty breathing or swallowing. Immediate medical care is necessary if sharp, sudden pain develops in the upper left abdomen, which can signal a ruptured spleen. If mono is confirmed, avoiding strenuous activity and contact sports is advised for several weeks to prevent trauma to an enlarged spleen.