Can You Have Chronic Mono?

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Infectious mononucleosis, most notably known simply as mono, is a viral infection caused by the Epstein-Barr virus (EBV). It is typically found in young adults and teenagers, and is nicknamed the kissing disease because it spreads through saliva and other bodily fluids.

The infection is common, and roughly 90% of all Americans will have been infected by the time they turn 35. Once the virus has made its way into the body, it stays there for the rest of a person’s life—remaining inactive in tissues and immune cells. While some people may not experience any symptoms of mono, others will come down with a mild to severe case that is accompanied by ailments such as fatigue, body aches, fever, headaches, and swollen lymph nodes.

The infection typically lasts four weeks, but could last longer. When the symptoms are severe, they interrupt a person’s ability to carry on with their day-to-day life. Usually, people won’t get mono twice because the body builds up antibodies that provide immunity to EBV. In a small number of cases, though, the infection can recur since the virus never leaves the body.

In very rare cases, the virus that causes mono can remain active within the body for a long period of time. When this happens, it is referred to as chronic active Epstein-Barr virus (CAEBV) infection.

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Recurrent Mono

Many people with mono only experience symptoms of the infection once, but others may come down with the illness months or even years after the initial transmission.

Often if the virus does reactivate for a second time, the symptoms will be either milder or nonexistent. Those who have a weakened immune system are most likely to experience symptoms from a reactivation of the virus.

Although it is not entirely clear what causes the virus to be active after being dormant, the recurrence of symptoms can likely be attributed to the function of the immune system. For those with adequate immune function, certain cells known as natural killer (NK) cells and T-cells will fight off further infection by killing cells that are infected with EBV.

However, if the immune system isn’t working as it should or there are defects in those cells, the virus can reactivate and cause symptoms. The virus can also reactivate while the body is fighting off another infection.

Risk Factors

A few risk factors can cause a mono infection to recur. Often referred to as mono relapse, those with weakened immune systems, autoimmune deficiencies, or other diseases that affect immune function are at a higher risk.

Chronic Epstein-Barr 

CAEBV infection is a rare disorder that occurs when the body cannot control EBV. As the disease progresses, higher levels of EBV are found within DNA in the blood and organs.

Some symptoms of CAEBV infection, such as fever and an enlarged spleen and lymph nodes, are similar to those of mono. However, the rare disorder can present with other symptoms as well, including:

  • Anemia
  • Nerve damage
  • Pneumonia
  • Enlargement of the airways of the lungs
  • Decreased immune function
  • Viral hepatitis

Risk Factors

Certain risk factors can make a person more likely to develop a case of CAEBV infection. Ethnicity may play a role. There is an increased risk among people who are Asian, South American, Central American, and Mexican.

Genetics can also play a role in the development of a CAEBV infection, and research has shown that an inherited immunodeficiency in certain immune cells can be a risk factor. The prevalence of the chronic condition in those of specific ethnic backgrounds also suggests that a genetic component may be at play.

According to research, no one genetic defect has been linked to an increased risk of developing the disease, but some believe that specific antigens known as A26 and B52 could play a role in its development.

How Is Chronic Fatigue Syndrome Related to Mono?

Having mono may increase a person’s risk of developing chronic fatigue syndrome, which is a long-term illness that hinders a person’s ability to perform daily activities because of overwhelming fatigue.

Mono-Like Illnesses

It’s important to get a proper diagnosis from medical professionals when you suspect mono or a CAEBV infection because there are some other health conditions that can mimic these conditions.

Strep Throat

Strep throat is caused by the bacteria Streptococcus. The overlapping symptoms of strep throat and mono include fever, sore throat, headache, rash, and swollen lymph nodes. However, strep throat also presents with pain when swallowing, red and swollen tonsils, red spots on the roof of the mouth, nausea, vomiting, and stomach pain.

The Flu and Other Viruses

A few different viral infections can mimic the symptoms of mono. The flu, for example, is incredibly common and presents with symptoms similar to mono such as fever, sore throat, muscle or body aches, headaches, and fatigue. Adenovirus infections can also cause symptoms similar to those of the flu and mono, such as fever and a sore throat.

Human herpesvirus 6 (HHV-6) and herpes simplex virus type 1 are from the same family of viruses that EBV belongs to. Because of this, some of the symptoms can overlap.

The symptoms of a human herpesvirus 6 infection include fever and enlarged lymph nodes. A herpes simplex virus type 1 infection can also present with fever and swollen lymph nodes, which are typical in a case of mono.

Cytomegalovirus (CMV)

A cytomegalovirus infection presents similarly to mono in many ways. Its prevalence is quite high, as is the case with mono, and it is thought that over half of all adults have been infected with CMV at some point in their life.

It also remains inactive in the body forever, but it can reactivate in the future in some cases. Most people who contract CMV don’t have any symptoms, which is similar to mono, but when they do appear, they consist of fever, sore throat, fatigue, and swollen glands.

Hepatitis A

Hepatitis A is another viral infection that can present in the same way as mono. Since hepatitis A does affect the liver, there are typically other symptoms not related to mono that are present, such as:

  • Dark-colored urine
  • Jaundice
  • Loss of appetite
  • Diarrhea
  • Nausea
  • Abdominal discomfort

The symptoms of hepatitis A that overlap with those of mono include fever and fatigue. Research has found that a mono infection can also lead to a form of hepatitis known as acute hepatitis.

Toxoplasmosis

Toxoplasmosis is a parasitic infection caused by the Toxoplasma gondii parasite. The parasite can be found across the globe, but the prevalence of this infection is high in the United States, and more than 40 million Americans may have the infection.

The parasite can live within a human body for their entire lives without ever causing symptoms. When rare symptoms do occur, they tend to appear in those with a weak immune system and can include flu-like symptoms, such as swollen lymph glands and muscle aches and pains.

Acute Retroviral Syndrome

Acute retroviral syndrome is the first stage of infection with the human immunodeficiency virus (HIV) and can be found in the majority of those who have the infection. The symptoms present in the syndrome are so similar to those of mono that it can often be hard to tell the difference. These symptoms include headache, fever, enlarged lymph nodes, sore throat, and headache.

When to See Your Doctor

Anytime you have symptoms that could be mono for longer than a few days, you should check in with your doctor. Since mono can mimic other conditions, getting a proper diagnosis is vital to your recovery.

Treatment

There is no cure or medication that can treat mono. The treatment used to help speed up recovery often centers around relieving symptoms for those who have the infection so that they can rest comfortably while they get better.

Some management techniques for mono include:

  • Rest: Fatigue is a dominating symptom of mono, and the best way to fight fatigue is to get plenty of rest.
  • Hydration: Dehydration can make an infection worse, so making sure you are hydrated will help speed up your recovery.
  • Pain-relieving medications: Mono can cause all types of pain, including headaches and muscle aches. It can also cause fever and inflammation. Taking over-the-counter medications such as ibuprofen (Advil), naproxen (Aleve), and acetaminophen (Tylenol), can help address the discomfort caused by these symptoms.
  • Other medications to soothe a sore throat: Using throat lozenges or gargling with salt water can help soothe the pain of a sore throat.
  • The avoidance of tiring activities: Sports and other physical activity can increase the risk of a spleen rupture in those with mono because of the pressure that it can cause on the already enlarged organ. All strenuous physical activity should be avoided while you are sick with mono and then up to four weeks after you recover. 

Since mono can’t be cured, the best way to speed up recovery and be as comfortable as possible while dealing with the illness is to follow the aforementioned treatment techniques.

Coping

Coping with mono can be difficult because of the severity of symptoms and the length of time that they can last. The best way to deal with being sick is to let yourself rest, relax, and take the medications you need to alleviate your symptoms.

You could also focus on boosting your immune system with healthy whole foods that are designed to give the immune system everything it needs to fight off an infection. Foods such as green leafy vegetables, bell peppers, apples, and green tea are great choices to start an immune-aiding diet while coping with mono.

A Word From Verywell

The sheer commonness of mono makes it a difficult virus to prevent. Chances are you’ve already had it or it’s in your body right now and you never noticed because you were one of the lucky ones who were asymptomatic or had mild discomfort from the infection.

If you have mono and the symptoms seem too hard to bear, the best thing you can do is to see your doctor, rest, and enjoy as much of the downtime required for recovery as possible.

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