Mononucleosis, also called “mono” or “the 

kissing disease,” is a contagious viral infection that can

leave you feeling absolutely wiped out — as if you’re fighting the worst cold or flu you’ve ever had.
Infectious mononucleosis is primarily caused by the Epstein-Barr virus (EBV), but other infections,
such as cytomegalovirus or toxoplasmosis, can cause the disease, too, according to a review article
published in a December 2015 article in Current Topics in Microbiology and Immunology. (1)

EBV, mono’s primary driver, is extremely common — so much so that not having been infected with
EBV is much rarer than being infected by it at some point. “As many as 90 to 95 percent of adults are
infected with EBV,” says Eric Johannsen, MD, an associate professor of infectious disease at the
University of Wisconsin School of Medicine and Public Health in Madison, who specializes in EBV. (1)

Anyone can get mono at any age — even young children — but it’s most prevalent in teens and
college-aged young adults, and tends to be more severe the older you get, according to another
review article published in February 2015 in the journal Clinical & Translational Immunology. (2,3,4)
As many as 25 percent of teens and young adults who become infected with EBV develop infectious
mononucleosis, according to the Centers for Disease Control and Prevention. (3,5)

When someone gets mono, it can be debilitating. The good news is that most people recover
completely after resting in about two to four weeks without long-term complications, though some
people may feel tired and not be able to fully resume their normal activities for several more weeks.
(1,2,3,6)

Mono tends to bring about the same symptoms as a cold or flu, but they linger longer and can be
more severe.

How do you know if you have mono? Here are some common signs: (1,2,3)

 Sore throat

 Severe fatigue

 Fever

 Body aches

 Swollen lymph nodes in the neck and armpits

 Enlarged spleen or liver

 Headache

 Loss of appetite

 Rash

Symptoms typically appear anywhere from four to six weeks after someone gets infected with EBV.
Doctors aren’t sure why, but symptoms tend to be much less severe in younger kids. Unlike teens
and adults who typically feel very ill and are knocked off their feet by mono, younger children may
only experience a mild fever or feel tired — or they may not have any symptoms at all.

“In children as young as age three, four, or five, it may be very benign,” says Octavio Ramilo, MD,
chief of infectious disease at Nationwide Children’s Hospital in Columbus, Ohio. (1,7)

“We still don’t understand how the immune system changes in life,” Dr. Ramilo says.
It’s worth noting that sometimes mono symptoms can be so mild that they may get mistaken for the
common cold or flu, and clear up on their own without further medical attention or an actual
diagnosis, Dr. Johannsen says (as might be the case in young children). But other cases of mono —
particularly those in individuals who have weakened immune systems — can potentially be life-
threatening. 

RELATED: Everything You Need to Know About the Cold and Flu

If you’re experiencing any of the aforementioned mono symptoms and they persist for more than a
few days, especially if any are severe or not showing signs of getting better, it’s a good idea to see
your doctor, who can test you for mono and rule out other illnesses. (8)

Whether you’ve been diagnosed with mono or not, these are the symptoms that warrant an
immediate call to your doctor or seeking emergency care right away:

 Sudden and sharp pains in the upper left side of your abdomen — this could be an indication
that your spleen may be ruptured and you need to seek medical attention right away. This
danger is a key reason why doctors urge anyone with mono to avoid any sports or activities
that require any physical contact or strain.

 Difficulty breathing or swallowing (caused by enlarged tonsils)

 Decreased urine output (a sign of dehydration)

 Symptoms of mono that get worse or do not go away after two to four weeks (4,9)

How to Tell the Difference Between Mono Versus a Cold or Strep Throat

Mononucleosis is frequently mistaken for other illnesses, such as strep throat, chronic fatigue, or
another infection, because the symptoms can overlap, Ramilo says.

RELATED: All About Symptoms of Strep Throat and How to Get Diagnosed

But there are telltale signs that point to mono. For instance, if someone still has a sore throat, fever,
and rash by day seven, it’s likely a sign that they have mono rather than a cold or strep, says Ramilo.

“For doctors, the most common indicator of mono is fatigue,” says Hank Balfour, MD, professor of
laboratory medicine and pathology, as well as pediatrics, at the University of Minnesota Medical
School in Minneapolis.

Another indication that the infection may be mono versus a cold or flu is when the symptoms occur.
People tend to come down with a cold or the flu in the cooler months, says Dr. Balfour. But people
get mono all year long, he adds.

RELATED: The Ultimate Guide to Winter Wellness

Another condition that often gets confused with mono is chronic fatigue syndrome (CFS). Both
conditions share symptoms such as extreme fatigue, muscle aches, and sore throat. But one of the
most obvious distinguishing features is that the symptoms of mono do not recur for most people,
whereas CFS symptoms are, as the name indicates, chronic. Mono symptoms do linger longer than a
cold or the flu typically would, but they certainly aren’t chronic, Ramilo says.

And while mono doesn’t cause CFS, some research suggests having had infectious mononucleosis
increases the risk of developing CFS in adults and adolescents, Johannsen says. 
How Long Is Someone Contagious After Mono Symptoms First Show Up?

As of now, there is no vaccine to prevent mono. But — like chicken pox, which usually doesn’t flare
up again even though the varicella virus stays dormant in the body — most people do not get mono
more than once, even though the EBV virus stays inactive in their bodies for the rest of their lives.
(11)

Still, knowing how EBV spreads (and how mono spreads) can help you take the right steps to avoid
getting the infection.

EBV is transmitted through saliva (hence the name “kissing disease”), and it can stay in the saliva of
people who’ve been infected for months, though how long it stays in the saliva and how long
someone with the virus is contagious can vary.

“We don’t know how much virus is necessary to transfer from person to person,” Balfour says. It’s
important to know that someone can appear fine (and may not have a mono infection or any
symptoms yet or at all), but can still shed the virus in their saliva.

It can take about four to seven weeks for symptoms to show up after someone’s been infected with
the virus, and symptoms tend to last for another two to four weeks — and a person is contagious
through all of this time. (12) Research has not yet confirmed how long after symptoms disappear
that a person who’s had mono remains contagious.

“Unlike a cold sore, you don’t know when someone [with mono] is shedding and infectious,”
Johannsen says.

The most effective way to prevent mono is to avoid very intimate contact, such as kissing, with
someone who has mono for several months, even after the person is feeling better.

EBV is most easily spread through direct body-fluid contact, such as by exchanging saliva while
kissing or blood or semen contact during sex, blood transfusions, or organ transplants. But EBV can
still live in bodily fluids once they’re outside the body, too. So avoid sharing utensils, cups, or
toothbrushes with someone you know who has been infected with EBV or mono, and steer clear
when they sneeze or cough.

The bottom line is that you are not likely to catch mono from someone in a non-intimate setting,
such as attending class with or standing in line near someone who’s been infected with EBV. And if
you take precautions, you can avoid getting EBV — that is, if you don’t already have it — even from
someone in your household, says Johannsen.