Medically Reviewed by Carol DerSarkissian, MD on July 28, 2021
Epstein-Barr is the virus that causes mononucleosis. You might know this disease better by its nickname, "mono." It's also called the "kissing disease" because of one way you can spread it to someone else. Even though Epstein-Barr virus (EBV) isn't a household name, you've probably been infected without knowing it. Lots of people carry the virus but don't get sick. Once you're infected with EBV, symptoms can take 4 to 6 weeks to show up. When they do, they're often mild, especially in young children. Kids' symptoms may be more like those of a cold or flu. Teens often have more obvious symptoms of mono. If you do get symptoms, most likely you'll have: Although you should start feeling better in 2 to 4 weeks, the fatigue can stick around much longer. You may still feel tired a couple of months later. The virus is found in saliva, so you can catch mono from kissing someone who’s infected. You can also get it from drinking from the same glass or using an infected person's toothbrush. It's also found in blood and semen, so it's possible to get mono from sex, a blood transfusion, or an organ transplant. You don't have to be sick to pass the virus to someone else. EBV stays in your body long after you get over mono. The virus can become active again months or years later, making you contagious once more. It's hard to tell whether you have mononucleosis just by your symptoms. Fever, fatigue, and sore throat could also be signs of other illnesses, like the flu or a cold. See your doctor for an exam to learn for sure what's making you sick. They might find signs that you have mono, such as an enlarged spleen, an organ in your belly that filters blood. Your doctor will also check to see if you have a swollen liver and white patches on your tonsils. You may also need to get some blood tests. One test looks for antibodies, substances your immune system makes in response to the EBV virus. Another test looks for a type of white blood cell your body uses to fight off the EBV infection.
Like other viruses, Epstein-Barr can't be treated with antibiotics. Mono should clear up on its own without treatment in a few weeks. Although no medicine can cure an EBV infection, you can take these steps at home to ease your symptoms: Ease back into work or school, taking things slowly until you feel better. For a month or so, avoid sports, heavy lifting, or other vigorous activities in which you could injure your spleen. No vaccine can protect you against the EBV virus. The best way to avoid catching it is to stay away from anyone who has mono. Don't share any items, including glasses, silverware, and toothbrushes, with someone who is infected. Also avoid kissing or having sex with an infected person. There are some rare complications of mono, so see your doctor if you or your child has any of these symptoms: Also call if your symptoms don't go away after 4 to 6 weeks. You could have another type of infection besides mononucleosis. EBV is best known for causing mononucleosis, but less often it can lead to other diseases, including:
- Ear infections and diarrhea in children
- Guillain-Barre syndrome
- Certain cancers, including Burkitt's lymphoma and cancers of the nose and throat
Studies also show a link between EBV and multiple sclerosis (MS), but more research is needed to determine if the virus can lead to MS.
© 2021 WebMD, LLC. All rights reserved. View privacy policy and trust infoEpstein-Barr virus (EBV) is a virus in the herpesvirus family that can infect humans. EBV infections are very common — you may have already contracted the virus without even knowing it.
The condition that you may associate EBV infection with is infectious mononucleosis, or mono. However, experts are researching potential links between EBV and other conditions, including cancer, autoimmune diseases, and long COVID.
Read on to learn more about EBV, including common symptoms of an infection and how the virus spreads.
EBV infections don’t always cause symptoms. This is especially true for children.
Teens and adults are more likely to experience symptoms, which can include:
These symptoms can last for 2 to 4 weeks, though feelings of fatigue may linger for weeks or months.
If you have an enlarged spleen, doctors may recommend restricting contact sports until you’ve fully recovered to prevent rupture.
EBV spreads from person to person through bodily fluids, particularly saliva. This is why mononucleosis, one of the most well-known EBV infections, is casually known as the “kissing disease.”
But you can also get the virus by sharing personal items, such as toothbrushes or eating utensils, with someone who has an active EBV infection. EBV can also be spread through blood and semen.
EBV can start spreading to others as soon as you contract it. This means you can pass it on before you even start to have symptoms of an active infection.
You’ll be able to pass EBV on to others as long as the virus is active, which could be weeks or even months. Once the virus becomes inactive, you can no longer spread it to others, unless it reactivates.
Potential EBV infections are often diagnosed without any testing. However, blood tests can detect the presence of antibodies associated with EBV.
One of these is known as the monospot test. However, the Centers for Disease Control and Prevention doesn’t recommend it for general use because the results aren’t always accurate.
In addition to the monospot test, there are other blood tests for more specific antibodies to EBV, including:
- viral capsid antigen (VCA): Antibodies to VCA appear early in the infection. One type (anti-VCA IgM) disappears after several weeks while another (anti-VCA IgG) persists for life.
- early antigen (EA): Antibodies to EA appear during an active infection. They typically become undetectable after several months, although they may persist for longer in some people.
- EBV nuclear antigen (EBNA): Antibodies to EBNA slowly appear in the months following infection and can be detected throughout a person’s life.
A doctor will take these results and other factors into account, including a person’s overall health and any underlying health conditions, to make a diagnosis.
There’s no specific treatment or vaccine for EBV. And because they’re caused by a virus, EBV infections don’t respond to antibiotics.
Instead, treatment focuses on managing common symptoms. This includes:
- getting enough rest
- drinking plenty of fluids
- taking over-the-counter pain relievers to ease fever or sore throat
- avoiding contact sports or heavy lifting
In some cases, EBV infections can lead to complications, some mild and some serious.
These include:
If you suspect you may have an active EBV infection, it’s best to see a doctor if you are concerned about your symptoms. They can monitor you for signs of complications and tell you what to look for as you recover.
Once you’ve contracted EBV, the virus remains inactive within your body for the rest of your life. This is called latency.
In some cases, the virus can reactivate. In many people, it does not usually cause symptoms.
But in others, it can cause chronic or serial infections.
Reactivated EBV may cause symptoms similar to those of an initial EBV infection in people who have a weakened immune system.
EBV reactivation and COVID
EBV and COVID-19 are caused by different viruses.
However, a research study from 2021 and another from 2022 suggest that inflammation caused by COVID-19 may cause EBV reactivation in some people.
Some people hospitalized with COVID-19 were also found to have reactivated EBV as well.
Long COVID, also known as post-COVID 19 condition, and EBV reactivation have many symptoms in common. The above studies suggest that EBV reactivation may cause some of the symptoms of long COVID.
It’s important to note that EBV is not the only health condition associated with long COVID. Having type 2 diabetes or certain antibodies associated with autoimmune diseases such as lupus and rheumatoid arthritis may also be linked to developing long COVID. A high viral load, or the amount of the virus in your blood early in the infection, is also considered a risk factor.
Additional studies are still needed to better understand the link between EBV and long COVID.
In very rare cases, EBV infection can lead to a chronic condition called chronic active EBV (CAEBV). CAEBV is characterized by ongoing symptoms and blood test results that show an active EBV infection.
CAEBV starts out as a typical EBV infection. However, some people’s immune systems aren’t able to control the infection, allowing the active virus to linger instead of going dormant.
Symptoms of CAEBV can include:
- swollen or tender lymph nodes
- fever
- enlarged liver (hepatomegaly) or spleen (splenomegaly)
- fatigue
- sore throat
- headache
- muscle pain
- joint stiffness
- anemia
- liver failure
Experts aren’t sure why some people develop CAEBV. But they believe genetic factors or mutations in EBV-infected cells may play a role. In addition, CAEBV is more common in Asia, Central America, and South America.
Currently, the only effective treatment for CAEBV is a hematopoietic stem cell transplant.
Over time, CAEBV can cause several complications, including:
EBV infection can increase the risk of developing certain rare cancers. This is because mutations in cells infected with EBV can lead to cancerous changes.
According to the American Cancer Society, some types of cancer that may be associated with EBV include:
EBV-associated cancers are uncommon. Most people who have had an EBV infection will not go on to develop one of these cancers. Experts are still trying to identify these specific mutations and why EBV infection seems to cause them. But overall, it’s estimated that EBV infection contributes to only about 1 percent of cancers worldwide.
EBV may also play a role in the development of other health conditions, including autoimmune disorders and schizophrenia.
Autoimmune disorders
EBV has long been thought to be linked to autoimmune disorders, such as lupus. Experts believe that EBV may cause changes in the way some genes are expressed. This altered gene expression could increase your risk of developing an autoimmune disorder.
One 2018 study supported by the National Institute of Allergy and Infectious Diseases and other NIH components found a potential link between EBV and an increased risk of developing lupus, an autoimmune condition.
The study’s authors believe that same mechanism linking EBV and lupus may also link EBV to other autoimmune conditions, which can include:
They suggest that EBV may activate certain genes that can affect your risk for developing autoimmune disease in combination with other factors.
Still, more research is needed to fully understand the potential link between EBV and autoimmune conditions.
Schizophrenia
A 2019 study looked at rates of EBV infection in more 700 people both with and without schizophrenia. Those with schizophrenia had higher levels of antibodies to some EBV proteins than those who didn’t, suggesting they had an unusual immune response to the virus.
The researchers also found that participants with genetic risk factors for schizophrenia as well as elevated antibodies were over eight times more likely to have schizophrenia than the control group.
A smaller 2021 study led by the same researcher found that in 84 individuals with schizophrenia, having a higher amount of antibodies was associated with a lower cognitive performance. The study’s authors suggest that EBV exposure may contribute to cognitive deficits in people with schizophrenia.
Further research is needed to study a possible link between EBV infection and schizophrenia.
EBV infection is very common and is spread by coming into contact with bodily fluids of people who are sick with it. Often, people get the virus during childhood and don’t experience any symptoms. If a teenager or adult gets sick, they may experience symptoms like fatigue, swollen lymph nodes, and fever.
In very rare cases, EBV can cause a chronic infection, which can be fatal if left untreated. EBV has also been linked with a variety of conditions, including cancers, autoimmune disorders, and long COVID. However, additional research is needed to determine EBV’s overall role in these conditions.