Common Ailments

Mono (Mononucleosis)

(Written by: Nancy Merrill, M.D. | 8/21/2003)

What is mono?

Mono (infectious mononucleosis) is a viral infection. The Epstein Barr virus causes mono in over 95% of cases in college students.

What are the symptoms?

Common symptoms include:

  • Sore throat (Physical findings include enlarged tonsils with exudates or pus)
  • Fatigue
  • Swollen glands (lymph nodes, especially in the neck)
  • Fever
  • Loss of appetite
  • Depression and lack of motivation

Less common symptoms include:

  • Skin rash (especially on the chest)
  • Jaundice (yellowing of eyes and skin, indicating infection of liver)
  • Nausea
  • Joint aches
  • Enlarged spleen (a lymphoid organ which lies just under the left ribs)

How is it transmitted?

The virus that causes mono is spread mainly through saliva, which is why it is named the “kissing disease.” Sharing a cup or toothbrush and kissing on the mouth are known methods of transmission. Being a household contact (boyfriend/girlfriend and occasionally roommate) increases your chances of exposure. However most people that get mono (> 50%) have no known exposure. Sitting in a classroom or lecture hall or living in a residence hall with a student who has mono does not increase your chance of getting the disease (unless the student with mono kisses you on the mouth or spits in your face). Being tired, stressed, malnourished or fatigued place you at greater risk, since your immune system is not able to fight exposure to the virus.

How is it diagnosed?

Your health care provider at the student health center will do a history and physical (ask you questions and examine you). Blood tests may be recommended. Often the initial blood test (which tests for antibodies to the virus) may be negative, because your immune system has not yet produced enough antibodies to be detectable by lab confirmation. If the 1st test is negative, this does not indicate that you have either been misdiagnosed or that you do not have mono. You will probably also be tested for “strep throat”, as many of the signs and symptoms of mono and strep are similar. If the strep test is negative, and if your signs and symptoms and CBC (blood count) results suggest mono, you will be asked to return to the health center in a few days for further testing.

How is it treated?

Since mono is caused by a virus, there is no antibiotic treatment. Rest and fluids (allowing your immune system to fully function) are the best treatment. Your health care provider may prescribe steroids if airway obstruction is a possibility to try to decrease the size of the tonsils.

How long does it last?

Symptoms usually last for one to two weeks. If your immune system is compromised or if you are not resting, symptoms may last a few months. You will be advised to get plenty of sleep and to abstain from strenuous physical activity.

Can I attend classes with mono?

Most college students can continue to attend classes. Since mono is not spread in the air, isolation is not required to prevent contagion. Adequate rest and proper nutrition (including fluids) are necessary for recovery. If you feel like you are falling behind academically, academic advisors and professors may be notified (with your written consent), and most are willing to assist and accommodate while you recover.

What are complications of mono?

  • Rupture of the spleen (if it is enlarged). Strenuous physical activity and contact sports are not recommended.
  • Airway obstruction from enlarged tonsils. Steroids will be prescribed if you have difficulty breathing.
  • Infection of the liver. Alcohol should be avoided while you are ill and recovering.
  • Depression and lack of motivation. A patient with mono will be reminded that fatigue and depression are common, and almost always resolve with time.

What should I do if I think I have mono?

If you suspect you have mono, make an appointment to be seen by a health care provider (physician, nurse practitioner, or nurse) at the student health center.