Just under the weather, or mono?

Originally Published: November 1, 1993 - Last Updated / Reviewed On: November 16, 2007
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Dear Alice,

For the past 2-3 weeks+ I haven't been able to get by without an average of 16+ hours of sleep a day. It's a real chore to get up for class (which as a grad student I have only twice a week), or just in general. I have a bit of a sore throat occasionally and headaches/aches, and the glands in my throat are pretty swollen and hard, some days worse than others. I seem to have zero energy, and it's really starting to make life difficult. Also I haven't really been that hungry. I saw an NP and she tested me for mono/strep and both came out negative. One of my roommates (a pre-med) said that sometimes mono doesn't show up in the quick blood test, and needs to be cultured. Should I go back in and retest? Could this be mono?

— Zzzzzzzzzzzzz...

Dear Zzzzzzzzzzzzz,

Your pre-med roommate is correct — there are different ways to test for mono and like most lab tests a false negative is possible. But let's first talk about the disease itself before we jump into the different screening methods. Mono (short for mononucleosis) is caused by the Epstein-Barr virus that is usually transmitted through saliva. Although most infamously known for being spread through kissing; coughing, sneezing, and sharing drinks and food utensils are also likely transmission mechanisms. Common symptoms for the disease include fatigue, weakness, sore throat, fever, swollen lymph nodes and tonsils, headache, skin rash, loss of appetite, swollen spleen, and night sweats.

Your symptoms sound akin to those attributed to mono. Even though you tested negative, the test you describe sounds like the Monospot test. This checks your blood for Epstein-Barr virus antibodies and will give you results in a day. However, it may not detect antibodies during the first week of your illness. There are other blood tests that require more time to spot the disease. You can also have a blood test to look for an elevated white blood cell count — while it won't confirm that the disease is mono, it can suggest the possibility. It is important to see your health care provider to figure out what is really going on. Only s/he will be able to order the tests that will determine if you have mono or something else (and there are plenty of conditions that have similar symptoms).

Because mono is a viral disease, the virus will stay in your body for life and there is no specific way to treat it. Most health care providers will suggest bed rest and adequate fluid intake. Antibiotics will not help. However, strep throat, sinus infection, and tonsillitis often accompany mono. These infections are bacterial and thus antibiotics are prescribed. It is normal to feel fatigued for several weeks with mono. In fact, while most signs and symptoms lessen within a few weeks, it may take two to three months to feel completely normal. If it is mono, your sore throat will probably be at its worst during the first five to seven days and your swollen lymph nodes should return to normal size during the fourth week of infection.

In the meantime, here are several suggestions to help you recover:

  • Drink lots of fluids. Drinking water and fruit juice can help relieve fever and sore throat and prevents dehydration.
  • Take over-the-counter pain medication. Pain relievers such as acetaminophen and ibuprofen can help relieve pain and fever, but will not help against viral attack.
  • Gargle with salt water. Mix ½ teaspoon of salt in a glass of warm water and gargle several times a day to relieve a sore throat.
Get some rest, check with your health care provider and you can be back up and running (and going to class, etc) soon.