Just under the weather, or mono?

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 false negatives are possible. But first, what exactly is mono? Mono (short for mononucleosis), sometimes referred to as the kissing disease, is caused by the Epstein-Barr virus (EBV) and is usually transmitted through saliva. Although most infamously known for being spread through kissing (hence the nickname); coughing, sneezing, and sharing drinks and food utensils are also possible transmission mechanisms.

How might you know if you have mono? Common symptoms include fatigue, weakness, sore throat, fever, swollen lymph nodes and tonsils, headache, skin rash, loss of appetite, swollen spleen, and night sweats. If your health care provider requires additional confirmation to diagnose, they may do a blood test. The test you described sounds like the Monospot test. This checks your blood for EBV antibodies and will give you results in a day. The Centers for Disease Control (CDC) found that the Monospot test has been known to produce both false positives and false negatives. Also, it sometimes detects antibodies caused by other conditions. However, the test may show if someone has a typical case of mono.

If you are still concerned that you have mono, you might talk to your health care provider about other possible tests. Other tests for antibodies to the EBV-associated antigens require more time to spot the disease (so you won’t get results the same day). But, no test is perfect. Here’s one example: The early antigen (EA) test will detect an active EBV in many people, however, about 20 percent of healthy people may have these antibodies for years. So, if they get tested, it could result in a false positive. Another option is that you can 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 may be 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 treat mono. However, strep throat, sinus infection, and tonsillitis often accompany mono. These infections are bacterial and thus antibiotics may be 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. It’ll also help prevent 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 take care. Here’s to a swift and full recovery!

Last updated Sep 12, 2014
Originally published Nov 01, 1993

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