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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,

Since you are experiencing much more fatigue than you typically do, your decision to see a medical provider was prudent. Mono (short for mononucleosis) can be caused by numerous viruses, the most common of which is the Epstein-Barr virus (EBV). Part of the herpes family of viruses and known for being spread through kissing, transmission of EBV can also occur through coughing, sneezing, and sharing drinks and food utensils, and less commonly through blood and semen. Common symptoms include fatigue, weakness, sore throat, fever, swollen lymph nodes and tonsils, headache, skin rash, loss of appetite, and swollen spleen—symptoms that do seem to align with much of your experience. That being said, only a health care provider can provide a diagnosis, so it's wise that you've sought out their expertise. If you're still not getting any answers, it may be wise to go back or to see another provider. 

While medical providers don't require testing for diagnosis, one of the most common tests for mono is the monospot, a rapid blood test that detects the presence of a certain type of antibody the immune system usually produces when infectious mono is present. A positive test can indicate the presence of infectious mono which is usually caused by the EBV. However, testing isn't perfect and errors do occur. A false negative could occur if someone with EBV is tested before the body’s immune system has produced antibodies at a level high enough to be detected by the test, yielding a negative result when there is an infection—what your roommate suggested. Similarly, monospot false positive test results have also been reported in people with certain conditions such as rubella and lymphoma, meaning there can be a positive monospot result when infectious mononucleosis caused by EBV isn't present.        

If you're still concerned about mono, you might talk to your health care provider about re-testing or virus-specific testing for Epstein-Barr. EBV stays in your body for life and there is no specific way to treat it. Antibiotics won't help treat mono caused by EBV; however, strep throat and bacterial sinus infections often accompany mono and are treatable with such medications. It's normal to feel fatigued for several weeks and it's possible for symptoms to last months. Most health care providers will suggest bed rest and adequate fluid intake. Some general ways to care for yourself while feeling ill include:

  • Drinking lots of fluids. Drinking water and fruit juice can help relieve fever and sore throat. It’ll also help prevent dehydration.
  • Taking over-the-counter pain medication. Pain relievers such as acetaminophen and ibuprofen can help relieve pain and fever but won't help against viral attack.
  • Gargling with salt water. Mix half of a 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!

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Last updated Nov 25, 2022
Originally published Nov 01, 1993

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