Diagnosis

Physical exam

Your doctor may suspect mononucleosis based on your signs and symptoms, how long they've lasted and a physical examination. He or she will look for signs like swollen lymph nodes, tonsils, liver or spleen, and consider how these signs relate to the symptoms you describe.

Blood tests

  • Antibody tests. If there's a need for additional confirmation, a monospot test may be done to check your blood for antibodies to the Epstein-Barr virus. This screening test gives results within a day. But it may not detect the infection during the first week of the illness. A different antibody test requires a longer result time, but can detect the disease even within the first week of symptoms.
  • White blood cell count. Your doctor may use other blood tests to look for an elevated number of white blood cells (lymphocytes) or abnormal-looking lymphocytes. These blood tests won't confirm mononucleosis, but they may suggest it as a possibility.

Treatment

There's no specific therapy available to treat infectious mononucleosis. Antibiotics don't work against viral infections such as mono. Treatment mainly involves bed rest, good nutrition and drinking plenty of fluids.

Medications

  • Treating secondary infections. Occasionally, a streptococcal (strep) infection accompanies the sore throat of mononucleosis. You may also develop a sinus infection or an infection of your tonsils (tonsillitis). If so, you may need treatment with antibiotics for these accompanying bacterial infections.
  • Risk of rash with some medications. Amoxicillin and other penicillin derivatives aren't recommended for people with mononucleosis. In fact, some people with mononucleosis who take one of these drugs may develop a rash. The rash, however, doesn't necessarily mean that they're allergic to the antibiotic. If needed, other antibiotics that are less likely to cause a rash are available to treat infections that may accompany mononucleosis.

Lifestyle and home remedies

Besides getting plenty of bed rest, these steps can help relieve symptoms of mononucleosis:

  • Drink plenty of water and fruit juices. Fluids help relieve a fever and sore throat and prevent dehydration.
  • Take an over-the-counter pain reliever. Use pain relievers such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) as needed. These medicines have no antiviral properties. Take them only to relieve pain or a fever.

    Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.

  • Gargle with salt water. Do this several times a day to relieve a sore throat. Mix 1/2 teaspoon salt in 8 ounces (237 milliliters) of warm water.

Wait to return to sports and some other activities

Most signs and symptoms of mononucleosis ease within a few weeks, but it may be two to three months before you feel completely normal. The more rest you get, the sooner you should recover. Returning to your usual schedule too soon can increase the risk of a relapse.

To avoid the risk of rupturing your spleen, wait at least one month before returning to vigorous activities, heavy lifting, roughhousing or contact sports. Rupture of the spleen results in severe bleeding and is a medical emergency.

Ask your doctor when it's safe for you to resume your normal level of activity. Your doctor may recommend a gradual exercise program to help you rebuild your strength as you recover.

Coping and support

Mononucleosis can last weeks, keeping you at home as you recover. Be patient with your body as it fights the infection.

For young people, having mononucleosis will mean some missed activities — classes, team practices and parties. Without a doubt, you'll need to take it easy for a while. Students need to let their schools know they are recovering from mononucleosis and may need special considerations to keep up with their work.

If you have mononucleosis, you don't necessarily need to be quarantined. Many people are already immune to the Epstein-Barr virus because of exposure as children. But plan on staying home from school and other activities until you're feeling better.

Seek the help of friends and family as you recover from mononucleosis. College students should also contact the campus student health center staff for assistance or treatment, if necessary.

Preparing for your appointment

If you suspect you have mononucleosis, see your family doctor. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, noting any major stresses, recent life changes, your daily routine — including sleep habits — or exposure to anyone with mononucleosis.
  • Make a list of all medications, vitamins and supplements you're taking.
  • Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For mononucleosis, some basic questions to ask your doctor include:

  • What are the likeliest causes of my symptoms or condition?
  • Other than the most likely cause, what are other possible causes for my symptoms or condition?
  • What tests do I need?
  • I have these other health conditions. How can I best manage them?
  • Are there restrictions I need to follow?
  • Do I need to stay home from work or school? How long should I stay home?
  • When can I return to strenuous activities and contact sports?
  • Are there any medications I need to avoid with mononucleosis?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did you develop symptoms?
  • Have you been exposed to anyone with mononucleosis?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Aug. 03, 2017
References
  1. AskMayoExpert. Epstein-Barr virus infection. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  2. Sullivan JL. Clinical manifestations and treatment of Epstein-Barr virus infection. http://www.uptodate.com/home. Accessed Oct. 26, 2015.
  3. Aronson MD, et al. Infectious mononucleosis in adults and adolescents. http://www.uptodate.com/home. Accessed Oct. 26, 2015.
  4. Epstein-Barr virus and infectious mononucleosis. Centers for Disease Control and Prevention. http://www.cdc.gov/epstein-barr/index.html. Accessed Oct. 26, 2015.
  5. Infectious mononucleosis. Merck Manual Professional Version. http://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis. Accessed Oct. 26, 2015.
  6. Reye's syndrome information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm. Accessed Oct. 26, 2015.