Infectious Mononucleosis Quiz
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Fatigued
Sore throat
Have a fever
Joint pain that is always there
The chills
Have a headache
Swelling in the area under my right ribs
Not seeing your symptoms? No worries!
What is Infectious Mononucleosis?
A viral infection transmitted through saliva.
Typical Symptoms of Infectious Mononucleosis
- Fever
- Swollen lymph nodes or lumps in the neck, armpits, groin, or behind the ears
- Headache
- Sore throat with pain when swallowing
- Feels a hard lump in upper right abdomen
- Swelling around the front and sides of the neck
- Difficulty swallowing
- Chills or feeling cold
Diagnostic Questions for Infectious Mononucleosis
Your doctor may ask these questions to check for this disease:
- Do you have a fever?
- Do you have any swollen lymph nodes or lumps in your neck, armpits, groin, or behind your ears?
- Do you have a headache?
- Do you have a sore throat with pain when swallowing?
- Do you feel a hard lump in your upper right abdomen?
Treatment of Infectious Mononucleosis
This condition resolves on its own, but it may take several months for fatigue to fully disappear. Treatment mainly involves maintaining a healthy lifestyle with enough rest and a nutritious diet. Painkillers may help with the sore throat and ulcers.
Reviewed By:
Scott Nass, MD, MPA, FAAFP, AAHIVS (Primary Care)
Dr. Nass received dual medical degrees from the David Geffen School of Medicine at UCLA and Charles R. Drew University in Medicine and Science. He completed Family Medicine residency at Ventura County Medical Center with subsequent fellowships at Ventura, University of North Carolina-Chapel Hill, George Washington University, and University of California-Irvine. He holds faculty appointments at Keck School of Medicine of USC, Loma Linda University School of Medicine, and Western University of Health Sciences.
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Dec 5, 2025
Following the Medical Content Editorial Policy
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Infectious Mononucleosis?
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- Lymph swollen
- My body is hot
- Recurrent fevers
- Pain when swallowing
- Swollen lymph nodes above collar bone
- Periodic fever (>100.4°F / 38°C)
- Swelling under ribs right side
- Fever then no fever then fever again
- Pulsating headache
- Swollen armpit
- Remittent fever of 102.2°F / 39°C
- Extremely high fever of 106.7°F / 41.5°C or higher
- Hard to eat
- Swollen lymph nodes continue to grow larger
- Fever of 100.4°F / 38°C or more for weeks
See full list
Symptoms Related to Infectious Mononucleosis
Diseases Related to Infectious Mononucleosis
FAQs
Q.
What Is Mono? Why Your Body Is Shutting Down and Your Medically Approved Next Steps
A.
Mono is infectious mononucleosis, usually caused by Epstein Barr virus, that can make you feel like your body is shutting down because your immune system is in overdrive, leading to profound fatigue, sore throat, swollen glands, and sometimes an enlarged spleen. Medically approved next steps are rest, hydration, over the counter pain relievers as directed, avoiding contact sports until a clinician clears you, and seeking urgent care for severe left upper abdominal pain, trouble breathing or swallowing, persistent high fever, jaundice, or prolonged symptoms; antibiotics do not help, and there are several factors to consider, so see the complete guidance below.
References:
* Asif A, Al-Othman M, Al-Otaibi T, Al-Otaibi L, Al-Yousef A. Infectious Mononucleosis: A Comprehensive Review of Pathophysiology, Clinical Manifestations, Diagnosis, and Management. Cureus. 2023 Dec 13;15(12):e49998. doi: 10.7759/cureus.49998. PMID: 38213600; PMCID: PMC10787752.
* Cohen JI. Epstein-Barr Virus Infection. N Engl J Med. 2024 Jan 18;390(3):263-271. doi: 10.1056/NEJMcp2311027. PMID: 38231575.
* Dunmire SK, Hogquist KA, Balfour HH Jr. Infectious Mononucleosis. Curr Top Microbiol Immunol. 2015;390(Pt 1):211-40. doi: 10.1007/978-3-319-22822-8_9. PMID: 26463240.
* Wysocki M, Styczyński J, Witt M. Clinical aspects of infectious mononucleosis in children and adolescents. Postepy Hig Med Dosw (Online). 2017 Jan 2;71(0):149-158. doi: 10.5604/01.3001.0010.5641. PMID: 28169956.
* Luzuriaga K, Sullivan JL. Infectious Mononucleosis. N Engl J Med. 2010 Sep 23;363(14):1395. doi: 10.1056/NEJMcp1001116. PMID: 20860520.
Q.
Still Exhausted? Why Your Body Is Fighting Mono & Medically Approved Next Steps
A.
Lingering exhaustion after mononucleosis is common and usually reflects ongoing immune recovery while EBV remains dormant, sometimes with an enlarged spleen, deconditioning, and sleep disruption; most people improve within 4 to 8 weeks, though some need 3 to 6 months. Medically approved next steps are rest, gradual return to activity with sports restrictions, good hydration and nutrition, and watching for red flags like severe abdominal pain, breathing trouble, persistent high fever, or jaundice, and seeing a clinician if you are not improving by 4 to 6 weeks. There are several factors to consider; see the complete guidance below for key details that may affect your personal next steps.
References:
* Munk-Jørgensen L, Laursen JE, Hansen HS. Post-mononucleosis fatigue syndrome: an overview. Rev Med Virol. 2018 Sep;28(5):e2009.
* Kimura H, Cohen JI. Chronic active Epstein-Barr virus infection: A distinct entity requiring a different treatment strategy. Blood. 2017 Aug 10;130(6):745-752.
* Davis HE, McCorkell L, Vogel JM, et al. The Complex Pathogenesis of Post-Acute Infectious Syndromes: A Focus on Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Cell. 2023 Jul 6;186(14):2902-2920.
* Kalla M, O'Grady J, Dolman C, et al. Management of Epstein-Barr Virus Infection and Associated Disorders. Viruses. 2021 Aug 30;13(9):1720.
* Niller HH, Wolf H, Minarovits J. Epstein-Barr Virus Infection in Human Disease: A Clinical and Immunological Perspective. Viruses. 2020 Apr 16;12(4):E450.
Q.
Doxycycline Not Working? Why Symptoms Persist + Medically Approved Next Steps
A.
If doxycycline is not working, there are several factors to consider. Common causes include a viral rather than bacterial illness, antibiotic resistance, an incorrect diagnosis or dose and duration, poor absorption from dairy or antacids, complicated infections, or medication side effects. Medically approved next steps include finishing the course unless told otherwise, contacting your doctor if you are not improving within 72 hours to a week for reassessment and testing, and knowing when urgent symptoms need care; see below for timing details, absorption tips, and special cases like acne, Lyme, and STIs that can change what you should do next.
References:
* Golden, M. R., Workowski, K. A., & Bolan, G. (2020). Treatment Failure in Patients with Chlamydia trachomatis Urogenital Infections and Potential Causes: A Review. *Infectious Diseases in Clinical Practice*, *28*(4), e195-e202.
* Workowski, K. A., Golden, M. R., & Bolan, G. A. (2020). Antimicrobial Resistance and Treatment Failure in Mycoplasma genitalium Infections: A Systematic Review. *Infectious Diseases in Clinical Practice*, *28*(4), e188-e194.
* Dattwyler, R. J., & Forrester, J. D. (2021). Persistent symptoms after Borrelia burgdorferi infection: A systematic review of treatment approaches. *Vector-Borne and Zoonotic Diseases*, *21*(9), 619-630.
* Liu, Z., Li, S., Wang, H., & Fan, X. (2023). Mechanisms of bacterial persister formation and eradication strategies. *Frontiers in Microbiology*, *14*, 1118671.
* Aucott, J. N., & Dumler, J. S. (2019). Post-treatment Lyme disease syndrome (PTLDS): a critical appraisal of its conceptualization, diagnosis, and management. *Clinical Infectious Diseases*, *69*(Supplement_1), S48-S56.
Q.
Still Exhausted? Why Mono Lingers & Medically Approved Recovery Steps
A.
Lingering exhaustion after mono is common because your immune system is still recalibrating, EBV remains dormant, and sleep and spleen recovery take time, with energy often improving over 1 to 3 months. Medically approved recovery steps include rest with gradual activity, protecting your spleen, staying hydrated, eating well, using acetaminophen or ibuprofen as directed, optimizing sleep, and avoiding alcohol, plus knowing red flags and when to see a doctor. There are several factors to consider. See below for timelines, warning symptoms, and step by step guidance that could change your next steps.
References:
* Mechanisms of Epstein-Barr Virus-Associated Fatigue. Viruses. 2021 Oct 21;13(10):2111. doi: 10.3390/v13102111. PMID: 34696417.
* Epstein-Barr Virus and Chronic Fatigue Syndrome. Pathogens. 2020 Jun 30;9(7):533. doi: 10.3390/pathogens9070533. PMID: 32629738.
* Management of Infectious Mononucleosis: A Review. Clin Ther. 2019 Nov;41(11):2293-2303. doi: 10.1016/j.clinthera.2019.09.006. PMID: 31636043.
* Post-infectious fatigue syndrome following glandular fever. J Infect Dis. 2014 Dec 1;210(11):1858-65. doi: 10.1093/infdis/jiu315. PMID: 24891469.
* Fatigue, immune activation and EBV reactivation in patients with infectious mononucleosis. J Transl Med. 2017 Jul 10;15(1):145. doi: 10.1186/s12967-017-1249-2. PMID: 28693444.
Q.
Exhausted? Why Your Mono Symptoms Persist and Medically Approved Next Steps
A.
Lingering mono symptoms, especially fatigue, are common and usually come from immune recovery and post-viral fatigue, with gradual improvement over weeks to months; pushing activity too soon or having an enlarged spleen can prolong recovery, and rare issues like anemia, hepatitis, thyroid problems, or chronic active EBV should be considered if symptoms worsen. There are several factors to consider. See below for medically approved next steps on follow-up testing, safe activity pacing and spleen precautions, sleep and nutrition, and the red flags that need urgent care such as severe left upper abdominal or shoulder pain, breathing trouble, jaundice, or fatigue persisting beyond 3 to 6 months.
References:
* Nacul, L., Auth, R., & Nacul, R. (2020). Postinfectious Fatigue Syndrome: The Past, the Present, and the Future. *Healthcare (Basel)*, *8*(3), 282.
* Vernon, S. D., & Nacul, L. (2020). Epstein-Barr Virus and Chronic Fatigue Syndrome: An Updated Review. *Viruses*, *12*(7), 754.
* Lo, S. C., & Xiao, Y. (2021). The Role of Epstein-Barr Virus in the Pathogenesis of Chronic Fatigue Syndrome. *Viruses*, *13*(6), 1109.
* Cortes, E., O'Rourke, D., & Montoya, J. G. (2020). Treatments for myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review and meta-analysis. *Journal of Neurology, Neurosurgery & Psychiatry*, *91*(3), 253-264.
* Sapey, E., & Nacul, L. (2021). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Diagnostic and Therapeutic Strategies. *Current Treatment Options in Infectious Diseases*, *13*(2), 126-140.
Q.
Bone-Deep Fatigue? Why Your System Is Crashing From Mono & Medical Next Steps
A.
Mono from the Epstein Barr virus can crash your system with bone-deep fatigue, sore throat, swollen glands, and brain fog as immune overdrive plus spleen and liver inflammation sap energy; acute illness often lasts 1 to 3 weeks, and fatigue can persist longer. Next steps include confirming the diagnosis with a clinician, strict rest and hydration, avoiding alcohol and contact sports, and urgent care for red flags like sharp left upper belly pain, trouble breathing, high persistent fever, or yellowing eyes. There are several factors to consider. See the complete details below.
References:
* Clark, C., et al. (2021). Post-infectious fatigue syndrome following infectious mononucleosis. *Nature Reviews Neurology*, 17(8), 522-536.
* Lo, A., et al. (2022). Epstein-Barr virus and chronic fatigue syndrome. *Frontiers in Immunology*, 13, 858514.
* Katz, B. Z., et al. (2018). Persistence of fatigue, malaise, and poor sleep in infectious mononucleosis. *Pediatrics*, 141(2), e20172605.
* Chu, A. E., et al. (2018). Long-term follow-up of adolescents with infectious mononucleosis. *Clinical Infectious Diseases*, 66(11), 1686-1692.
* Sullivan, R., et al. (2020). Persistent symptoms after infectious mononucleosis in adolescents. *Journal of Adolescent Health*, 66(4), 415-420.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician. 2015 Mar 15;91(6):372-6. PMID: 25822555.
https://www.aafp.org/pubs/afp/issues/2015/0315/p372.htmlEbell MH. Epstein-Barr virus infectious mononucleosis. Am Fam Physician. 2004 Oct 1;70(7):1279-87. PMID: 15508538.
https://www.aafp.org/pubs/afp/issues/2004/1001/p1279.htmlCeraulo AS, Bytomski JR. Infectious Mononucleosis Management in Athletes. Clin Sports Med. 2019 Oct;38(4):555-561. doi: 10.1016/j.csm.2019.06.002. Epub 2019 Jul 29. PMID: 31472766.
https://www.sportsmed.theclinics.com/article/S0278-5919(19)30044-4/fulltextNaughton P, Healy M, Enright F, Lucey B. Infectious Mononucleosis: diagnosis and clinical interpretation. Br J Biomed Sci. 2021 Jul;78(3):107-116. doi: 10.1080/09674845.2021.1903683. Epub 2021 Apr 14. PMID: 33721513.
https://www.tandfonline.com/doi/full/10.1080/09674845.2021.1903683Greydanus DE, Merrick J. Infectious mononucleosis: be aware of its lethality! Int J Adolesc Med Health. 2019 Jan 12;31(1). doi: 10.1515/ijamh-2018-0284. PMID: 30645196.
https://www.degruyter.com/document/doi/10.1515/ijamh-2018-0284/html