Mono: Facts vs. myths

It’s been quite a year for mono. We’ve all heard of it, of course and the conventional wisdom is that teenagers and young adults are most likely to get it and will be down and out for weeks if they are infected. I’ve got some facts and myths about mono to share that will shake up the image most people have of this common infection.

Fact: Mono is a viral illness and as a result there’s no specific treatment to cure it. The typical symptoms include fever for 3-8 days, sore throat with swelling and white exudate on the tonsils, swollen glands especially in the back of the neck, abdominal pain on the left side due to spleen enlargement, and fatigue.

Myth: Kids with mono need to stay out of school for weeks because they are contagious. Actually most people with mono are contagious for a few days before they get symptoms and are most contagious while they have fever. Once the fever is gone, the contagiousness has decreased and kids can return to school or work.

Fact: If put on amoxicillin for the tonsillitis, an extensive red rash is likely to develop. In the past when there were no tests available to diagnose mono, one of the ways we could make the diagnosis was to put a patient on medication for the tonsil swelling and if the classic “mono rash” developed, we knew what we were dealing with.

Myth: Mono is is primarily contracted through kissing. In reality, most children have mono long before they are old enough to date and kiss. For most children, mono is caught like other viral illness through more casual contact like toddlers playing together and mouthing toys and sharing them, or school-aged kids having sleep overs with other children who are carrying the virus and don’t realize it.

Myth: Teenagers and young adults are most likely to get mono. Actually, the majority of college freshman have blood titers indicating they have been exposed to and are immune to the Ebstein Barr Virus (EBV) that causes mono even though they can’t ever remember having had it.

Fact: The older you are when you get infected, the sicker you’re likely to be. As a result, teenagers and young adults who get infected are often super sick but often their friends (including the people they are dating) don’t get any symptoms despite close contact, reinforcing that most people are immune by that point.

Myth: If your girlfriend was diagnosed with mono last week and you have a sore throat now, you probably have mono too. In reality, the incubation period for mono (the time from exposure to symptoms) is 6-8 weeks. The virus brews in your system for almost 2 months before symptoms arise so unless both your child and the girlfriend were exposed to the same ill person 6-8 weeks ago they aren’t likely to get symptoms of illness at the same time.

Fact: Most people have mono and never know it. Yep, you read it right. Most people are immune and never even realize they’ve had an infection with the virus. The body can handle it and develop immunity with few or no symptoms, so don’t assume you aren’t immune just because you can’t remember a significant illness.

Myth: Kids with mono symptoms are sick for months. Actually most kids with mono are sick for no more than 2-4 weeks, with many actively symptomatic for less than a week and then fatigued for a couple of weeks afterward.

Fact: Mono causes fatigue.

Myth: Most fatigue is caused by mono. Most tired teenagers do not have active mono. If fatigue is the only symptom without fever, sore throat, or swollen glands preceding it the chances of mono as the cause of fatigue is very, very small.

Fact: Kids with active symptoms of mono shouldn’t participate in sports. Because the spleen can get enlarged as a result of symptomatic mono infection, restrictions from playing sports have to be in place until the spleen is normal in size again. Even minor abdominal trauma can cause an enlarged spleen to rupture.

Myth: Mono relapses. (Well, this one is sort of a myth.) Very very rarely mono can relapse or recur. The majority of the time you have it once and never again. If a person has a severe case though, any subsequent illnesses for the next several months can be longer lasting and more severe than they might otherwise have been. Subsequent illnesses can cause more fatigue than expected and sometimes parents report that their child has relapsed. This isn’t technically the case, but it is true that kids have a harder time getting over different illnesses in the months following mono infection.

Overall, when mono is symptomatic enough to bring someone to the office, the illness is going to be a bit rough and may last for weeks. But remember, most of us get exposed and become immune without any significant symptoms at all.