Can EBV Come Back?

Medically Reviewed by Carol DerSarkissian, MD on May 26, 2023
4 min read

The Epstein-Barr virus (EBV) is a type of herpes virus that causes infections in those affected. EBV infections can cause a sore throat, headache, and swollen lymph nodes, among other symptoms.

Once you’re infected with EBV, you will always carry it in your body. EBV infections often remain dormant in your body but can come back or reactivate in the future. Read on to learn more about how to recognize when you have EBV and what you can do about it.

EBV can cause infectious mononucleosis, which is also known as the “kissing disease” or “mono.” 

In general, EBV is spread through the exchange of bodily fluids such as saliva. Although EBV can infect people of all ages, from kids to adults, it is most common in teens and young adults, who often spread the virus through kissing and sexual contact.

Additionally, you can get infected by the virus if you share personal items, such as eating utensils, plates, and toothbrushes with someone infected with EBV. You can also get the virus through organ transplants since it can be spread through contact with blood.

Once you have EBV, you can spread it to others, even if you don’t have recognizable symptoms. EBV never truly goes away. Even if the symptoms subside, the virus will remain inactive inside your body until it is reactivated by a trigger. Some triggers include stress, a weakened immune system, taking immunosuppressants, or hormonal changes such as menopause.

When EBV reactivates within your body, you will probably not have any symptoms. However, if you have a weak immune system due to cancer, chronic fatigue syndrome, or other conditions, you may experience the same symptoms that you had when you first contracted the virus.

It's not always clear when you have EBV since many people with the virus don’t experience obvious symptoms. Children are less likely than teens and adults to have recognizable symptoms.

Symptoms last around two to four weeks and may include:

  • Swollen tonsils
  • Extreme fatigue
  • Rash
  • Sore throat
  • Headache
  • Enlarged spleen (splenomegaly)
  • Swollen liver
  • Swollen lymph nodes

In rare cases, EBV infections can last for more than six months. If you are constantly fatigued and experience some of the other symptoms above, you may have been infected with EBV or have an older EBV infection reactivate.

There are a variety of blood tests that are used to detect an EBV infection.

Monospot test. This test detects antibodies that are caused by an EBV infection. However, the Centers for Disease Control and Prevention says it isn't very accurate, since it may also detect antibodies caused by other conditions.

EBV nuclear antigen (EBNA). This tests for antibodies to EBNA. These antibodies will be seen if you've been infected by EBV for more than two to four months. You will continue to show signs of EBNA for the rest of your life after you’ve been infected.

Early antigen (EA). This tests for antibodies to EA, which appear in the first three to six months after you get infected by EBV. However, this test isn’t always conclusive, since 20% of healthy people already have antibodies to EA.

Viral capsid antigen (VCA). This tests for antibodies to VCA, which appears in the first few weeks of infection. One antibody to VCA will disappear after a few weeks, but another will remain in your body for the rest of your life.

If you have an EBV infection, your blood work may show:

  • Suggestions of mild liver damage
  • More unusual white blood cells than is typical
  • More white blood cells than is typical

EBV infections can’t be treated with medicine or a vaccine. Because these are viral infections, they can’t be treated with antibiotics either.

You can prevent EBV by not kissing or sharing drinks, personal items, and food with people who might have infectious mononucleosis.

Since EBV infections are generally not life-threatening, most doctors recommend taking care of your symptoms by:

  • Going to bed early and sleeping for longer periods
  • Taking more frequent breaks
  • Avoiding physical exertion
  • Taking medication for your sore throat and fever
  • Drinking plenty of water

Although EBV is generally easy to manage, in rare cases, it can lead to complications such as:

Although current research is inconclusive, EBV has also been linked to certain autoimmune disorders, such as:

  • Lupus
  • Type 1 diabetes
  • Inflammatory bowel disease
  • Celiac disease
  • Thyroid conditions, such as Hashimoto’s thyroiditis

Furthermore, EBV can increase the risk of developing certain cancers such as:

  • Stomach cancer
  • Burkitt’s lymphoma
  • Nasopharyngeal cancers

However, this is a rare occurrence. Most people with EBV will not have these cancers, and it's still uncertain whether people with EBV develop cancer due to another underlying health condition.

Additionally, certain conditions, such as schizophrenia, may change how EBV affects you. A study found that people with schizophrenia had more antibodies to some EBV proteins than those who did not have the condition. This suggests that people with schizophrenia have a different immune response to EBV.

If you believe you may have an EBV infection and are experiencing symptoms that don’t go away after a few weeks, you should book an appointment with your doctor. They will provide a proper diagnosis and guide you through the recovery process.