Epstein-Barr Virus (EBV) Infection: Symptoms, Diagnosis, and Treatment

Medically Reviewed by Jabeen Begum, MD on December 01, 2023
7 min read

The Epstein-Barr virus (EBV) is very common and very contagious. You spread it through your saliva and other body fluids, and it can cause mononucleosis (aka mono), as well as other illnesses. 

Epstein-Barr is a type of herpesvirus known as herpesvirus 4. Once you're infected with EBV, the virus stays in your body forever. It can stay inactive or it can reactivate and you can have symptoms again.

You may have been infected without even knowing it because some people have the virus and don't get sick.

Once you're infected with EBV, symptoms can take 4 to 6 weeks to show up, but you can still pass it to others during that time. When symptoms appear, they're often mild, especially in young children, though they may not show signs of infection at all. Most symptoms tend to be  like those of a cold or the flu. Teens often have more obvious symptoms of mono, including extreme fatigue.

Symptoms of Epstein-Barr virus usually include:

  • Fatigue
  • Fever
  • Lack of appetite
  • Rash
  • Sore throat
  • Swollen glands in the neck
  • Weak and sore muscles
  • Enlarged spleen and liver

Although you should start feeling better in 2-4 weeks, you could feel tired for a couple of months.

The virus is very contagious and spreads through your saliva, so you can catch it from kissing someone who’s infected. EBV also spreads easily from person to person through: 

  • Coughing or sneezing
  • Sharing drinks or food
  • Sexual contact
  • Sharing toothbrushes, drinking glasses, or utensils
  • Touching toys or pacifiers kids put in their mouths 

Infection with Epstein-Barr virus happens in three phases:

  1. Infection. The virus copies itself in your body, and you may or may not have symptoms.
  2. Latency. EBV basically goes to sleep in your body.
  3. Reactivation. The virus can sometimes "wake up" and cause symptoms again. 

It's hard to tell whether you're infected with EBV just by your symptoms. Fever, fatigue, and sore throat could also be signs of other illnesses, like the flu or a cold.

See your doctor for an exam to find out what's making you sick. They might find signs that you have mono, such as an enlarged spleen, an organ in your belly that filters blood. Your doctor will also check to see if you have a swollen liver and white patches on your tonsils.

EBV tests

Your doctor may need to run some blood tests to look for antibodies, substances your immune system makes against the virus. The tests can show if you currently have EBV, or if you had an infection in the past. Other tests look for white blood cells your body uses to fight off the EBV infection.

There is also a test called monospot you can buy online. Monospot is a blood test that can tell you in 5-10 minutes whether you’re positive or negative for EBV. 

The CDC doesn’t recommend you use this Epstein-Barr test at home because it’s not very accurate, especially compared to those your doctor can run. Your body makes the same antibodies monospot detects against many infections, not just EBV. The test can have false-positive and false-negative results, which means that it could find EBV when you don’t have the virus or miss EBV when you do have it.

As with other viruses, Epstein-Barr can't be treated with antibiotics. 

Right now, there’s no specific treatment for EBV, but researchers are looking at some medicines that may work against the virus. Dipyridamole is a drug that may help prevent EBV from reactivating in your body. It’s already approved to prevent blood clots in people who've had heart valve replacements. Researchers are now studying dipyridamole for EBV in clinical trials.

Symptoms of EBV should clear up on their own in a few weeks with rest, fluids, and over-the-counter medications

There are many Epstein-Barr virus long-term effects. The virus can affect many parts of your body, including the nervous system, blood, and lungs. EBV may cause complications like:

  • Heart muscle swelling called myocarditis
  • Increased risk for cancers like Burkitt’s lymphoma, Hodgkin’s and non-Hodgkin’s lymphoma, and cancer of the upper throat (nasopharyngeal cancer)
  • Lung diseases like pneumonia
  • Problems with the brain and spinal cord, such as meningitis, encephalitis, and Guillain-Barré syndrome
  • Rupture of the spleen
  • Sinus infection (bacterial sinusitis)
  • Swelling of the pancreas (pancreatitis)
  • Swelling of the tonsils
  • Weakening of the immune system that makes it harder to fight off infections

EBV symptoms usually go away within 2 weeks to a month after you're infected. Then the virus goes dormant. But rarely, EBV symptoms don’t clear up. The virus stays active. A small number of people have symptoms like a fever, swollen glands, and an enlarged liver or spleen that come and go or get worse over time. 

If you have symptoms and positive blood tests for at least 3 months, you may have a chronic active EBV infection. Your doctor will recommend treatments to manage your symptoms and help you feel better.

EBV reactivation symptoms

The virus can wake up after it has been dormant in your body and cause symptoms again. This is more likely to happen if you have a weak immune system

Symptoms of EBV reactivation include:

  • Fever
  • Sore throat
  • Swollen glands in the neck
  • Swollen liver or spleen
  • Tiredness

See your doctor if you or your child has any of these symptoms a few months after an EBV infection.

Although no medicine can cure an EBV infection, you can take these steps at home to ease your symptoms:

  • Get plenty of rest.
  • Drink a lot of water and other liquids to stay hydrated.
  • Suck on lozenges or ice pops, or gargle with warm salt water, to make your sore throat feel better.
  • Take over-the-counter medications like acetaminophen or ibuprofen if you have a fever or body aches. (Don't give aspirin to children under 19 years of age because of the risk of a rare but serious condition called Reye’s syndrome.)

Ease back into work or school, and take things slowly until you feel better. For a month or so, avoid sports, heavy lifting, or other vigorous activities that could injure your spleen.

Is there an EBV diet?

No diet is proven to treat EBV. It’s always a good idea to eat nutritious meals full of antioxidant-rich foods like leafy green vegetables and berries to strengthen your immune system. Drink lots of fluids to keep you hydrated.

Caffeine and Epstein-Barr

You may want to avoid caffeinated drinks while you have an EBV infection. One reason is that non-caffeinated drinks like water hydrate you better. Also, drinking a lot of coffee has been linked to a higher risk of stomach cancer from EBV. The risk is very small overall – only 8% to 10% of stomach cancers test positive for EBV. Still, it may be a good idea to cut back on caffeine if you drink a lot of it.

No vaccine can protect you against the Epstein-Barr virus, but that might change in the future. The National Institutes of Health has launched a study of a possible vaccine to protect against EBV infection. They should have results by 2026.

Another vaccine that researchers are studying produced a strong immune response against EBV in mice. Whether it will work in humans still has to be proved.

Right now, the best way to avoid the virus is to stay away from anyone who you know is infected, and especially someone who has mono. Try these EBV prevention tips:

  • Avoid kissing an infected person.
  • Don’t share food or drinks with someone who has the virus.
  • Don't share personal items like glasses, silverware, and toothbrushes with someone who's infected. 
  • Use protection if you have sex with someone who has the virus.
  • Wash your hands after you touch anything that has contacted the saliva of an infected person.

There are some rare complications of EBV, so see your doctor if you or your child has any of these symptoms:

  • Sudden, sharp pain on the left side of the belly, which could mean a problem with your spleen
  • Very little urine, a sign of dehydration
  • Trouble breathing or swallowing – call 911 right away

Also call if your symptoms don't go away after 4-6 weeks. You could have another type of infection.

EBV is best known for causing mononucleosis, but less often it can lead to other diseases, including:

  • Ear infections and diarrhea in children
  • Guillain-Barre syndrome
  • Certain cancers, including Burkitt's lymphoma and cancers of the nose and throat
  • Post-transplant lymphoproliferative disease (PTLD), a rare complication of people who get organ and stem cell transplants

Epstein-Barr virus and MS

There may also be a link between EBV and the autoimmune disease multiple sclerosis (MS). Studies show that people who’ve had an EBV infection are at much higher risk of MS than those who’ve never been infected.

Overall, the risk is still small. About 95% of adults eventually get an EBV infection, but very few get MS. More research is needed to show whether the virus does lead to MS.

Epstein-Barr virus (EBV) is one of the most common human viruses. It spreads through bodily fluids like saliva and is very contagious. EBV is best known for causing mononucleosis. Symptoms are similar to the flu and include a sore throat, fever, and fatigue. Once you're infected with EBV, the virus stays in your body forever.

Does Epstein-Barr virus ever go away?

If you're having symptoms from an infection from EBV, you should get better within a few weeks. But once you're infected with the Epstein-Barr virus, it stays in your body forever. It can be triggered by something like stress, and you can have symptoms again.

How serious is Epstein-Barr virus?

Most of the time, it's not very serious. If you have symptoms, you won't feel good and shouldn't go to work or school because it's very contagious. In rare cases, it can cause some types of cancer and other diseases.