Epstein-Barr Virus

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is the Epstein-Barr virus?

The Epstein-Barr virus, also called EBV, is an extremely common virus that infects most people at one time or another during their lifetimes. Epstein-Barr virus infection generally causes a minor cold-like or flu-like illness, but, in some cases, there may be no symptoms of infection.

In adolescents and young adults, the Epstein-Barr virus can cause mononucleosis, which is a more serious illness. Epstein-Barr virus infection has also been linked to the development of certain rare cancers including Burkitt's lymphoma and nasopharyngeal carcinoma.

Epstein-Barr virus is very contagious and spreads from person to person through intimate contact with the saliva of a person who has the Epstein-Barr virus. As many as 95% of all adults have had an Epstein-Barr virus infection at some point in their lives, according to the Centers for Disease Control and Prevention.

Treatment of most viral diseases begins with preventing the spread of the disease with basic hygiene measures. However, controlling the spread of the Epstein-Barr virus is extremely difficult because it is so common and because it is possible to spread the Epstein-Barr virus even when a person does not appear sick. Many healthy people who have had an Epstein-Barr virus infection continue to carry the virus in their saliva, which means they can spread it to others throughout their lifetimes. However, avoiding contact with another person's saliva by not sharing drinking glasses or toothbrushes is still a good general disease prevention measure.

There is currently no specific cure for an Epstein-Barr virus infection. Treatment includes measures to help relieve symptoms and keep the body as strong as possible until the disease runs its course. This includes rest, medications to ease body aches and fever, and drinking plenty of fluids. People who are in good health can generally recover from an Epstein-Barr virus infection at home with supportive care, such as rest, fluids and pain relievers.

Corticosteroids may be prescribed in some cases of mononucleosis. Antibiotics are ineffective against the Epstein-Barr virus, but may be prescribed if a secondary bacterial infection develops, such as bacterial tonsillitis.

Serious or life-threatening complications, such as encephalitis, ruptured spleen, or hepatitis, may develop in some cases of Epstein-Barr virus infection or mononucleosis, which is often caused by the Epstein-Barr virus.  

Seek prompt medical care if you, or your child, have symptoms of mononucleosis, such as extreme fatigue, swollen lymph nodes, or a cold- or flu-like illness that is not getting better. Seek immediate medical care (call 911) if you, or someone you are with, have life-threatening symptoms, such as shortness of breath, seizure, confusion or delirium, or a change in alertness or consciousness.

What are the symptoms of an Epstein-Barr virus infection?

Symptoms of an Epstein-Barr virus infection vary greatly among individuals. Toddlers and adults may experience no symptoms at all, but are still capable of spreading the infection.

General symptoms of an Epstein-Barr virus infection

Symptoms of an Epstein-Barr virus infection are often mild, vague, and similar to symptoms of a cold or the flu. Symptoms include:

Symptoms of mononucleosis caused by the Epstein-Barr virus

In adolescents and young adults who develop mononucleosis, which is often caused by the Epstein-Barr virus, symptoms generally begin about four to six weeks after exposure to the virus. Early symptoms are similar to symptoms of a cold or the flu. As mononucleosis progresses, symptoms become more severe and can include:

  • Enlarged spleen

  • Extreme fatigue

  • Painful swollen glands (lymph nodes) in the neck, armpits or groin

  • Rash

Serious symptoms that might indicate a life-threatening condition

In rare cases, an Epstein-Barr virus infection or mononucleosis can result in serious or life-threatening complications, such as meningitis, hepatitis or ruptured spleen. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:

  • Change in alertness or level of consciousness or passing out

  • Dizziness

  • High fever (higher than 101 degrees Fahrenheit)

  • Left upper abdominal pain (possible rupture of spleen)

  • Lethargy or unresponsiveness

  • Rash of small reddish purple spots

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

  • Seizure

  • Stiff neck

  • Yellowing of the skin and whites of the eyes (jaundice)

What causes an Epstein-Barr virus infection?

Epstein-Barr virus is a member of the herpesvirus family of viruses. The Epstein-Barr virus is contagious and spreads from person to person through intimate contact in which saliva is exchanged. This is why mononucleosis, which is often caused by the Epstein-Barr virus, is commonly referred to as “the kissing disease.”

The Epstein-Barr virus can spread from person to person by such activities as:

  • Kissing

  • Sharing unwashed water bottles, drinking glasses, eating utensils and dishes, and personal items used in and around the mouth, such as toothbrushes and lip balm

  • Spitting in the face near or in the mouth, or on the lips

What are the risk factors for catching the Epstein-Barr virus?

The Epstein-Barr virus can occur in any age group or population. Almost everybody will develop an Epstein-Barr virus infection at some point during their lives, but a number of factors increase the risk of catching the disease.

Risk factors include any activity that exposes you to the saliva of a person who carries the Epstein-Barr virus. Carriers of the Epstein-Barr virus may not appear ill but can still spread the disease. Risk factors include:

  • Kissing

  • Sharing unwashed water bottles, drinking glasses, eating utensils and dishes, and personal items used in and around the mouth, such as toothbrushes and lip balm

  • Spitting in the face near or in the mouth, or on the lips

Reducing your risk of catching an Epstein-Barr virus infection

The Epstein-Barr virus is an extremely common virus that infects most people at one time or another during their lifetimes. In addition, many people who have had an Epstein-Barr virus infection may carry the virus in their saliva after they are no longer sick, which means they can continue to spread the infection.

Because of this, there is little that can be done to prevent its spread. However, avoiding contact with another person's saliva by not sharing unwashed water bottles or drinking or eating utensils and toothbrushes is still a good disease prevention measure. Washing hands frequently throughout the day with soap and warm water for at least 15 seconds is a good habit that can help prevent the spread of infectious diseases in general.

How is an Epstein-Barr virus infection treated?

There is currently no cure for an Epstein-Barr virus infection. Treatment includes measures aimed at relieving symptoms so that you are comfortable enough to get the rest you need to keep up your strength and recover without developing complications. Treatment of an Epstein-Barr virus infection includes:

  • Acetaminophen (Tylenol) or ibuprofen (Advil or Motrin), which reduce fever and minimize other symptoms of infection, such as headache, sore throat and body aches

  • Corticosteroid drugs, which reduce the swelling of the tonsils and throat that can occur in mononucleosis

  • Drinking extra fluids

  • Getting extra rest and sleep

Antibiotics are not prescribed for Epstein-Barr virus infections because they are ineffective against viruses. However, antibiotics may be prescribed if a person develops a secondary bacterial infection as a complication of an Epstein-Barr virus infection, such as bacterial tonsillitis. Antiviral drugs that are currently available also have no effect in treating Epstein-Barr virus.

Children and teenagers with an Epstein-Barr virus infection or other viral infection should not use aspirin or products that contain aspirin because of the risk of developing a rare but life-threatening condition called Reye syndrome. Reye syndrome most commonly affects children and teenagers and has been linked to taking aspirin during a viral illness, such as an Epstein-Barr virus infection, the common cold, or the flu.

Complementary and traditional treatments

Complementary and traditional treatments will not cure an Epstein-Barr virus infection but may help to increase comfort, promote rest, and maintain strength during an Epstein-Barr virus infection. Treatments include:

  • Chicken soup, which can help break up nasal congestion and provides easy-to-digest nutrients and extra fluids to help keep up your strength

  • Supplements or products that contain vitamin C, echinacea or zinc

What are the possible complications of an Epstein-Barr virus infection?

Rarely, Epstein-Barr virus infection or mononucleosis caused by the Epstein-Barr virus can cause serious, even life-threatening complications. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of an Epstein-Barr virus infection or mononucleosis include:

  • Anemia

  • Behavioral abnormalities

  • Blockage of airways by the swollen lymph nodes

  • Certain cancers, such as Burkitt's lymphoma and nasopharyngeal carcinoma

  • Fatigue that lasts for weeks or months

  • Hepatitis

  • Meningitis (inflammation of the tissues covering the brain) and encephalitis (inflammation of the brain)

  • Nerve damage

  • Ruptured spleen

  • Secondary bacterial infection such as bacterial tonsillitis

  • Seizure

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 16
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Epstein-Barr Virus and Infectious Mononucleosis. Centers for Disease Control and Prevention. http://www.cdc.gov/epstein-barr/index.html
  2. Mononucleosis. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000591.htm