Do you have mono?

Do you have flu-like symptoms? Do you feel tired all the time? Do you feel just fine? If so, you might have mono! Who knows!

Let’s say you really want to know. Let’s say you want to know so you don’t rupture your spleen or spread it to all your family. Good news. There’s a test for you! Many tests!

  • The Monospot Test checks for antibodies that respond to the Epstein-Barr virus (EBV), which is the virus that causes mono. It’s a quick test. Just wait an hour to get an answer! But you do have to wait before taking the test. It only works reliably when you’ve already had symptoms for two to four weeks. And “Reliably” is a relative term, because the Monospot Test also doesn’t work that well even after two to four weeks.
  • For more accurate results, consider the EBV Antibody Test! This one looks for different antibodies, and you only need to have had symptoms for a week. It’s not very accurate, either.
  • Don’t fret! You can also get a White Blood Cell Count that won’t confirm anything but could “suggest a strong possibility.”
  • There’s also a Complete Blood Count, a more robust count that also indicates and suggests but neither confirms nor denies.

One caveat: mono tests have a high rate of false positives. Another caveat: mono tests have a high rate of false negatives. Another caveat: mono has a latency period of four to six weeks, so you might already have the virus but not the symptoms, which means you have to wait four to six weeks for symptoms to appear and another one to two weeks for the antibodies to emerge before the not-very-accurate tests can work. Or not work. And one more thing: the latency period might be eight weeks. The jury’s out.

You probably have mono. Ninety-five percent of the population has mono. Or has had mono? The terminology isn’t clear. Some people/doctors/medical reports/websites say mono is an EBV infection, and other people/doctors/medical reports/websites say mono is the sickness that EBV causes. Some people get mono and never know it, since mono only occurs twenty-five percent of the time when an adolescent or young adult is infected with EBV. But EBV causes noticeable symptoms in fifty percent of infected adolescents and adults, which either means twenty-five percent get symptoms without mono, or the jury’s still out there, too. Regardless, approximately ninety to ninety-five percent of adults are EBV-seropositive.

You’re probably EBV-seropositive, too, which means you probably have mono or maybe you didn’t have mono but have the virus, or maybe you’re the five to ten percent that doesn’t have the virus, but maybe you do have the virus and you’re just in the two-month latency period.

But you don’t have mono without the Epstein-Barr virus. We’re sure about that one.


Can you get mono?

If you’ve had mono or an EBV infection before (which might be the same thing or different things), you can’t get it again. Or you at least aren’t likely to get it again. The vast majority of adults are not susceptible to this infection because of prior exposure.

But did you get prior exposure? See the section above. Who knows!


Are you spreading mono?

Mono spreads through bodily fluids like saliva and blood and snot and semen and vaginal fluid. If you have mono, don’t kiss anyone. Or share food or drinks. Or sneeze on anyone.

Mono is most contagious in its four- or six- or eight-week latency phase when you don’t show symptoms and can’t get tested, so you’re probably spreading mono. But most people already have mono, so who cares. Or just don’t kiss anyone.


What does mono do?

Mono doesn’t kill you. Other than that, who knows! It feels like a cold or the flu or depression, or none of them, or all three, or like boredom or death. Let’s say you want to mentally prepare for the experience, though. Or let’s say you don’t want to pay $40 for another trip to the doctor just to get the same diagnosis you got last week. Let’s say you want to know what mono could do.

  • Fatigue
  • Severe fatigue
  • Swollen lymph glands
  • Sore throat
  • Low fever, moderate fever, high fever, or no fever
  • Muscle aches
  • Muscle weakness
  • Malaise
  • Headache
  • Swollen tonsils
  • Night sweats
  • Splenomegaly (enlarged spleen)
  • Hepatomegaly (enlarged liver)

Some people have all these symptoms. Some people have one or two. Some have none! Most cases of mono are mild and resolve easily with minimal treatment. Some cases of mono rupture your spleen.

That’s the part you should worry about. Splenomegaly occurs in as many as fifty percent of patients, which means you’ve got a coin-toss chance of your spleen swelling to double or triple its usual size and maybe exploding spontaneously. It’s unlikely your spleen will explode spontaneously, but it could if you bump into something or lift more than ten pounds. Your spleen is less likely to explode if you are female, and any explosion is rare, anyway, but it’s potentially life-threatening so pay attention to this part. The silver lining of the spleen thing, though, is that splenic rupture may be the first symptom of mono—no need to wait for an inaccurate test after weeks of feeling tired!

Mono might also be linked to cancer, but what isn’t? Ninety-five percent of adults have mono anyway, so it’s hard to pin cancer on the mono. Either way, just for peace of mind, mono/EBV might or might not “be associated with the development of B cell lymphomas, T cell lymphomas, Hodgkin lymphoma and nasopharyngeal carcinomas in certain patients.”

Fortunately, mononucleosis is rarely ever fatal. Did we say it’s not fatal earlier? We meant rarely.


What do you do with mono?

If you like waiting, this is the illness for you. Get lots of rest. Lie in bed. Don’t exert yourself. Exertion only makes it last longer.

You should stay hydrated and take over-the-counter pain medications like Tylenol. Whatever you do, don’t lift more than ten pounds. Or more than fifteen pounds. Just don’t lift anything heavy.

What about work? You can’t work. Unless you can (see the symptoms section above), but if you do work, don’t lift anything or bump into anything or do anything that might make your spleen break open. That means no contact sports, either. Emphatically no contact sports.

But let’s say you’re still thinking about work. Let’s say you’re waiting in bed like you’re supposed to and your spleen hasn’t exploded, and you feel tired but not cancerous, and you need to tell your boss what to do for scheduling. Can you work next week? Here’s some advice:

  • Take three days off work
  • You should take a week off work and go back on light duty
  • You shouldn’t work because you’ll just confuse people about whether you’re okay or not
  • You should plan to take a month off work


How long does mono last?

Mono is typically not serious and usually goes away on its own in one to two months. It’s really up to your body, since antibiotics, surgery, and bloodletting are all equally effective at treating it. Trust your immune system, and keep waiting and resting until your body clears things up. But let’s say you’re still thinking about work, or maybe you have travel plans, or maybe you don’t like lying in bed and want some light at the end of the tunnel.

  • Mono lasts four to six weeks
  • The signs and symptoms of mono typically last one to two months
  • Acute symptoms resolve in one to two weeks, but fatigue often persists for months
  • Symptoms last one to two weeks
  • Symptoms persist for two to four months
  • Symptoms usually begin to improve within one to two weeks

Anecdotal evidence ranges from a few days of symptoms to an entire summer to six months to a year to the rest of their lives thus far. But the usually agree that the more you push yourself, the longer it takes to get better—so if you know you have mono (see the first section), don’t try to go back to normal life like you would with another illness. Baby steps only take you backward. Light duty at work could make a two-month bout of mono last six months. Here’s a good rule of thumb: if you can feel your spleen, stay in bed. But if you feel tired, and if the not-accurate tests say you do or don’t have mono, you should maybe take it easy just in case, unless you don’t have mono and have something else, or unless you had mono and are actually over it, in which case you can get back to it. If you like beds and waiting, this is good news. Resting is safer. You’re just being responsible.


Are you still spreading mono?

Probably! How do you think ninety-five percent of adults got it? Mono is contagious for weeks after symptoms subside, or maybe it’s contagious for up to six months. Who knows! Some studies say you can spread it eighteen months after the fact, but if you don’t like change, here’s something to look forward to: “mono persists asymptomatically for life in nearly all adults.” So if you want to be responsible, you probably shouldn’t share drinks ever again, and don’t risk donating blood. And maybe invest in dental dams.

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