By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

NOT KISSING OR SHARING EATING UTENSILS CAN STOP SPREAD OF MONO

Question: My daughter was diagnosed with mono. The doctor told her there was no treatment for it, and she shouldn’t kiss anyone. Can you tell me more about this? How did she get it, and why can’t she kiss anyone? Does she have the “kissing disease” that teenagers get? What can she do since there is no treatment?

Answer: Mononucleosis -- also called infectious mononucleosis or simply "mono" -- is a very common infection caused by the Epstein-Barr virus (EBV). Sixty percent of U.S. children and ninety percent of adults over 40 years old have antibodies to this virus in their blood. It is interesting, however, that this illness is often so mild that less than half of us can recall ever having a "mono-like" illness.

That leaves an unfortunate one third, like your daughter, who develop classic “mono” symptoms -- usually during their teenage years. Though the peak age for infection is between 15 and 17, mono is common throughout the young adult years.

After exposure to the infection, symptoms can develop in 14 to 50 days. This often makes it hard to find the source of the infection. The symptoms of mono can come on gradually or abruptly. Usually, there is a fever, a very sore throat, swollen glands and fatigue. The person may also have very bad breath. In some cases the spleen and liver can become enlarged. It is not unusual for mono to coexist with strep throat -- or a “streptococcal infection of the throat,” if you want to get technical about it. In fact, it is usually the very sore throat that triggers the visit to the doctor.

Those with an acute infection have a high concentration of the Epstein-Barr virus in their saliva, and the disease is spread by exchange of this bodily fluid. In the teenage years and on college campuses, this exchange is most often accomplished by kissing. So, you are correct, mono is often referred to as the kissing disease. However, the infection can also be spread by drinking out of someone else’s glass, using another’s straw, or coming into contact with the airborne virus as a result of an infected person’s coughing and sneezing.

Remember that I mentioned earlier that a large number of people can have mono and never have symptoms? Well, guess what -- they can spread the infection, too.

The diagnosis of mono can be made with a simple blood test that many physicians perform in the office. Once this diagnosis is made, the treatment is primarily rest, fluids and management of the fever as well as over-the-counter medications for aches and pains. If a strep throat is present, that is treated with antibiotics. Strenuous exercise and contact sports should be avoided for the first few weeks. These activities can be resumed once the fever is gone, any spleen enlargement has subsided and the patient has no more symptoms.

While there can be serious complications from mono, they are not very frequent. Most people can resume full activity in three to six months with no problems.

But while your daughter is ill, be sure that no one drinks or eats using the same cups, bowls, glasses, place setting or utensils. Even when free of symptoms, she still may be able to spread the virus for several weeks. That’s why I’d recommend that you keep up this routine for the next month or so. Also, it’s always a good idea to use paper cups in the bathroom.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.