Glandular fever

Glandular fever is a contagious disease that’s most often caused by the Epstein-Barr virus. It mostly affects teenagers and young adults 15 to 24 years of age. Occasionally glandular fever can be caused by other viruses such as cytomegalovirus (CMV) or adenovirus.  

It’s also known as infectious mononucleosis (or ‘mono’) or the ‘kissing disease’ because it’s spread by close person-to-person contact such as kissing and sharing cups, drink bottles and toothbrushes. 

Most people get better within 2 to 4 weeks, but it can take months to fully recover. 

Usually, symptoms of glandular fever appear 4 to 6 weeks after you’re infected with the Epstein-Barr virus. They may develop slowly and may not all appear at the same time.

Symptoms can include: 

• Tiredness – you may have a feeling of intense tiredness (fatigue). This is often the last symptom to go away and can last for several months.
• Sore throat – this may be mild, but more commonly your throat is very sore, red and swollen. You may see white spots or a white layer at the back of your throat. Your healthcare provider will usually suspect glandular fever if you have a severe sore throat that’s lasted longer than usual. It may hurt to swallow so you may get a lot of saliva in your mouth.
• Flu-like symptoms – like other viral infections, glandular fever often causes a high temperature (fever), muscle and joint aches and headaches. It can make you feel quite unwell.
• Swollen glands around your neck – as your body's immune system fights off the virus, it causes your lymph glands to swell. The glands in your neck are usually the most prominent, but any lymph gland can swell so you may also feel pain in your armpits, elbows and groin.
• Eye symptoms – about 1 in 5 people with glandular fever become quite puffy and swollen around the eyes. This goes in a short time. Glandular fever can also cause conjunctivitis which can make the white of your eyes look red.
• Sore abdomen (tummy) and poor appetite – the spleen is part of your immune system and can swell like your lymph gland. It may cause pain under your ribs on the left side. You can also get liver inflammation which can cause pain on the right side under your ribs, or cause your skin to look yellow (jaundice).  
• Rash – a red rash commonly develops if you have glandular fever and take antibiotics such as amoxicillin for your sore throat – this doesn't mean you're allergic to the antibiotics. 

You may not get any symptoms and many people have had the virus that causes glandular fever at some time without knowing it. Most people get better in 2 to 4 weeks, you may feel tired for several more weeks. Occasionally, some symptoms of glandular fever, particularly the tiredness, can last for 6 months or more. 

Many people in the community carry the Epstein-Barr virus. It's spread mainly by close contact with saliva (spit) or nasal (nose) secretions of infected people. This can happen by touching hands, or sharing toys, eating utensils and drink bottles or by kissing. These viruses can also spread through blood and semen during sexual contact, blood transfusions and organ transplantations.

Only some people who are exposed to the virus get the symptoms of glandular fever. If you do get symptoms, you can be infectious for many weeks beforehand, and for many months after your symptoms go away.

Avoid close contact with anyone who has, or has recently had, glandular fever.  

Avoid spreading it

If you develop glandular fever, avoid kissing and sharing cutlery, cups or towels after your symptoms begin. You also need to practice good hand hygiene – take extra care with washing your hands regularly, particularly after coughing or sneezing. 

You don’t need to be isolated from others, because most people will already be immune to the Epstein-Barr virus.

If you have a sore throat and fever that has lasted for more than a few days, you should see your healthcare provider for advice. In many cases, they'll be able to make a diagnosis based on your history and examination. Sometimes blood tests are needed to help confirm the diagnosis.

It’s important to make an accurate diagnosis of the cause of glandular fever if you’re pregnant, as other less common causes (eg, cytomegalovirus and toxoplasmosis) can cause health problems for your unborn child.



Image credit: Canva

There’s no specific medical treatment for glandular fever. Because it's usually caused by a virus, antibiotics won't work. The symptoms usually go away by themselves but there are things you can do help relieve them – see the self-care section below. 

Managing glandular fever aims to reduce your symptoms until you recover. 

Things to do

• Use medicines for pain and fever, eg, paracetamol or ibuprofen. 
• Try gargling with warm salt water (mix half a teaspoon of salt to a cup of warm water).  
• Get plenty of rest.
• Drink lots of fluids, especially water. 
• Gradually increase your activity levels as you’re able to. 
• Return to school, university or work when you’re feeling well. 

You may need to reduce some of your normal activities for a while. Getting enough rest and sleep is important but complete bed rest isn’t recommended as it can make the symptoms of fatigue last longer. 

Things to avoid

• Avoid alcohol, as this could damage your liver, which is often affected by the infection.
• Avoid strenuous activities and exercise.
• Avoid contact sports or activities for 3 to 4 weeks – this is because if you have a swollen spleen, a sudden knock could cause it to rupture. 

Most people with glandular fever will have few, if any, long-term complications other than fatigue. However, there can be complications. These include:

• a low level of blood cells, such as anaemia or thrombocytopenia
• lung (pneumonia), heart (pericarditis) or kidney problems
• a neurological illness, such as Guillain-Barré syndrome or Bell's palsy
• a widespread red (not itchy) rash and other skin conditions
• inflammation of your liver (hepatitis) – this is more common in older people
• post-viral fatigue, where you feel low and tired
• a damaged spleen – this is rare and is usually a result of contact sport.

Most people get better in 2 to 4 weeks. However, glandular fever can cause tiredness and loss of energy for up to a few months.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after glandular fever isn't common. It's been reported in 7% of adolescents after 12 months and 4% after 24 months.