Table of ContentsView AllTable of ContentsWhat It IsSymptomsComplicationsTestingTransmissionPrevention
Table of ContentsView All
View All
Table of Contents
What It Is
Symptoms
Complications
Testing
Transmission
Prevention
EBV also increases the risk of certain cancers, and it seems to play a role in some autoimmune and other medical conditions.
This article discusses the Epstein-Bar virus and the diseases it causes. It also goes over potential symptoms, treatment, and diagnosis.
What Is the Epstein-Barr Virus?
EBV is in the herpes family of viruses. It is sometimes referred to as human herpesvirus 4. However, it doesn’t cause the same symptoms as a couple of otherviruses in this familythat can cause sores around the lips or genitals.
The virus often first attaches to and infects certain cells that line your mouth. From there it spreads mostly to certain cells of the immune system, particularly a type known as B cells.
The virus is named for Epstein and Barr, who discovered it in 1964.
Active Versus Inactive Infections
Infection with EBV includes an active phase and an inactive, latent phase. During the active phase, the virus multiplies and spreads through the body. You might or might not have symptoms from the virus during this time.
During the inactive phase, the virus can still be found in some cells of your body, but it doesn’t actively divide or cause symptoms. However, the virus inserts some of its own DNA into yourDNA.This may or may not cause problems down the line.
Sometimes, the inactive virus becomes active again. Usually, people don’t experience symptoms during this reactivation phase, but they are much more likely to spread the virus during this time.
Reactivation of the virus is particularly concerning for people who have impaired immune systems. These people are more at risk for complications from EBV, like certain cancers.
Symptoms of Epstein-Barr Infection
Many people get infected with EBV and never experience any symptoms. This is called “asymptomatic infection.” When people get infected in childhood—as happens most commonly—EBV often causes no symptoms at all.
Some children get mild symptoms, like fever, that aren’t distinguished from other normal childhood illnesses. Middle-aged adults first infected with EBV often don’t have any symptoms either.
However, infection with EBV can sometimes lead to a syndrome ofsymptoms called mononucleosis, sometimes called “mono” for short. This most commonly occurs when people become infected with EBV during adolescence or early adulthood. It might take several weeks after infection before you start showing symptoms.
Someone with mononucleosis might have symptoms like the following:
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Most of these symptoms go away within a few weeks. However, fatigue from mononucleosis can be debilitating, and it may last for weeks or months.
Mononucleosis also occasionally causes a person’s spleen to enlarge. Very rarely, this can lead to a serious problem—spleen rupture. Mononucleosis also sometimes also causes other very rare but serious symptoms, like encephalitis.
It should be noted that although EBV is the most common virus that causes mononucleosis, other viruses, such asCMV, can sometimes cause it as well.
Notreatmentcurrently exists to directly treat mononucleosis. Pain medications, hydration, and rest are the main treatment approaches.
Chronic EBV
Extremely rarely, the EBV virus doesn’t go into its inactive phase, instead staying active inside the body. This causes a serious syndrome called chronic active Epstein-Barr virus disease (CAEBV).
It can cause symptoms like fever, enlarged spleen, and liver disease. CAEBV can also impair the immune system, making people much more prone to serious infections and lymphomas.
Complications of EBV Infection
There are complications linked to EBV infection.
Cancer Risks
EBV infection also increases one’s risk of getting certain cancers, at least for a limited time after getting infected. Some people are familiar with human papillomavirus (HPV), which increases the risk of cervical cancer and some other cancer types. Similarly, infection with EBV increases the risk of certain cancers.
For example, if you get mononucleosis from EBV, you have an increased risk of gettingHodgkin lymphomafor the next 10 years or so. A person’s risk of gettingBurkitt lymphomais also increased after getting mononucleosis from EBV.
Other types of cancer associated with EBV include stomach cancers and nasopharyngeal carcinoma. EBV can also cause an aggressive cancer calledposttransplant lymphoproliferative disorderin people who have received an organ or stem cell transplant.
Some of the trouble from EBV comes from the fact that the body never really gets rid of it. The virus inserts its DNA inside the host and can trick the body into making copies of viral proteins. Some of these proteins affect key genes already in the DNA. Through this, they ultimately play a role in cancer development in some people, though not in the large majority of people who get infected.
You might be told that your cancer is EBV positive. That means that EBV and its proteins can be found in the cancerous cells of your body. If that’s the case, it’s likely the virus played a role in causing your cancer.
It’s not clear why some people who have EBV develop cancers while most others don’t. Many factors are probably involved, including genetics and the presence of other infections. For example, lymphomas that have the EBV proteins are more common in areas of the world where malaria is prevalent.
People who areimmunocompromisedare particularly prone to developing cancers related to EBV. For example, this applies to people with impaired immunity fromHIVor an organ or stem cell transplant.
As of now, there aren’t any treatments that specifically target cancers that have EBV as a partial cause. However, this might change in the future, as we develop therapies that specifically address EBV’s role.
Chronic Fatigue Syndrome
For many years, some researchers have proposed a link between chronic fatigue syndrome (CFS) and infection with EBV and/or potentially other viruses, though the issue is not yet settled. This idea has been an especially popular one for practitioners of alternative or complementary medicine.
Some studies have shown differences in how the immune system is functioning in people with CFS.We know that mononucleosis can cause symptoms of extreme fatigue that may last for weeks or months, and that its symptoms can appear similar to some of those that appear in chronic fatigue syndrome.
Autoimmune Disease
More recently, scientists have discovered a potential link between EBV and autoimmune diseases such asrheumatoid arthritis, lupus,Sjögren’sdisease, and multiple sclerosis.
The data on this are not yet clear, and scientists are not exactly sure what role the virus might be playing. It may be that the immune response to EBV plays a role in the body’s inflammatory response to its own cells in autoimmune disease.
Epstein-Barr Virus Testing
However, in some situations, you might need to get one or more antibody tests for EBV. These antibody tests are not usually needed todiagnose mononucleosis, but they might be necessary if you have an unusual case, or if you have another health problem related to EBV infection.
For example, they might be important if you are getting an organ transplant. However, most people will never need testing for EBV.
How Is the EBV Virus Transmitted?
However, EBV can spread in other ways too. You might get it if you use an object that an infected person recently used, such as a toothbrush. You can get it through sexual contact, blood transfusions, and organ transplants as well.
You are most likely to spread the virus if it is in its active phase. People who get EBV may spread it for weeks before they have symptoms. Or they may be actively spreading it, even though they never go on to get any symptoms at all.
Preventing EBV Infection
Standard infection control measures can decrease the spread of the virus. This means things like not sharing food or kissing someone with mononucleosis, covering coughs, and frequently washing your hands.
Unfortunately, most adolescents and young adults don’t know whether they have already been infected with EBV or not. So it’s wise to be cautious around someone who has mononucleosis or who has had it in the past several months.
However, because it is so common in the population, avoiding infection with EBV is nearly impossible over the course of one’s lifetime. Many people shedding the virus won’t have any symptoms. And it may be more desirable not to try to prevent virus infection during childhood, because infections then are usually mild.
No vaccine is currently available to prevent infection with EBV. However, this is still an active area of research.If successful, vaccination for EBV might one day be included as part of standard childhood vaccinations, theoretically decreasing the risk for medical conditions related to EBV.
Summary
The Epstein-Barr virus is a very common virus that will affect most people at some point during their lives. It doesn’t always cause symptoms, but some people who are infected with it may develop mononucleosis.
The Epstein-Barr virus is associated with serious complications including certain kinds of cancer, autoimmune conditions, and chronic fatigue syndrome. Although it can be prevented with measures like hand washing and not sharing food, the fact that it is so prevalent and doesn’t usually cause symptoms makes it difficult to avoid.
18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Womack J, Jimenez M.Common questions about infectious mononucleosis.Am Fam Physician. 2015;91(6):372-376.Stanfield BA, Luftig MA.Recent advances in understanding Epstein-Barr virus.F1000Res. 2017;6:386. doi:10.12688/f1000research.10591.1Kang MS, Kieff E.Epstein-Barr virus latent genes.Exp Mol Med. 2015;47(1):e131. doi:10.1038/emm.2014.84American Cancer Society.Viruses that can lead to cancer.Nijland ML, Kersten MJ, Pals ST, Bemelman FJ, Ten Berge IJ.Epstein-Barr virus-positive posttransplant lymphoproliferative disease after solid organ transplantation: pathogenesis, clinical manifestations, diagnosis, and management.Transplant Direct. 2015;2(1):e48. doi:10.1097/TXD.0000000000000557Dunmire SK, Grimm JM, Schmeling DO, Balfour HH Jr, Hogquist KA.The incubation period of primary Epstein-Barr virus infection: Viral dynamics and immunologic events.PLoS Pathog. 2015;11(12):e1005286. doi:10.1371/journal.ppat.1005286Centers for Disease Control and Prevention.About infectious mononucleosis (mono).Kimura H, Cohen JI.Chronic active Epstein-Barr virus disease.Front Immunol. 2017;8:1867. doi:10.3389/fimmu.2017.01867Hutcheson RL, Chakravorty A, Sugden B.Burkitt lymphomas evolve to escape dependencies on Epstein-Barr virus.Front Cell Infect Microbiol. 2021;10:606412. doi:10.3389/fcimb.2020.606412Velavan TP.Epstein-Barr virus, malaria and endemic Burkitt lymphoma.EBioMedicine. 2019;39:13-14. doi:10.1016/j.ebiom.2018.12.041Gandhi MK, Hoang T, Law SC, et al.EBV-associated primary CNS lymphoma occurring after immunosuppression is a distinct immunobiological entity.Blood. 2021;137(11):1468-1477. doi:10.1182/blood.2020008520Pedersen M, Asprusten TT, Godang K, et al.Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study.Brain Behav Immun. 2019;75:94-100. doi:10.1016/j.bbi.2018.09.023Loebel M, Eckey M, Sotzny F, et al.Serological profiling of the EBV immune response in Chronic Fatigue Syndrome using a peptide microarray.PLoS One. 2017;12(6):e0179124. doi:10.1371/journal.pone.0179124Houen G, Trier NH.Epstein-Barr virus and systemic autoimmune diseases.Front Immunol. 2020;11:587380. doi:10.3389/fimmu.2020.587380Harley JB, Chen X, Pujato M, et al.Transcription factors operate across disease loci, with EBNA2 implicated in autoimmunity.Nat Genet. 2018;50(5):699-707. doi:10.1038/s41588-018-0102-3Centers for Disease Control and Prevention.Laboratory testing for Epstein-Barr virus (EBV).Centers for Disease Control and Prevention.About Epstein-Barr virus.Bu W, Joyce MG, Nguyen H, et al.Immunization with components of the viral fusion apparatus elicits antibodies that neutralize Epstein-Barr virus in B Cells and epithelial cells.Immunity. 2019;50(5):1305-1316.e6. doi:10.1016/j.immuni.2019.03.010
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Womack J, Jimenez M.Common questions about infectious mononucleosis.Am Fam Physician. 2015;91(6):372-376.Stanfield BA, Luftig MA.Recent advances in understanding Epstein-Barr virus.F1000Res. 2017;6:386. doi:10.12688/f1000research.10591.1Kang MS, Kieff E.Epstein-Barr virus latent genes.Exp Mol Med. 2015;47(1):e131. doi:10.1038/emm.2014.84American Cancer Society.Viruses that can lead to cancer.Nijland ML, Kersten MJ, Pals ST, Bemelman FJ, Ten Berge IJ.Epstein-Barr virus-positive posttransplant lymphoproliferative disease after solid organ transplantation: pathogenesis, clinical manifestations, diagnosis, and management.Transplant Direct. 2015;2(1):e48. doi:10.1097/TXD.0000000000000557Dunmire SK, Grimm JM, Schmeling DO, Balfour HH Jr, Hogquist KA.The incubation period of primary Epstein-Barr virus infection: Viral dynamics and immunologic events.PLoS Pathog. 2015;11(12):e1005286. doi:10.1371/journal.ppat.1005286Centers for Disease Control and Prevention.About infectious mononucleosis (mono).Kimura H, Cohen JI.Chronic active Epstein-Barr virus disease.Front Immunol. 2017;8:1867. doi:10.3389/fimmu.2017.01867Hutcheson RL, Chakravorty A, Sugden B.Burkitt lymphomas evolve to escape dependencies on Epstein-Barr virus.Front Cell Infect Microbiol. 2021;10:606412. doi:10.3389/fcimb.2020.606412Velavan TP.Epstein-Barr virus, malaria and endemic Burkitt lymphoma.EBioMedicine. 2019;39:13-14. doi:10.1016/j.ebiom.2018.12.041Gandhi MK, Hoang T, Law SC, et al.EBV-associated primary CNS lymphoma occurring after immunosuppression is a distinct immunobiological entity.Blood. 2021;137(11):1468-1477. doi:10.1182/blood.2020008520Pedersen M, Asprusten TT, Godang K, et al.Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study.Brain Behav Immun. 2019;75:94-100. doi:10.1016/j.bbi.2018.09.023Loebel M, Eckey M, Sotzny F, et al.Serological profiling of the EBV immune response in Chronic Fatigue Syndrome using a peptide microarray.PLoS One. 2017;12(6):e0179124. doi:10.1371/journal.pone.0179124Houen G, Trier NH.Epstein-Barr virus and systemic autoimmune diseases.Front Immunol. 2020;11:587380. doi:10.3389/fimmu.2020.587380Harley JB, Chen X, Pujato M, et al.Transcription factors operate across disease loci, with EBNA2 implicated in autoimmunity.Nat Genet. 2018;50(5):699-707. doi:10.1038/s41588-018-0102-3Centers for Disease Control and Prevention.Laboratory testing for Epstein-Barr virus (EBV).Centers for Disease Control and Prevention.About Epstein-Barr virus.Bu W, Joyce MG, Nguyen H, et al.Immunization with components of the viral fusion apparatus elicits antibodies that neutralize Epstein-Barr virus in B Cells and epithelial cells.Immunity. 2019;50(5):1305-1316.e6. doi:10.1016/j.immuni.2019.03.010
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Womack J, Jimenez M.Common questions about infectious mononucleosis.Am Fam Physician. 2015;91(6):372-376.Stanfield BA, Luftig MA.Recent advances in understanding Epstein-Barr virus.F1000Res. 2017;6:386. doi:10.12688/f1000research.10591.1Kang MS, Kieff E.Epstein-Barr virus latent genes.Exp Mol Med. 2015;47(1):e131. doi:10.1038/emm.2014.84American Cancer Society.Viruses that can lead to cancer.Nijland ML, Kersten MJ, Pals ST, Bemelman FJ, Ten Berge IJ.Epstein-Barr virus-positive posttransplant lymphoproliferative disease after solid organ transplantation: pathogenesis, clinical manifestations, diagnosis, and management.Transplant Direct. 2015;2(1):e48. doi:10.1097/TXD.0000000000000557Dunmire SK, Grimm JM, Schmeling DO, Balfour HH Jr, Hogquist KA.The incubation period of primary Epstein-Barr virus infection: Viral dynamics and immunologic events.PLoS Pathog. 2015;11(12):e1005286. doi:10.1371/journal.ppat.1005286Centers for Disease Control and Prevention.About infectious mononucleosis (mono).Kimura H, Cohen JI.Chronic active Epstein-Barr virus disease.Front Immunol. 2017;8:1867. doi:10.3389/fimmu.2017.01867Hutcheson RL, Chakravorty A, Sugden B.Burkitt lymphomas evolve to escape dependencies on Epstein-Barr virus.Front Cell Infect Microbiol. 2021;10:606412. doi:10.3389/fcimb.2020.606412Velavan TP.Epstein-Barr virus, malaria and endemic Burkitt lymphoma.EBioMedicine. 2019;39:13-14. doi:10.1016/j.ebiom.2018.12.041Gandhi MK, Hoang T, Law SC, et al.EBV-associated primary CNS lymphoma occurring after immunosuppression is a distinct immunobiological entity.Blood. 2021;137(11):1468-1477. doi:10.1182/blood.2020008520Pedersen M, Asprusten TT, Godang K, et al.Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study.Brain Behav Immun. 2019;75:94-100. doi:10.1016/j.bbi.2018.09.023Loebel M, Eckey M, Sotzny F, et al.Serological profiling of the EBV immune response in Chronic Fatigue Syndrome using a peptide microarray.PLoS One. 2017;12(6):e0179124. doi:10.1371/journal.pone.0179124Houen G, Trier NH.Epstein-Barr virus and systemic autoimmune diseases.Front Immunol. 2020;11:587380. doi:10.3389/fimmu.2020.587380Harley JB, Chen X, Pujato M, et al.Transcription factors operate across disease loci, with EBNA2 implicated in autoimmunity.Nat Genet. 2018;50(5):699-707. doi:10.1038/s41588-018-0102-3Centers for Disease Control and Prevention.Laboratory testing for Epstein-Barr virus (EBV).Centers for Disease Control and Prevention.About Epstein-Barr virus.Bu W, Joyce MG, Nguyen H, et al.Immunization with components of the viral fusion apparatus elicits antibodies that neutralize Epstein-Barr virus in B Cells and epithelial cells.Immunity. 2019;50(5):1305-1316.e6. doi:10.1016/j.immuni.2019.03.010
Womack J, Jimenez M.Common questions about infectious mononucleosis.Am Fam Physician. 2015;91(6):372-376.
Stanfield BA, Luftig MA.Recent advances in understanding Epstein-Barr virus.F1000Res. 2017;6:386. doi:10.12688/f1000research.10591.1
Kang MS, Kieff E.Epstein-Barr virus latent genes.Exp Mol Med. 2015;47(1):e131. doi:10.1038/emm.2014.84
American Cancer Society.Viruses that can lead to cancer.
Nijland ML, Kersten MJ, Pals ST, Bemelman FJ, Ten Berge IJ.Epstein-Barr virus-positive posttransplant lymphoproliferative disease after solid organ transplantation: pathogenesis, clinical manifestations, diagnosis, and management.Transplant Direct. 2015;2(1):e48. doi:10.1097/TXD.0000000000000557
Dunmire SK, Grimm JM, Schmeling DO, Balfour HH Jr, Hogquist KA.The incubation period of primary Epstein-Barr virus infection: Viral dynamics and immunologic events.PLoS Pathog. 2015;11(12):e1005286. doi:10.1371/journal.ppat.1005286
Centers for Disease Control and Prevention.About infectious mononucleosis (mono).
Kimura H, Cohen JI.Chronic active Epstein-Barr virus disease.Front Immunol. 2017;8:1867. doi:10.3389/fimmu.2017.01867
Hutcheson RL, Chakravorty A, Sugden B.Burkitt lymphomas evolve to escape dependencies on Epstein-Barr virus.Front Cell Infect Microbiol. 2021;10:606412. doi:10.3389/fcimb.2020.606412
Velavan TP.Epstein-Barr virus, malaria and endemic Burkitt lymphoma.EBioMedicine. 2019;39:13-14. doi:10.1016/j.ebiom.2018.12.041
Gandhi MK, Hoang T, Law SC, et al.EBV-associated primary CNS lymphoma occurring after immunosuppression is a distinct immunobiological entity.Blood. 2021;137(11):1468-1477. doi:10.1182/blood.2020008520
Pedersen M, Asprusten TT, Godang K, et al.Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study.Brain Behav Immun. 2019;75:94-100. doi:10.1016/j.bbi.2018.09.023
Loebel M, Eckey M, Sotzny F, et al.Serological profiling of the EBV immune response in Chronic Fatigue Syndrome using a peptide microarray.PLoS One. 2017;12(6):e0179124. doi:10.1371/journal.pone.0179124
Houen G, Trier NH.Epstein-Barr virus and systemic autoimmune diseases.Front Immunol. 2020;11:587380. doi:10.3389/fimmu.2020.587380
Harley JB, Chen X, Pujato M, et al.Transcription factors operate across disease loci, with EBNA2 implicated in autoimmunity.Nat Genet. 2018;50(5):699-707. doi:10.1038/s41588-018-0102-3
Centers for Disease Control and Prevention.Laboratory testing for Epstein-Barr virus (EBV).
Centers for Disease Control and Prevention.About Epstein-Barr virus.
Bu W, Joyce MG, Nguyen H, et al.Immunization with components of the viral fusion apparatus elicits antibodies that neutralize Epstein-Barr virus in B Cells and epithelial cells.Immunity. 2019;50(5):1305-1316.e6. doi:10.1016/j.immuni.2019.03.010
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