Mononucleosis: The Kissing Disease

By Henry Balfour, Jr., M.D.

As thousands of students head back to class this fall, many will find their studies interrupted by the arrival of an unwelcome illness--infectious mononucleosis, or mono.

Sometimes referred to as the "kissing disease," mono is caused by a virus, usually the Epstein-Barr virus, which is spread through contact with saliva or mucus. Once a person is exposed to the Epstein-Barr virus, he or she may spread it to others, even if the person is symptom-free. This makes it of particular concern on college campuses, where many students are housed in close quarters.

Mono is commonly spread through direct contact with the saliva of an infected person, usually through kissing. While common sense suggests that sharing eating utensils and drinking out of the same glass would be easy ways to pass the infection, these are not the usual modes of transmission.

The two most typical symptoms of the disease are a very sore throat and extreme fatigue. People with mono may also have a fever and swollen glands. These symptoms can last from two to three weeks; however, some people still feel rundown several months after being diagnosed. In rare cases, a person's spleen may become enlarged. While mono is a relatively minor disease, it causes sufferers to miss countless hours of time at work and school.

The disease occurs most commonly between ages 15 and 25 so high school and college students often lose valuable time with their studies after being infected.

Currently, the standard treatment for mono involves getting plenty of rest and taking painkillers such as acetaminophen or ibuprofen to relieve fever, sore throat pain, and headaches. In extreme cases, doctors may prescribe anti-inflammatory drugs and steroids.

But at the University of Minnesota, we are searching for a better answer, a better treatment for mono.

Last fall, we completed a small clinical trial with the anti-viral drug valacyclovir. Twenty study participants were randomly assigned to receive, or not receive, the drug. They visited the clinic for follow-up visits for six months. We documented their symptoms, as well as collected blood and saliva samples to determine their "viral load," or how much of the virus was present in their systems.

Study participants who received the valacyclovir felt better sooner and had smaller viral loads than the participants who did not receive the drug. While the initial results appear promising, more rigorous study is necessary to determine whether valacyclovir is an effective and cost-effective way to treat mono.

This fall, we will begin a larger clinical trial, in which we will follow a group of student volunteers who have never been exposed to the Epstein-Barr virus. Throughout their college years, some of the students will get the virus and not develop mono, some will get the virus and develop mono with varying degrees of severity, and others may not get the virus at all. By looking at all of these cases, we hope to examine what the risk factors are for acquiring severe mono, and which patients might be helped most by treatment with an anti-viral drug such as valacyclovir.

This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu.