Epstein-Barr virus (EBV) is a virus in the herpesvirus family that can infect humans. EBV infections are very common — you may have already contracted the virus without even knowing it.
The condition that you may associate EBV infection with is infectious mononucleosis, or mono. However, experts are researching potential links between EBV and other conditions, including cancer, autoimmune diseases, and long COVID.
Read on to learn more about EBV, including common symptoms of an infection and how the virus spreads.
EBV infections don’t always cause symptoms. This is especially true for children.
Teens and adults are more likely to experience symptoms, which can include:
- feeling tired or fatigued
- sore throat
- swollen lymph nodes in your neck or underarms
- swollen tonsils
- enlarged spleen (splenomegaly) or swollen liver
- body aches
- skin rash
These symptoms can last for
If you have an enlarged spleen, doctors may recommend restricting contact sports until you’ve fully recovered to prevent rupture.
EBV spreads from person to person through bodily fluids, particularly saliva. This is why mononucleosis, one of the most well-known EBV infections, is casually known as the “kissing disease.”
But you can also get the virus by sharing personal items, such as toothbrushes or eating utensils, with someone who has an active EBV infection. EBV can also be spread through blood and semen.
EBV can start spreading to others as soon as you contract it. This means you can pass it on before you even start to have symptoms of an active infection.
You’ll be able to pass EBV on to others as long as the virus is active, which could be weeks or even months. Once the virus becomes inactive, you can no longer spread it to others, unless it reactivates.
Potential EBV infections are often diagnosed without any testing. However, blood tests can detect the presence of antibodies associated with EBV.
One of these is known as the monospot test. However, the Centers for Disease Control and Prevention
In addition to the monospot test, there are other blood tests for more specific antibodies to EBV, including:
- viral capsid antigen (VCA): Antibodies to VCA appear early in the infection. One type (anti-VCA IgM) disappears after several weeks while another (anti-VCA IgG) persists for life.
- early antigen (EA): Antibodies to EA appear during an active infection. They typically become undetectable after several months, although they may persist for longer in some people.
- EBV nuclear antigen (EBNA): Antibodies to EBNA slowly appear in the months following infection and can be detected throughout a person’s life.
A doctor will take these results and other factors into account, including a person’s overall health and any underlying health conditions, to make a diagnosis.
There’s no specific treatment or vaccine for EBV. And because they’re caused by a virus, EBV infections don’t respond to antibiotics.
Instead, treatment focuses on managing common symptoms. This includes:
- getting enough rest
- drinking plenty of fluids
- taking over-the-counter pain relievers to ease fever or sore throat
- avoiding contact sports or heavy lifting
In some cases, EBV infections can lead to complications, some mild and some serious.
- rupture of the spleen
- low platelet count (thrombocytopenia)
- conditions affecting the nervous system, including encephalitis, meningitis, and Guillain-Barré syndrome
If you suspect you may have an active EBV infection, it’s best to see a doctor if you are concerned about your symptoms. They can monitor you for signs of complications and tell you what to look for as you recover.
Once you’ve contracted EBV, the virus remains inactive within your body for the rest of your life. This is called latency.
In some cases, the virus can reactivate. In many people, it does not usually cause symptoms.
But in others, it can cause chronic or serial infections.
Reactivated EBV may cause symptoms similar to those of an initial EBV infection in people who have a weakened immune system.
EBV reactivation and COVID
EBV and COVID-19 are caused by different viruses.
Some people hospitalized with COVID-19 were also found to have reactivated EBV as well.
Long COVID, also known as post-COVID 19 condition, and EBV reactivation have many symptoms in common. The above studies suggest that EBV reactivation may cause some of the symptoms of long COVID.
It’s important to note that EBV is not the only health condition associated with long COVID. Having type 2 diabetes or certain antibodies associated with autoimmune diseases such as lupus and rheumatoid arthritis may also be linked to developing long COVID. A high viral load, or the amount of the virus in your blood early in the infection, is also considered a risk factor.
Additional studies are still needed to better understand the link between EBV and long COVID.
In very rare cases, EBV infection can lead to a chronic condition called chronic active EBV (CAEBV). CAEBV is characterized by ongoing symptoms and blood test results that show an active EBV infection.
CAEBV starts out as a typical EBV infection. However, some people’s immune systems aren’t able to control the infection, allowing the active virus to linger instead of going dormant.
Symptoms of CAEBV can include:
- swollen or tender lymph nodes
- enlarged liver (hepatomegaly) or spleen (splenomegaly)
- sore throat
- muscle pain
- joint stiffness
- liver failure
Experts aren’t sure why some people develop CAEBV. But they
Currently, the only effective treatment for CAEBV is a hematopoietic stem cell transplant.
Over time, CAEBV can cause several complications, including:
EBV infection can increase the risk of developing certain rare cancers. This is because mutations in cells infected with EBV can lead to cancerous changes.
According to the
- nasopharyngeal cancers, or cancers in the back of the nose
- certain types of lymphoma, including Burkitt’s lymphoma
- Hodgkin’s lymphoma
- Gastric adenocarcinoma (stomach cancer)
EBV-associated cancers are uncommon. Most people who have had an EBV infection will not go on to develop one of these cancers. Experts are still trying to identify these specific mutations and why EBV infection seems to cause them. But overall, it’s estimated that EBV infection contributes to only about
EBV may also play a role in the development of other health conditions, including autoimmune disorders and schizophrenia.
EBV has long been thought to be linked to autoimmune disorders, such as lupus. Experts believe that EBV may cause changes in the way some genes are expressed. This altered gene expression could increase your risk of developing an autoimmune disorder.
The study’s authors believe that same mechanism linking EBV and lupus may also link EBV to other autoimmune conditions, which can include:
- multiple sclerosis
- rheumatoid arthritis
- celiac disease
- type 1 diabetes
- inflammatory bowel disease
- juvenile idiopathic arthritis
- thyroid autoimmune diseases, including Hashimoto’s thyroiditis and Graves’ disease
They suggest that EBV may activate certain genes that can affect your risk for developing autoimmune disease in combination with other factors.
Still, more research is needed to fully understand the potential link between EBV and autoimmune conditions.
A 2019 study looked at rates of EBV infection in more 700 people both with and without schizophrenia. Those with schizophrenia had higher levels of antibodies to some EBV proteins than those who didn’t, suggesting they had an unusual immune response to the virus.
The researchers also found that participants with genetic risk factors for schizophrenia as well as elevated antibodies were over eight times more likely to have schizophrenia than the control group.
A smaller 2021
Further research is needed to study a possible link between EBV infection and schizophrenia.
EBV infection is very common and is spread by coming into contact with bodily fluids of people who are sick with it. Often, people get the virus during childhood and don’t experience any symptoms. If a teenager or adult gets sick, they may experience symptoms like fatigue, swollen lymph nodes, and fever.
In very rare cases, EBV can cause a chronic infection, which can be fatal if left untreated. EBV has also been linked with a variety of conditions, including cancers, autoimmune disorders, and long COVID. However, additional research is needed to determine EBV’s overall role in these conditions.