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Epstein-Barr Virus Infection, Symptoms, and Possible Treatments

Linda Crampton is an experienced teacher with a first-class honors degree in biology. She writes about the scientific basis of disease.

A healthy diet that includes vegetables may boost the immune system and help to keep the Epstein-Barr virus under control.

A healthy diet that includes vegetables may boost the immune system and help to keep the Epstein-Barr virus under control.

The Epstein-Barr Virus and Its Effects

The Epstein-Barr virus, or EBV, is very common in the human population and infects people of all ages. In the United States, it's estimated that ninety to ninety-five percent of people between the ages of thirty-five and forty have been infected by the virus at some point in their lives. The percentage is believed to be similar in other parts of the world. Once a person has been infected by EBV, it stays in their body.

The Epstein-Barr virus is a member of the herpes family, which is technically known as the herpesvirus family. Like its relatives, such as the cold sore virus, EBV goes through periods of activity and dormancy. When the virus is active it may produce no noticeable effects, produce symptoms that resemble flu, or cause health problems such as infectious mononucleosis and some types of cancer.

Researchers are investigating the factors that activate the virus. Ideally, after the initial infection the virus would remain dormant throughout a person's life and would be unable to cause disease. Although most of us apparently suffer no ill effects from the infection, researchers suspect that EBV may be responsible for more diseases than we realize.

 Simplified diagram of an Epstein-Barr virion

Simplified diagram of an Epstein-Barr virion

The Epstein-Barr virus was named after Anthony Epstein and Yvonne Barr, two of the scientists in the team that discovered that the virus can cause some types of cancer.

Structure of a Virus

Individual virus particles are known as virions. A virion consists of a core of genetic material surrounded by a coat of protein, which is known as a capsid. In the Epstein-Barr virus the genetic material is DNA, as it is in us.

Some viruses are surrounded by a protective envelope, including the Epstein-Barr one. The envelope of EBV is made of lipid and is covered with spikes made of proteins. These spikes enable the virus to attach to our cells.

Not all biologists consider viruses to be living things because they aren't made of cells and can't reproduce without the aid of a living organism. They send their genetic material into a host cell and then "force" the cell to make new virions. As scientists discover more about the nature of viruses and the complexity of some types, the idea that they are non-living seems to be changing.

Life Cycle of the Epstein-Barr Virus

Although almost all of us have the Epstein-Barr virus in our bodies, its behaviour isn't completely understood. The virus infects mainly two types of cells—the epithelial cells of the salivary glands and the B lymphocytes. Epithelial cells line the chambers, or acini, of a salivary gland. Each acinus (singular of acini) makes and secretes saliva. A B lymphocyte is a type of white blood cell that is made in the bone marrow and matures there. When infected saliva enters someone’s body, the virus first infects the tissues of the mouth. It then migrates to the salivary glands and the lymphocytes.

When EBV is dormant, it's hiding in an inactive form in the B lymphocytes. The inactive virus is said to be in a “latent” state. The latent virus may be reactivated by conditions such as illness or stress.

Research suggests that many people have low grade infections from active EBV virions. The virions reproduce and enter the person’s saliva, a process known as shedding. They can then be transferred to other people. An active virus doesn't necessarily cause problems in the infected person. The immune system is usually able to keep the infection under control and prevent symptoms of disease.

Two virions (virus particles) of the Epstein-Barr virus; each virion is round and is loosely surrounded by a protective envelope

Two virions (virus particles) of the Epstein-Barr virus; each virion is round and is loosely surrounded by a protective envelope

The Infection Process

EPV is passed from one person to another inside saliva. Saliva can be transferred between people during kissing or by sharing food, drinks, or eating utensils. Touching infected saliva and then touching the mouth or nose can also transmit the virus.

Coughing and sneezing can spread EBV through saliva and mucus droplets, but scientists have found that this is a weak method of infection. Direct saliva contact is far more likely to cause an infection. Tears can sometimes transmit the virus. Rarely, the Epstein-Barr virus can be transmitted from one person to another in blood.

People may not realize that they are carrying EBV in their bodies for several reasons. The virus may be dormant, the active form may cause no symptoms, or the symptoms may resemble those of a cold or influenza.

A Physician's Assistant Describes Mononucleosis

Infectious Mononucleosis or Glandular Fever

When teenagers and young adults are infected by the Epstein-Barr virus, they have about a fifty percent chance of developing mononucleosis. The disease is also called infectious mononucleosis, mono, glandular fever, or the kissing disease. Mononucleosis may sometimes develop in people of other ages as well. The term “glandular fever” refers to the fact that the lymph glands under the arms, in the groin, and sometimes in the neck may become swollen and to the fact that the person may develop a high temperature.

Someone suffering from mononucleosis may also experience one or more of the following symptoms. The symptoms could be caused by a different condition, however. A doctor must be consulted for a diagnosis.

  • a sore throat
  • swollen tonsils
  • headache
  • chills
  • muscle aches
  • loss of appetite
  • a spotty rash
  • extreme fatigue
  • swollen upper eyelids
  • photophobia (light sensitivity)
  • a general feeling of illness and discomfort, which is known as malaise.

The blood of someone with mononucleosis may contain more white blood cells than normal, and the cells may have an unusual appearance. The lymphocytes are often enlarged. In this condition, they are said to be reactive.

A stained blood smear from someone with infectious mononucleosis; the blue cells are reactive lymphocytes while the pink cells are red blood cells

A stained blood smear from someone with infectious mononucleosis; the blue cells are reactive lymphocytes while the pink cells are red blood cells

Additional Effects of Mononucleosis

In about fifty percent of mononucleosis cases, the spleen may become enlarged. The patient may also experience hepatitis (liver inflammation) and jaundice (a yellow colour to the skin and the white part of the eyes). Very rarely, the heart, lungs, or nervous system may be affected.

Mononucleosis symptoms develop about four to six weeks after the initial infection by EBV. Acute mononucleosis symptoms last for around two to four weeks, but the fatigue may be experienced for several months. Mononucleosis may sometimes occur in a chronic state that lasts for much longer or that reappears at intervals for years.

Possible Treatments for an Epstein-Barr Virus Infection

Rest and plenty of fluids are usually prescribed for an active Epstein-Barr infection that is producing mononucleosis or flu-like symptoms. Pain and fever reducers like aspirin, ibuprofen, and acetaminophen may help, but their use must be recommended by a doctor. Some popular pain relievers can cause problems in certain situations. Children and teenagers shouldn’t be given aspirin since they may develop Reye’s syndrome, a very dangerous condition involving swelling of the brain.

Antibiotics don’t affect viruses but may be prescribed if the person’s weakened body has developed a bacterial infection as well as an EBV infection. Corticosteroids may be prescribed if the tonsils are very swollen.

If the spleen is swollen, there is a possibility that it could rupture if it isn't treated gently. A ruptured spleen is a medical emergency. It's important to follow a doctor's instructions in order to avoid damaging the organ. Exercise and contact sports must be avoided for as long as recommended by the doctor.

The Epstein-Barr Virus and Cancer

Diseases Linked to EBV

The Epstein-Barr virus causes or contributes to some kinds of cancer, including Burkitt (or Burkitt's) lymphoma, nasopharyngeal carcinoma, and some cases of Hodgkin (or Hodgkin's) lymphoma and stomach cancer. In addition, it may be linked to some cases of multiple sclerosis, although this is less certain. Various sources claim that the virus is also involved in chronic fatigue syndrome and fibromyalgia, but the scientific evidence for this is scant.

A possible connection between EBV and fibromyalgia is especially interesting to me. My sister has suffered from fibromyalgia, chronic fatigue, and migraines for many years. The three conditions often accompany one another. The cause of fibromyalgia is unknown, although there are a variety of theories to explain its origin. One of them is that the Epstein Barr virus causes or contributes to the disease.

In fibromyalgia, a person experiences chronic and widespread body pain for no obvious reason. Many patients experience periods called flare-ups when symptoms are worse than normal. Chronic fatigue is a condition that often involves periods of debilitating tiredness. Migraines may be debilitating, too. They are more than just a bad headache. A migraine is actually a syndrome involving a range of symptoms.

Determining the cause of my sister's health problems would be great, whether or not EBV is involved; finding a treatment would be even better. The problems seriously interfere with her life and with the lives of many other sufferers.

Gene regulation refers to the mechanisms that act to induce or repress the expression (activity) of a gene.

— Springer Nature

A Genetic Discovery

In April 2018, scientists associated with the Cincinnati Children’s Hospital Medical Center made an interesting announcement. The researchers discovered that a protein made by the Epstein-Barr virus called EBNA2 binds to sites on our genome associated with seven diseases. These diseases are:

  • multiple sclerosis, or MS
  • rheumatoid arthritis, or RA
  • juvenile idiopathic arthritis, or JIA
  • systemic lupus erythematosus, or SLE
  • inflammatory bowel disease, or IBD
  • celiac disease, or CD
  • type 1 diabetes

The EBNA2 protein acts as a transcription factor, which regulates the action of genes. By regulating particular genes, the protein may be causing specific diseases. If this is the case, finding a way to treat an EBV infection could also treat the other diseases. More research is needed, but the idea that the virus harms us by influencing our genes is intriguing.

Fruit can be part of a healthy diet and boost the activity of the immune system.

Fruit can be part of a healthy diet and boost the activity of the immune system.

Following general good-health guidelines is the single best step you can take toward naturally keeping your immune system strong and healthy

— Harvard Health Publishing

Strengthening the Immune System

Scientists are continuing to study the Epstein-Barr virus and are learning more about it. Recent research had discovered that the virus can infect more areas of the body than was previously thought.

Since most of us have already been infected by the Epstein-Barr virus, we need to do what we can to help our immune systems control it. In general, when the virus is reactivated after the initial infection, no symptoms are produced. This isn't always the case, though.

Studies related to strengthening the immune system are continuing. The evidence obtained so far suggests that eating a healthy and nutritious diet helps the system to function efficiently. The evidence also suggests that we should limit the amount of alcohol that we drink and avoid smoking. We should also try to maintain a healthy weight, since being very overweight has been shown to lower immunity to disease.

Regular exercise appears to boost the activity of the immune system and often reduces emotional stress. Exercise has many benefits. Very intense exercise or exercising for too long or too often may contribute to physical stress within the body and should probably be avoided, however. Getting an adequate amount of sleep and avoiding other infections should help to reduce physical stress. Steps to avoid infections, such as washing hands frequently, are important.

Regular walking in the countryside or in a city can boost the immune system and protect the body from viral infections.

Regular walking in the countryside or in a city can boost the immune system and protect the body from viral infections.

Questions About the Virus

Many unanswered questions about the Epstein-Barr virus and its behaviour exist. Researchers are exploring the reasons why some of us are apparently not harmed by the EBV in our body while others are. They are also investigating the possibility of using a vaccine to prevent EBV infections.

For now, it seems as though the Epstein-Barr virus is our partner in life. We need to do what we can to make this relationship an unequal partnership and to prevent the virus from getting the upper hand.


This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: What do big lumps under armpits that are full of blood or yellow pus mean?

Answer: Armpit lumps are often caused by a minor problem, but they are sometimes caused by a serious one. Infection by the Epstein-Barr virus can cause swollen lymph glands in the armpits during mononucleosis, but there are many other possible causes for the lumps.

Since you say that your lumps are “big” and are “full of blood or yellow pus”, I urge you to visit a doctor as soon as possible. The doctor will be able to diagnose the problem and prescribe treatment.

© 2010 Linda Crampton


Linda Crampton (author) from British Columbia, Canada on January 16, 2015:

I cannot advise you, Albert. I'm a science writer, not a doctor! Visit your physician and ask him or her your questions.

Albert on January 16, 2015:

Hi! AliciaC.

Now i am Ebv positive. 7Nov reading 0.82, 17Nov 0.99, 28Nov 0.96, 31Dec 1.46.

Since oct i always suffer with sore throat, recovered then come again sore throat, on and off. When i drink water the felling like got ulcer very pain. Start with white spot on sore throat, then sore throat will continue for rew weeks even i am taken Amoxicillin also can't recover. It is this is EBV symptom? Is is normal? Kindly advise. Thanks

Linda Crampton (author) from British Columbia, Canada on January 15, 2015:

Albert, Epstein-Barr infections and HIV infections have different and unrelated causes. Many, many people have EBV in their body without having the HIV virus. In order to become infected by the HIV virus, a person needs to have been engaged in a specific risk activity for the transmission of the virus. You should talk to your doctor about your concerns.

Albert on January 15, 2015:

Hi! Now i am ebv positive, i worried causes by hiv virus. Anybody can explain?

Linda Crampton (author) from British Columbia, Canada on January 14, 2015:

Hi, Albert. The Epstein-Barr virus and HIV are different viruses. They both affect the immune system, but they do this in different ways.

Albert on January 14, 2015:

Hi! Hiv and ebv got relation or not?

Linda Crampton (author) from British Columbia, Canada on June 28, 2013:

Ineedinfo, as my article says, this infection is caused by a virus. It's sometimes an annoying infection and can produce unpleasant symptoms, which may be temporary or longer lasting, but in most people it's not dangerous. I suggest that you write down a list of questions that you would like to ask your doctor so that he or she can give you all the information that you need and set your mind at ease.

ineedinfo on June 28, 2013:

my doctor is having me get blood work for this tomorrow, one thing i did not read was, what is this caused by? is it genetic? I am very worried everything i read on this page and all these comments fit me exactley. I see him friday for the results. please pray for me.

workingsmarter1 on July 30, 2012:

Thank you So much Alicia~ These are things I Know but I sometimes get SO into just doing & going that I over do it & then suffer! I may be able to get some help with medical bur If i have to pay for my care/insurance i will. I cant keep going like this and just let it go. . . i have chronic back problems too (degenerative disk disease). I eat A lot of fruit & drink water too but sometimes i think my downfall (Of course) is sugar or even 1 drink of alcoholic beverage i noticed before my period! I have been running on empty & dealing with caring for my cat/dog i had with my ex boyfriend while he's in rehab. I Need to cut the cord on Him completely I told his mom. He's Draining me with my work & having to care for his & my own stuff! Stayed home from work today because I'm still feeling miserable! Drinking Echinacea Tea & having Chicken soup! Resting resting resting! thanks Again for your input!

Linda Crampton (author) from British Columbia, Canada on July 29, 2012:

I am so sorry that you are suffering from a chronic Epstein-Barr infection, workingsmarter1. I wish I could offer more advice than I've given in this hub, but I'm not a doctor. All I can suggest is to follow a healthy diet to strengthen your immune system, drink lots of water and get enough rest whenever this is practical. If at any time you can get treatment at a free medical clinic, be sure to take advantage of this opportunity to get a doctor's advice.

workingsmarter1 on July 29, 2012:

I was diagnosed with EBV in 1995, I still suffer to this day when I do too much activity, heavy lifting etc. . I am suffering to day after working back to back workshifts with hardly any rest and had to move my belongings to a new space myself. I was very tired and drank A lot of water but it caught up to me the last 2 days. I ache, my armpit lymph nodes are sore and I can barely move w/o pain again.! I hate this feeling. I have to Always try to remind myself to slow down but there is no one to help me do the things i need to do. Im alone and no insurance for doctor care either. Medicaid wont take me because (lol) make too much money. I just go day to day but no one in my family understands how I feel and EBV at All! They all just say, you're sick again?! Any comments/suggestion etc. would help Thanks

Linda Crampton (author) from British Columbia, Canada on December 29, 2010:

Thank you for your comment, RTalloni. I'm glad that you found the hub useful.

RTalloni on December 28, 2010:

Good practical advice with helpful info. Thanks.

Linda Crampton (author) from British Columbia, Canada on November 07, 2010:

Thank you for your comment. It will be interesting to learn how many other diseases and health problems the Epstein-Barr virus creates as scientists continue their research. Hopefully they’ll also discover better ways to treat the infection.

Helen Lewis from Florida on November 06, 2010:

Thank you for this hub. I have the anti-bodies for Epstein-Barr and my two youngest sons have had Mono - my youngest had it very badly when he was 7. He contracted it on the plane when he passed someone who was clearly ill and sneezing. (Being small he was at the target height for the sneeze)! I get a form of 'shingles' whenever I am stressed so it is definitely a very debilitation and multi-faced disease. I didn't know the following.. "The Epstein-Barr virus causes or contributes to some kinds of cancer, including Burkitt’s lymphoma, nasopharyngeal carcinoma and some cases of Hodgkin (or Hodgkin's) lymphoma."

Thanks for all this very useful information! Great hub.