Infectious Mononucleosis (“kissing disease”) in teenagers: Is it preventable?

There are a few viruses that can be spread through kissing, with a common one being the Epstein-Barr virus (EBV). EBV more often than not leads to infectious mononucleosis, or mono, which refers to a group of symptoms specifically caused by the virus.
Dr Dennis Chua - Kissing Disease
While anyone can get an EBV infection (including children as young as 2), it is more prominent in teenagers and young adults. At least 1 out of 4 teenagers with the EBV infection develop infectious mononucleosis. While getting an infection at a young age might appear scary to some, the good news is that once you have an EBV infection, the chances of you getting it again is very low. In fact, children who get EBV will probably be immune to EBV or mono for the rest of their lives.
However, that obviously doesn’t mean you should try to get the virus on purpose; we want to stay healthy for as long as possible. Here are some signs and symptoms you should look out for and what you can do if you get infectious mononucleosis.

What are the symptoms of infectious mononucleosis?

Most symptoms of infectious mononucleosis usually surface 4-6 weeks after you get infected with EBV. They may develop slowly and not all will occur at the same time.

  • Fatigue
  • Fever
  • Sore throat
  • Muscle weakness
  • Body aches and headaches
  • Swollen lymph nodes in the neck and armpit
  • Rashes consisting of pink or purple spots on your skin or in your mouth

Occasionally in severe cases, your liver or spleen may also swell, but mononucleosis is rarely fatal. For some people, their liver or spleen or even both may remain swollen even after their fatigue ends. Most cases of mononucleosis are mild and resolve in 2-4 weeks. However, some people may still feel fatigued for another month or so and occasionally the symptoms can last 6 months or longer.

How is infectious mononucleosis transmitted?

Infectious mononucleosis is usually caused by EBV, which is spread through direct contact with saliva from an infected person’s mouth, which explains the nickname “kissing disease”. It can also be spread through coughing or sneezing or sharing food and drinks and personal items with an infected person.

Mononucleosis can also be spread through sexual intercourse and blood transfusions, although this is a lot less common.

Am I at risk of infectious mononucleosis?

Anyone can get mono since it’s a condition spreadable by saliva contact, but if you fall into the following groups, you have a higher risk:

  • Aged 15-30
  • Students
  • Nurses, caregivers and/or anyone who works in healthcare
  • People on medication that suppress the immune system

The above are just common examples but generally, anyone who comes into close contact with large groups of people regularly are at an increased risk for mono — which explains why students are considered an at-risk group.

How does an ENT specialist diagnose infectious mononucleosis?

There are a few ways an ENT specialist diagnoses mono:

Initial exam

Infectious mononucleosis is usually easily diagnosed based on symptoms and other factors — are you 15-25 years of age? Have you been in contact with anyone who has mono? Are you experiencing fever, sore throat and swollen glands? Besides taking your temperature, the ENT specialist will also do a physical test and check your neck, armpits and groin and your upper left stomach to see if your spleen is enlarged.

Blood work

While lab tests are usually not necessary to diagnose mono, specific tests like blood work may be done to determine how severe your illness is and identify the cause of your illness.

Patients who have mono due to EBV typically show:

  • High white blood cell count
  • Unusual looking white blood cells
  • Fewer than normal platelets
  • Abnormal liver function

There is no specific treatment for mono as symptoms usually resolve on their own, but patients are usually advised to take medication for pain and fever or prescribed corticosteroids to reduce tonsil and throat swelling.

If you have questions or concerns about your ears, nose, and throat,
you may book a consultation with Dr Dennis Chua, an ENT specialist in Singapore.
He has completed his training in otorhinolaryngology locally and attained qualifications internationally.


  1. Vouloumanou, E. K., Rafailidis, P. I., & Falagas, M. E. (2012). Current diagnosis and management of infectious mononucleosis. Current opinion in hematology19(1), 14–20. https://doi.org/10.1097/MOH.0b013e32834daa08
  2. Kinderknecht J. J. (2002). Infectious mononucleosis and the spleen. Current sports medicine reports1(2), 116–120. https://doi.org/10.1249/00149619-200204000-00009