Epstein Barr Virus Symptoms, Causes and How to Manage - Dr. Axe

Fact Checked

This Dr. Axe content is medically reviewed or fact checked to ensure factually accurate information.

With strict editorial sourcing guidelines, we only link to academic research institutions, reputable media sites and, when research is available, medically peer-reviewed studies. Note that the numbers in parentheses (1, 2, etc.) are clickable links to these studies.

The information in our articles is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

This article is based on scientific evidence, written by experts and fact checked by our trained editorial staff. Note that the numbers in parentheses (1, 2, etc.) are clickable links to medically peer-reviewed studies.

Our team includes licensed nutritionists and dietitians, certified health education specialists, as well as certified strength and conditioning specialists, personal trainers and corrective exercise specialists. Our team aims to be not only thorough with its research, but also objective and unbiased.

The information in our articles is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

Epstein Barr Virus Causes, Symptoms and 5 Ways to Boost Your Immune System


Epstein Barr virus - Dr. Axe

Believe it or not, there’s a very high chance that you, or an immediate family member, has had Epstein Barr virus (EBV) at some point. Many children, teens and adults contract this virus but have no idea, since it doesn’t always cause any noticeable symptoms. EBV is considered a prevalent virus in most developed countries, affecting up to 90 percent to 95 percent of individuals before the age of 20. (1)

Like some other viruses, such as herpes, Epstein Barr virus can remain dormant in someone’s body for a lifetime. Even if someone doesn’t display any symptoms, they are still capable of spreading EBV to others, causing symptoms like extreme fatigue, weakness and fever, and potentially even serious autoimmune diseases. While EBV cannot be fully prevented or cured once someone is infected, there are a number of remedies that can help support your immune system while you overcome the virus.

What Is the Epstein Barr Virus?

The Epstein Barr virus (EBV), which is also called human herpesvirus 4, is one of eight known herpes viruses that affect humans. Does this mean EBV is a herpesvirus just like herpes simplex 1 or 2? Viruses in the herpes family have similarities, although they cause different symptoms. Like other herpes viruses, Epstein Barr virus is spread through intimate contact — meaning bodily fluids, primarily saliva, although it can also be passed through blood and semen. Another similarity is that “After initial infection, all herpesviruses remain latent within specific host cells and may subsequently reactivate.” (2)

Mononucleosis, or simply “mono” for short, is caused by the Epstein Barr virus. So are mono and Epstein Barr the same thing? Mononucleosis is the most common illness caused by EBV, but not the only one.

Recently, a study published in the journal Nature Genetics revealed that EBV can cause not only mono, but also contribute to at least seven other serious diseases. That’s because a protein that is produced by the Epstein Barr virus, called EBNA2, interacts with a number of genes that are associated with these diseases (most of which are considered autoimmune diseases). EBV proteins can essentially “turn on and off” certain genes, changing how cells of the immune system function. Researchers believe this is especially true of B cells — a type of white blood cell of the immune system that produces antibodies in response to infections and viruses. (3)

What diseases may be caused by Epstein Barr virus? Researchers believe the following conditions are linked to EBV:

According to a news report released by the Cincinnati Children’s Hospital Medical Center, “Overall, the study sheds new light on how environmental factors, such as viral or bacterial infections, poor diet, pollution or other hazardous exposures, can interact with the human genetic blueprint and have disease-influencing consequences.” (4)

Additionally, EBV has been linked to certain types of rare cancers. These include those that affect the lymphatic system. What types of cancer can Epstein Barr virus cause? EBV may play a role in the development of Burkitt’s lymphoma, Hodgkin disease, B lymphoproliferative disease, nasopharyngeal carcinom, and cancers of the nose and throat. Given how we now know that EBV can increase the chance of someone developing potentially life-threatening diseases, experts warn that prevention against the virus (by strengthening your immune system) is more important than ever.

Epstein Barr Virus Symptoms and Signs

What are the symptoms of Epstein Barr? EBV symptoms typically include: (5)

  • Fatigue, which can be severe sometimes. Fatigue is usually the most obvious symptom of mono and can sometimes last up to several months.
  • Muscle weakness.
  • Fever, and symptoms usually caused by a fever like lack of appetite and sometimes nausea.
  • Skin rash.
  • Sore throat and swollen glands in the neck.
  • Swollen and/or enlarged liver or spleen.
  • In children, flu-like symptoms. They also experience diarrhea and ear infections.

Not everyone will experience severe symptoms due to EBV. Children, for example, tend to have only mild symptoms, while teens and adults usually suffer more. It typically takes about four to six weeks for someone to start experiencing Epstein Barr virus symptoms after they have been infected.

How long do EBV symptoms last? Most people start feeling better after about two to four weeks. Just like with the flu, fatigue can sometimes last longer and linger for weeks while you fully recover. Even if you feel better after having mono, you can still carry the virus and transmit it to someone else. It’s also possible that your symptoms may return at a later time.

Some people will develop what is known as chronic active Epstein Barr virus (CAEBV). What are the symptoms of chronic Epstein Barr? For example, is chronic EBV linked to chronic fatigue syndrome?

Chronic active Epstein-Barr virus is considered to be a rare progressive disease that begins as a primary Epstein-Barr virus infection. It causes the body to produce too many lymphocytes (a type of white blood cell that helps to fight off diseases) for more than six months. (6) This is most likely to affect people with a weakened immune system and can result in ongoing symptoms including:

  • Fever
  • Liver dysfunction
  • Enlarged spleen (splenomegaly)
  • Swollen lymph nodes (lymphadenopathy)
  • Anemia
  • Increased susceptibility to other infections
  • Low numbers of platelets (thrombocytopenia)

Fatigue is also a common symptom of CAEBV, but no convincing link has been found between EBV and chronic fatigue syndrome.

Epstein Barr Virus Causes and Risk Factors

Some people refer to mono, caused by EBV, as the “kissing disease” because it’s commonly transmitted through saliva. So is EBV a sexually transmitted disease/infection then? No, although it can be transmitted like certain STIs, such as herpes, simplex 1 or 2.

The Epstein Barr virus can be passed from person to person in the following ways:

  • Spread via saliva, such as from kissing someone who’s infected.
  • Sharing drinks/drinking from the same glass as someone who’s infected.
  • Sharing a toothbrush.
  • Via blood and semen. EBV can be spread from any type of sex in which these bodily fluids are shared.
  • Through a blood transfusion
  • From an organ transplant.

Primary EBV infection usually occurs subclinically during childhood (especially in non-industrialized countries), but the virus establishes a latent infection and affects B lymphocyte production for many years afterwards. Research suggests that you have a greater risk for becoming infected with EBV and mono if any of these apply to you: (7)

  • You have a weakened or suppressed immune system, due to existing health conditions, autoimmune disease, HIV, or taking certain medications.
  • You’re a female, since women tend to experience mono more often.
  • You’re a college/university student, in the military, living in dorms, or living in close quarters with many other people (especially if you share a bathroom, kitchen, etc.). EBV most commonly affects people between the ages of 15–25 years in high socioeconomic areas.
  • Someone in your family, especially your siblings, has or had EBV in the past.
  • You are sexually active, especially if you have numerous sex partners.
  • You live in a tropical country, where EBV seems to spread more easily.
Epstein Barr virus: facts about EBV - Dr. Axe

Conventional Treatment

There is not one specific Epstein Barr virus test that doctors use to make a diagnosis. If a patient suspects they might have mono, their doctor can perform a physical exam and look for signs like swollen lymph nodes in the neck, an enlarged spleen, and white patches on the tonsils/back of the throat. Blood tests can also be done to check for certain antibodies and white blood cells that are produced in response to the virus.

As of today, there is no available vaccine in existence that can prevent EBV infection, and no medication that can “cure” the virus. How do doctors typically treat Epstein Barr virus symptoms then? EBV treatment usually involves managing symptoms while the virus passes, sometimes with medications to ease pain and discomfort. But antibiotics cannot be given since EBV is a virus and not a bacterial infection. Normally patients are told to rest and wait for the virus to pass within several weeks.

5 Natural Ways to Boost Your Immune System

1. Protect Against Infection

Prevention is very important when it comes to protecting yourself against Epstein Barr virus infection, since the virus cannot be treated once you catch it. Since EBV/mono is very contagious, it’s best for anyone who is infected to stay home from work or school until they are recovered. Remember that the virus can also sometimes be spread even if someone is no longer displaying symptoms. The virus is most likely to survive on objects short-term that remain moist (like toothbrushes).

  • Do not kiss or have sex with someone who is infected. Avoid this for at least four weeks.
  • Avoid sharing any items that can cause you to come into contact with saliva from someone who is infected, including utensils, toothbrush, chapstick, lip stick, drinking glasses, water bottles etc.
  • Practice safe sex and limit sexual partners. Always use a condom during any type of sexual intercourse.
  • Always wash your hands thoroughly after using public bathrooms, and shower after working out at a gym/fitness facility, or after engaging in contact sports.
  • Consume a nutrient-dense diet that’s low in sugar and processed foods but high in clean protein, healthy fats, and antioxidants from veggies and fruit. Include healthy fats such as coconut oil or wild-caught fish and foods with probiotics like yogurt or kefir.
  • Get enough sleep and try to keep stress under control in order to support your immune system. Try stress relievers including light exercise, yoga, meditation, reading, journaling, exercising, using essential oils and spending time in nature.
  • The following antiviral herbs and supplements may also help boost immunity against viruses: vitamin C, echinacea, elderberry, calendula, garlic and astragalus root.

Keep in mind that anyone who has had the virus in the past will not develop symptoms again because the body has developed immunity. It is only people who have never had EBV/mono before who should be concerned about contracting the virus. However, be very cautious when around someone with mono symptoms because it takes at least a few weeks for them to no longer be contagious. But something that’s tricky about mono is that once the virus is in your body, it stays there in an inactive state. It may become active again without causing any symptoms, but during this time you can still spread the virus to others.

2. Get Plenty of Sleep and Rest

Get plenty of sleep and rest, which will probably be easy to do considering how tired people with mono usually feel. Try sleeping in a dark, cool room that ideally has some ventilation so fresh air can make its way in.

Avoid vigorous physical activity/exercise for about a month after you start to feel better. Since your spleen may still be enlarged and swollen, it’s important to prevent twisting or impact that can lead to serious damage. You might also feel overexerted and exhausted from exercise more easily for a while, but this should go away with time. Give yourself breaks when needed, by napping, practicing light yoga/stretching, or doing meditation and breathing exercises.

Certain supplements might also help you to feel better if you continue to deal with low energy and lethargy. These include: adaptogenic herbs, omega-3 fatty acids, B vitamins, vitamin D3, magnesium and medicinal mushrooms.

3. Control Your Fever and Stay Hydrated

Your doctor may recommend over-the-counter painkillers such as acetaminophen or ibuprofen, but you can also use natural remedies to help control a fever and relieve muscle pains or headaches.

To prevent dehydration, make sure to drink water throughout the day, or other hydrating fluids like herbal tea and coconut water. Fruits, vegetables, bone broth and smoothies are also good choices for obtaining fluids.

When you have a fever and feel very fatigued, it’s common to deal with loss of appetite and potential weight loss. Here are some tips for dealing with loss of appetite; this way you can continue to eat foods that support your immune system:

  • Eat smaller meals more frequently, rather than one to two larger meals per day. If there’s a particular time of day you’re most hungry, eat your biggest meal then.
  • Sip on ginger tea, or use 1-2 drops of pure ginger essential oil mixed with water to soothe your stomach.
  • As much as possible, include nutrient-dense foods in your meals that will help your body fight the virus. These include: leafy green veggies (or fresh pressed green juices), orange and yellow fruits and vegetables, berries, melon, citrus fruits, avocado, clean lean proteins like eggs and grass-fed/pastured meats, olive and coconut oil, flax and chia seeds.
  • To obtain enough calories, eat energy-dense foods that don’t take up a lot of room in your stomach. For example, healthy fats (olive or coconut oil, grass-fed butter), eggs, grass-fed beef, full fat dairy, nuts and nut butters, avocado, and protein smoothies.
  • Limit caffeine consumption since caffeine can increase nervousness/anxiety, irritate your stomach and decrease appetite.
  • Don’t drink alcohol, since this may worsen dehydration, nausea and fatigue.
  • Inhale peppermint essential oil or rub it into your neck and chest. This can help to soothe your stomach.

4. Find Relief From a Sore Throat

If you’re dealing with a sore throat, these natural treatments can help ease the pain:

  • Try gargling with warm salt water (but do not swallow it).
  • Have some some raw honey stirred into tea or warm water with lemon juice.
  • Consume bone broth daily, or a smoothie made with powdered bone broth.
  • Take garlic capsules, or try adding raw garlic to some of your meals.
  • Take supplements that can help support your immune system, including: vitamin C, echinacea, licorice root, colloidal silver, zinc and a probiotic.
  • Use lemon and eucalyptus essential oil, either by diffusing them in your home or mixing them with coconut oil and then applying them to your skin over your chest.

5. Soothe Your Skin Rash

If you develop an Epstein Barr virus rash on your skin, try these natural rash remedies to reduce swelling and discomfort:

  • Take about 2,000 milligrams of vitamin C daily, which is a powerful antioxidant that can help reduce inflammation associated with rashes.
  • Apply a homemade DIY Rash Cream with Aloe & Lavender. Essential oils including geranium, rose and lavender can help to improve rashes. Combine 3 drops of each essential oil with a half teaspoon of coconut oil and apply it to the problem area three times per day. Aloe vera can help stop itching and redness. Either use aloe vera gel or a 0.5 percent aloe extract cream.
  • Apply organic coconut oil or coconut butter to skin if it becomes dry and irritated (make sure to use a product that contains no added fragrance, alcohol or dyes).


If you’re recovering normally from EBV/mono, you should feel better within four to six weeks. If your symptoms last longer, or you start noticing other symptoms like sharp pains in your abdomen, ongoing loss of appetite, severe dehydration, and fever, then always talk to your doctor.

Because mono may cause your spleen to enlarge, look for warning signs that this is happening. Head to the emergency room if you experience sudden, very sharp pains on the left side of your torso, which may mean that your spleen is in danger.

Final Thoughts

  • Epstein Barr virus (EBV) is a common virus in the herpes virus family that affects up to 90 percent of the population before the age of 20.
  • Not everyone will develop EBV symptoms. When they do occur, Epstein Barr virus symptoms can include: fatigue, loss of appetite, fever, sore throat, swollen glands, skin rash, and swollen liver and spleen.
  • EBV causes the common illness called mono (mononucleosis), and has also recently been linked to certain serious diseases, most of which are autoimmune in nature. These include: lupus, MS, arthritis, type 1 diabetes, celiac disease and inflammatory bowel disease. EBV may also contribute to certain types of cancers.
  • There is no vaccine for Epstein Barr virus and no cure once someone is infected. Treatment involves supporting your immune system while you recover over a four to six week period.
  • Natural ways to support your immune system while you recover from EBV include resting, staying hydrated, controlling your fever, managing a skin rash and easing sore throat pain.

More Health