Epstein-Barr Virus: What to Know, From Mono to Cancer (2023)

EBV infection is very common and is spread by coming into contact with bodily fluids of people who are sick with it. Adults who get sick may experience fatigue, swollen lymph nodes, and fever.

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 isinfectious 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:

These symptoms can last for2 to 4 weeks, though feelings of fatigue may linger for weeks or months.

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 testscan detect the presence of antibodies associated with EBV.

One of these is known as the monospot test. However, the Centers for Disease Control and Preventiondoesn’t recommendit for general use because the results aren’t always accurate.

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.

These include:

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 andCOVID-19are caused by different viruses.

However, a research study from2021and another from2022suggest that inflammation caused by COVID-19 may cause EBV reactivation in some people.

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 onlyhealth conditionassociated 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
  • fever
  • enlarged liver (hepatomegaly) or spleen (splenomegaly)
  • fatigue
  • sore throat
  • headache
  • muscle pain
  • joint stiffness
  • anemia
  • liver failure

Experts aren’t sure why some people develop CAEBV. But theybelievegenetic factors or mutations in EBV-infected cells may play a role. In addition, CAEBV ismore commonin Asia, Central America, and South America.

Currently, the only effective treatment for CAEBV is ahematopoietic 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 theAmerican Cancer Society, some types of cancer that may be associated with EBV include:

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 about1 percentof cancers worldwide.

EBV may also play a role in the development of other health conditions, including autoimmune disorders and schizophrenia.

Autoimmune disorders

EBV has long been thought to be linked to autoimmune disorders, such aslupus. 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.

One 2018studysupported by theNational Institute of Allergy and Infectious Diseasesand other NIH components found a potential link between EBV and an increased risk of developing lupus, an autoimmune condition.

The study’s authors believe that same mechanism linking EBV and lupus may also link EBV to other autoimmune conditions, which can include:

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 2019studylooked at rates of EBV infection in more 700 people both with and withoutschizophrenia. 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 2021studyled by the same researcher found that in 84 individuals with schizophrenia, having a higher amount of antibodies was associated with a lower cognitive performance. The study’s authors suggest that EBV exposure may contribute to cognitive deficits in people with schizophrenia.

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.


Epstein-Barr Virus: What to Know, From Mono to Cancer? ›

The Epstein Barr virus (EBV) increases the risk of some cancer types. But, for most people that have the virus, it will not cause them any problems. EBV is linked to Hodgkin lymphoma , Burkitt lymphoma (a rare type of non-Hodgkin lymphoma) and nasopharyngeal cancers.

What are the odds of getting cancer from mono? ›

Results: Patients diagnosed with infectious mononucleosis had a cancer incidence of 5.3 cases per 1000 person years versus 4.4 cases per 1000 person years for patients without infectious mononucleosis.

What type of cancer is most associated with Epstein-Barr virus? ›

EBV infection increases a person's risk of getting nasopharyngeal cancer (cancer of the area in the back of the nose) and certain types of fast-growing lymphomas such as Burkitt lymphoma. It may also be linked to Hodgkin lymphoma and some cases of stomach cancer.

What can the Epstein-Barr virus EBV induce tumors in? ›

The virus has been found to be associated with several malignancies, including gastric carcinoma, Hodgkin's lymphoma, leiomyosarcomas, lymphoepithelioma-like carcinoma, and nasopharyngeal carcinoma (NPC), with NPC being the most associated [10,11,12].

What are three tumors caused by Epstein-Barr virus? ›

Epstein–Barr virus (EBV) is a herpesvirus associated with a variety of tumours including B and T lymphomas, NK cell malignancies, carcinomas and smooth muscle tumours.

How often does EBV lead to cancer? ›

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 1 percent of cancers worldwide.

How often does mono turn into lymphoma? ›

The Epstein-Barr virus (EBV) causes infectious mononucleosis (often called mono). People who have had mono have an increased risk of HL. But even though the risk is higher than for people who haven't had mono, it is still very small (about 1 in 1,000).

What is the survival rate of EBV cancer? ›

In patients older than 45 years, the 5-year disease free survival was 37% in EBV+ cases vs. 74% in EBV- cases (p = 0.02). In patients younger than 45 years, the 5-year disease free survival was 50% in EBV+ cases vs. 67% in EBV- cases (p = 0.17).

What are the 4 stages of Epstein-Barr virus? ›

For EBV we have a six-stage model of infection (naive Blast, GC, memory, Immediate early lytic, Early lytic and Late lytic) where each stage may or may not be regulated by the immune response.

What is the life expectancy of someone with chronic Epstein-Barr virus? ›

Chronic active Epstein-Barr virus infection often results in poor prognosis. A large cohort study [18] in Japan reported that 43% of patients died during follow-up periods that ranged from 5 months to 12 years after the onset of severe CAEBV infection.

What organ does Epstein-Barr virus affect? ›

EBV infection can affect a person's brain, spinal cord, and nerves.

How does EBV turn into lymphoma? ›

Some occur as rare accidents of virus persistence in the B lymphoid system, while others arise as a result of viral entry into unnatural target cells. The early finding that EBV is a potent B-cell growth transforming agent hinted at a simple oncogenic mechanism by which this virus could promote lymphomagenesis.

What can EBV turn into? ›

EBV can cause infectious mononucleosis, also called mono, and other illnesses. Most people will get infected with EBV in their lifetime and will not have any symptoms. Mono caused by EBV is most common among teens and adults.

What is Epstein-Barr lymphoma? ›

The Epstein-Barr virus (EBV) is the virus that causes mononucleosis, also known as "mono," and it is associated with some types of NHL. These include Burkitt lymphoma, lymphomas occurring after an organ transplant, and, rarely, other lymphomas in people who are otherwise healthy.

Is Epstein-Barr virus HPV? ›

Epstein-Barr virus (EBV) and human papillomaviruses (HPVs) are human tumor viruses that cause head and neck cancers. EBV is an enveloped, double-stranded DNA virus with tropism for epithelial cells and resting B lymphocytes.

How often is mono serious? ›

In general, mononucleosis is not considered a serious illness. However, mononucleosis can lead to significant loss of time from school or work due to profound fatigue and, on rare occasion, can cause severe or even life-threatening illness.

What does mono increase the risk of? ›

Mono Can Also Cause These Rarer Complications

Nervous System Problems These include meningitis, encephalitis, Guillain-Barré syndrome, Bell's palsy, and seizures. Certain Cancers These include Burkitt lymphoma, Hodgkin lymphoma, and nasopharyngeal carcinoma.

Does mono cause breast cancer? ›

According to Medical News Today, a study published in EBioMedicine notes that EBV binds to a certain type of breast cells. These now infected breast cells can be more susceptible to cancer complications in the future. Many with EBV will never experience breast cancer in their lives.

What is the survival rate for lymphoma? ›

5-year relative survival rates for Hodgkin lymphoma
SEER Stage5-Year Relative Survival Rate
All SEER stages combined89%
Mar 2, 2023


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