What Is Epstein-Barr Virus (EBV)?

Epstein-Barr virus (EBV) is a common and highly contagious herpes virus that spreads through bodily fluids like saliva. About 90% of adults have had an EBV infection at some point. EBV is often asymptomatic but may cause symptoms such as fatigue, fever, sore throat, swollen lymph nodes, and rash. EBV may also cause infectious mononucleosis, or mono.  

Diagnosis of EBV can be challenging because symptoms are similar to those of many other conditions. A blood test that detects the presence of specific antibodies is the most common tool used to diagnose EBV. Treatment for EBV typically involves managing the symptoms, such as with rest, fluids, and pain relievers. 

Types of Epstein-Barr Virus

EBV is classified into two major types: type 1 and type 2. While your healthcare provider may not determine which type you have, researchers studying EBV may use molecular and genetic techniques to distinguish between different types or strains of the virus. Understanding different EBV strains can help support the development of vaccines and therapies to prevent and treat EBV and associated conditions.

Type 1 

Type 1 is the most common type of EBV and is linked to most cases of mono. There are several strains of the virus within type 1, which vary in their genetic makeup and geographic distribution. For example, the EBV strain most commonly associated with nasopharyngeal carcinoma (a type of throat cancer) is more prevalent in certain regions in Asia.

Type 2 

Type 2 is less common than type 1. Type 2 EBV is more prevalent in Alaska, central Africa, and Papua New Guinea. Less is known about type 2 EBV and its strains, but researchers continue to explore this type and its potential complications.

Epstein-Barr Virus Symptoms 

Most people with an active EBV infection are asymptomatic, meaning they do not experience any symptoms. By age 5, about 50% of children have been infected with the virus, with most of these children not having any symptoms.

Teenagers and adults, as well as people who are immunocompromised, might be more likely to develop symptoms.

When EBV causes symptoms, they can vary widely in severity and duration. Some people may experience only mild or no symptoms, while others may develop more severe symptoms that can last for weeks or months. Common EBV symptoms include:

• Fatigue 
• Sore throat 
• Swollen lymph nodes in the neck and armpits 
• Fever 
• Rash 
• Headache 
• Abdominal pain 

Once you’ve been infected with EBV, the virus lies dormant in your body. Certain factor, such as stress, can reactivate the virus. If you have a weakened immune system, you are more likely to experience symptoms when the virus reactivates.

EBV is the most common cause of mono, which may cause additional symptoms such as a swollen liver and enlarged spleen. About 25% of teenagers and young adults who have EBV will develop mono.

How Does Epstein-Barr Virus Spread?

By adulthood, most people have been infected with EBV. You most commonly first get infected with the virus sometime in childhood.

EBV is transmitted through contact with bodily fluids. This is most commonly saliva, but it can also be blood and semen. Sharing drinks, food, and utensils can spread the virus from person to person. Kissing and sexual contact, as well as blood transfusions and organ transplants, can also transmit the virus.

Once the virus enters the body, it infects B lymphocytes—a type of white blood cell involved in the body’s immune response. This leads to the production of viral particles, which can infect other cells, such as epithelial cells. Epithelial cells act as a “shield” on and inside the body, covering all body surfaces, organs, and glands. Research suggests that the EBV virus that has infected epithelial cells may explain why EBV increases the risk of certain cancers and other health conditions.

How Is Epstein-Barr Virus Diagnosed?

Epstein-Barr virus can be tricky to diagnose because symptoms are often similar to other common health conditions, such as influenza. If your healthcare provider suspects you have an EBV infection, they may order blood tests to confirm the diagnosis and rule out other possible causes. 

The most common diagnostic tool used to diagnose EBV is an Epstein-Barr virus antibody test. A blood sample is taken from a vein and sent to the lab where it is checked for antibodies that indicate an active or past EBV infection.

In the early stages of EBV, little to no antibodies may be detected in blood tests. Your healthcare provider may recommend repeating the test 10-14 days after the initial blood test. 

Treatments for Epstein-Barr Virus  

There is no antiviral medication for EBV, which means the virus itself can't be treated against. Treatment for EBV instead focuses on symptom relief. Treatment includes:

• Hydration: Drink plenty of water and other fluids to prevent dehydration.
• Rest: Get good-quality sleep each night and take breaks throughout the day as needed.
• Over-the-counter medicines: Over-the-counter medications may be recommended to relieve any pain or fever. 

How to Prevent Epstein-Barr Virus

EBV is so prevalent worldwide that it is difficult to avoid an infection. However, there are some steps you can take to lower your risk of infection:

• Avoid close contact with people with EBV or mono, especially if they have symptoms such as a fever or sore throat.
• Wash your hands frequently with soap and water.
• Do not share personal items like drinking glasses, utensils, or toothbrushes with others.

While researchers have been trying to develop an EBV vaccine for decades, there is not yet one available.

Related Conditions

EBV is linked to an increased risk of chronic health conditions and diseases. Research suggests that EBV alters the function of immune cells, which may “turn on” certain genes linked to a higher risk of these conditions.

EBV can cause complications and increase the risk of the following conditions:

• Chronic active EBV: In rare cases, EBV may become chronic and cause ongoing symptoms such as fatigue, swollen lymph nodes, and fever.
• Autoimmune diseases: EBV has been linked to an increased risk of certain autoimmune diseases like lupus, rheumatoid arthritis, and multiple sclerosis.
• Cancer: EBV increases the risk of certain types of cancer, including Hodgkin’s lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma. 
• Neurologic complications: In rare cases, EBV may affect the brain, nerves, and spinal cord and cause conditions such as viral meningitis, sleep disorders, and Guillain-Barré syndrome. Complications of EBV may also cause the brain or optic nerve to swell.
• Lung diseases: Pneumonia and interstitial lung diseases (a group of conditions that can cause lung scarring) may be tied to EBV.

Over the past decade, researchers have been trying to develop a vaccine to target some of the complications associated with EBV.

Living With Epstein-Barr Virus 

Most people with an EBV infection recover within two to four weeks, though some may experience fatigue and weakness for weeks to months after infection. When you have EBV, be sure to get plenty of rest, stay hydrated, and eat a balanced diet to support your immune system. If you experience ongoing symptoms, talk to your healthcare provider about what you can do to manage symptoms and maintain a good quality of life.