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You Can Get Mono Twice

Holistic Health

Can you get mono twice? Symptoms, Causes & Prevention

Mono is one of those illnesses with an embarrassing reputation. Called “the kissing disease,” mono causes extreme fatigue and can be almost impossible to avoid getting if you come into contact with someone carrying it.

95% of Americans will contract mono during their lifetime. By the age of five, half of children are already affected.

In children, mono is milder and can be mistaken for a cold. In teens and young adults, though, mono may put your life on pause for weeks or months.

So it’s a good thing you can’t get mono twice — right? That is the common thought, but it’s not true.

What are the chances of getting mono twice? It can happen

The virus that causes infectious mono is called Epstein-Barr virus (also known as human herpesvirus 4), and it remains in your body your whole life. Usually, EBV just lives in your body while your immune system makes sure it isn’t getting up to any trouble. But in some cases, EBV may reactivate causing symptoms and contagiousness again.

EBV is a stealth pathogen. Stealth pathogens lay dormant in your body, only to crop up at a later date and trigger symptoms that can be very hard to identify.

There are methods of preventing stealth pathogens from reactivating. Learn about them — and what mono really is — below.

What causes mono?

Infectious mononucleosis (AKA mono, or glandular fever) is an infectious disease. It’s sometimes called “the kissing disease” because one of the most common ways it spreads is body fluids, such as saliva. However it can also spread through blood transfusions, sexual contact, and organ transplants.

When you have a mono infection, you need plenty of rest. It’s best to avoid heavy lifting and contact sports while you recover, because of an enlargement of the spleen, known as splenomegaly. Visit your healthcare provider for tips on how to best care for yourself and handle the symptoms related to mono.

What causes mono flare ups?

Epstein-Barr virus (EBV) causes mono infections and remains in your body for your whole life. EBV is actually a member of the herpes virus family — EBV is also called human herpesvirus 4.

According to the Centers for Disease Control and Prevention, EBV is one of the most common viruses in the world. Almost 95% of adults are infected.

And it doesn’t just cause mono. It’s estimated that EBV leads to 200,000 new cases of cancer each year. (This is a relatively small amount since more than seven billion people live with EBV.) 

EBV induces cancer in a small number of people and is most commonly associated with cancers of the head, neck, and lymphoma. It is currently unclear why this happens in only a small number of people. It will be interesting as the science comes to light and new information develops to see where there are potentially more ties.

EBV can be diagnosed with a blood test that detects elevated white blood cell count or EBV antibodies. About nine in ten adults possess EBV antibodies, showing they either have or at one point had an EBV infection. 

However, let me say that testing can be confusing and frustrating. There are a number of tests that can be run, each indicating different stages of EBV. So to cut down on confusion talk with your functional medicine provider about testing.

It’s so easy to spread EBV:

Chronic active EBV disease (CAEBV) is a complication of EBV. It is not a simple reactivation, but a chronic continual EBV infection. It’s unclear why a few people with EBV go on to develop chronic EBV, but it might have to do with a weakened immune system. These patients often present similarly to other EBV patients, however, their labs will indicate marked elevation of EBV DNA in the blood and infiltration of organs by EBV-positive lymphocytes. 

This form of EBV occurs when patients who have EBV infection are unable to control the infection; the virus remains in an active state, allowing symptoms of EBV infection to persist and progress. These patients can suffer potentially fatal complications and succumb to opportunistic infections, hemophagocytosis, multiorgan failure, or EBV-positive lymphoma related to immunodeficiency if not treated. 

What looks like mono, but isn’t?

At this time it’s really unknown how common it is to get mono twice because there isn’t a lot of information or standardized tests yet to understand the virus, it’s possible you have contracted another virus that exhibits similar symptoms. Some other viruses and disorders to consider being checked for:

Note* that it is statistically less likely you have contracted Coronavirus (COVID 19), if you are having symptoms of fever, chills, fatigue, and headache (shared symptoms with mono) consider this alternative if you have a cough (dry or sputum producing). You then might want to get screened for COVID 19. 

Common Mono Symptoms

Symptoms of infectious mononucleosis usually appear 4-6 weeks after you have caught Epstein-Barr virus infection.

Mono symptoms

Symptoms of chronic EBV

Causes of Recurring Mono

Can you get mono twice? Yes, you can get mono twice. The medical community is just now coming around to the idea that many people don’t get mono just once, and that having the virus can result in issues for decades. Here are some risk factors that increase the likelihood of getting mono twice:

Your immune system can also be weakened by alcohol, smoking, chronic stress, or poor nutrition, making it easier for mono to recur.

Is mono worse the second time?

No, if mono recurs, it’s often weaker than the first time, however the symptoms can be drastically different and elusive. This is why it's known as a stealth pathogen. Sometimes, the recurring mono will not exhibit any similar symptoms.

Can mono come back with stress?

Chronic stress can weaken your immune system, so it’s possible that this could be one trigger leading to a bout of recurrent mono. 

A Whole-Body Approach to Preventing Mono

Preventing mono the first time is almost impossible. 95% of people will contract EBV in their lifetime, which leads to mono.

But you may be able to prevent mono from happening a second time.

EBV is a stealth pathogen. If your immune system remains strong and effective, EBV should should be less likely to give you mono a second time.

What are stealth pathogens? Stealth pathogens are bacteria or viruses that can survive undetected in your body for months or even years before triggering an infection. Usually, stealth pathogens lead to chronic diseases or autoimmune disorders.

This is a controversial topic. As scientific evidence mounts in favor of stealth pathogens’ ability to hide from or suppress your immune system, many doctors are unaware of the research. Because of this, a doctor who doesn’t practice with a functional mindset may not think to investigate stealth pathogens as a cause of your symptoms, or they may simply dismiss you as over reactive and refuse to do testing.

How to treat stealth pathogens like EBV

The best defense against getting mono a second time is making sure your immune system is top notch.

How can you strengthen your immune system?

NOTE ON ANTIBIOTICS FOR EBV OR MONO: It may be necessary to treat secondary infections related to mono such as streptococcal (strep) infection, sinus infection, or an infection of your tonsils (tonsillitis) with antibiotics (along with antibiofilms). However, antibiotic treatment, while experiencing mono, must be monitored and prescribed with caution. 

Taking an antibiotic if you have EBV can result in an itchy rash caused by Amoxicillin and other penicillin derivatives. This rash doesn't mean that they are allergic to the antibiotic — it's an interaction related to EBV. 

Conventional medicine would recommend painkillers, such as acetaminophen (Tylenol) or ibuprofen (Advil), to relieve the symptoms of mono. At The Fork, we do not recommend treatments that only mask symptoms while introducing adverse side effects to your body.

If you want to bring down a fever or ease aching, try these all-natural painkillers:

Also when we have patients with EBV we recommend rest, self care, and supplements that slow down the replication of the virus, strengthen the immune system, and suppress reactivation.  

Talk to your functional medicine provider to find out what's right for you. 


Always consult your healthcare provider for medical advice when you take up a new dietary supplement or lifestyle adjustment.

If you live in Middle Tennessee or are willing to travel for quality services, call 615-721-8008 or click here to make an appointment at The Fork Functional Medicine in Franklin, TN. We help patients develop an individualized plan for whole-body health that can prevent stealth pathogens from wreaking their havoc.

Looking to the Future

Mono has affected billions of people in the world. It is possible to get mono twice.

The people who do contract mono a second time may have a weak immune system for one reason or another. Working with a functional medicine provider, you can engage in whole-body health that strengthens your immune response and prevents all sorts of chronic diseases.

Seek medical attention right away if you have difficulty breathing or swallowing, a high fever, debilitating headache, sharp pain on your left side or in your abdomen, or yellow in your eyes — as these are signs of serious conditions needing immediate attention.

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