What Are the Stages of Mono?

Written by

Jessica Guht

Jessica is a medical writer with an unquenched thirst to discover something new. She believes that medical content should be accessible to everyone and strives to write content that every single person can understand. When Jessica isn’t writing, she can usually be found reading a book with a dog cuddled in her lap. Jessica has a Masters of Engineering degree in Biomedical Engineering.

Medically reviewed by

Amy Dougherty, FNP-BC, AGAC

Amy is a Board Certified Family Health Nurse Practitioner (FNP) with over 15 years of experience working in Hospital Medicine, Urgent Care and Primary Care practices. Amy graduated Thomas Jefferson University with high distinction earning a Bachelor of Science in Nursing in 2008, a Master of Science in Nursing in 2010 and a Post Master's Certificate in Adult Gerontology Acute Care (AGAC) in 2014. She was recognized by the Elite American Nurses Association in 2013 for her dedication, achievements and leadership in the field Nursing. She served as a clinical preceptor for a number of Nurse Practitioner students and enjoys teaching the bright minds of future NPs.

Mononucleosis, or mono, is a highly contagious disease often spread through kissing, earning it the nickname the “kissing disease.” Because of how contagious mono can be, many people contract it at some point in their lives, with children and teenagers at the highest risk.

Mono progresses through three distinct stages, which occur after the incubation period:

• The prodrome stage: Typically most of the symptoms of mono start to appear.
• The acute phase: Here symptoms intensify including sore throat, fever, and swollen lymph nodes.
• The convalescent phase: Focusing on recovery, which can last several months.

Each of these stages has its own set of symptoms, complications, and timeline. Knowing the stages of mono can help manage your symptoms and give you peace of mind knowing what to expect.

Key takeaways:

• Mononucleosis also known as mono is a contagious disease that is common among teenagers and young adults.
• Mono is caused by the Epstein-Barr virus which is spread through saliva, blood, and other bodily fluids.
• Mono progresses through three stages: the prodrome stage, the acute phase, and the convalescent phase.
• After the incubation period, it takes around 15 weeks to 8 months to fully recover from mono.

Continue reading to learn more about each stage of mono and how to cope with this illness.

Table of Contents

• What Is Mononucleosis (Mono)?
• Stages of Mono 
• Stage 1 of Mono: Prodrome
• Stage 2 of Mono: Acute Phase
• Stage 3 of Mono: Convalescent Phase
• How Long Does It Take for Mono to Run Its Course?
• How to Treat Mono?
• When to See a Doctor?
• In Conclusion

What Is Mononucleosis (Mono)?

Mononucleosis, also known as mono, is a contagious disease that is common among teenagers and young adults, especially those in college.

What Causes Mono?

Mono is most often caused by the Epstein-Barr virus (EBV), although it may also result from other viruses.

Not everyone who contracts EBV develops mono, though, and it occurs in only a quarter of those who are infected with EBV.

The viruses that cause mono spread most easily through body fluids, saliva in particular, although they can also spread through blood, breast milk, and semen, although this is less common.

In very rare cases, mono may be transmitted through organ transplants or blood transfusions.

Symptoms of Mono

The general symptoms of mono may not appear until four to six weeks after becoming infected with EBV. Additionally, symptoms may not occur all at the same time.

Some of the most common symptoms of mono include:

• fever
• extreme fatigue
• head and body aches
• sore throat
• rash
• swollen liver and/or spleen
• swollen lymph nodes in the armpits and neck

While many people get better within 2-4 weeks, fatigue may linger for several weeks. In some cases, the symptoms of mono may last for six months or more.

Stages of Mono

Mono infection can be divided into three stages, which occur after the incubation period. 

The incubation period is how long it takes between becoming infected and showing symptoms, and the length can vary by person between 4-6 weeks. However, some people, especially young children, may not even realize they have mono, and they will carry the virus in a dormant stage for their whole life unless it reactivates and begins causing symptoms.

Stage 1 of Mono: Prodrome

The first stage of mono, also called prodrome, is typically when most of the symptoms of mono start to appear.

The symptoms of the prodrome stage include:

• feeling “off”
• fatigue
• sore throat
• lack of appetite

These symptoms typically last 3-5 days, although some people may not have any symptoms.

While in the prodrome stage, it is possible to pass the virus to someone else, as EBV continues replicating in the body. However, since many people may not have symptoms or very general symptoms that are not attributed to mono, it is very easy to pass the virus to someone else.

Fatigue is the most common symptom of the prodrome stage, which can easily be confused with other illnesses or causes. If you are feeling unwell, it is always best to stay home and rest so that your body can heal and you are less likely to pass a potential infection to someone else.

Stage 2 of Mono: Acute Phase

The acute phase is the second phase of mono, where symptoms may start getting worse, and in some people, this may be when symptoms begin to appear. This is because, when entering the acute phase, the natural immune response is worn down due to the prodrome phase, and the infection is also at a maximum. This results in the appearance or worsening of symptoms.

The symptoms of this phase can include:

• sore throat
• fever
• swelling of the lymph nodes
• headaches
• exhaustion
• body aches
• rash
• swelling of the liver and/or spleen

While these are all potential symptoms of mono, not everyone will experience all these symptoms. Additionally, in many cases, these symptoms may appear at different times, not all at once.

On top of that, the severity of symptoms will vary in this stage, with some people experiencing only mild to moderate symptoms while others may experience more severe symptoms.

The length of time in this phase can vary from 2-6 weeks.

Stage 3 of Mono: Convalescent Phase

The final stage of mono is the convalescent phase, which is when the body begins to recover from the infection. This recovery period can last from three to six months.

Most symptoms of mono have gone away and gotten better by the time someone enters this third stage, although many people may still feel weak and tired.

Additionally, if you have an enlarged or inflamed spleen, it is crucial to avoid physical activities that may cause the spleen to rupture.

While you are recovering from mono, it is still possible to spread the virus to others. While it is not necessary to isolate, it is possible to spread mono by coughing or sneezing too close to someone, so always cover your mouth and nose when needed, and wash your hands frequently.

Mono can also spread through kissing, so you may need to avoid kissing others while you still have mono; otherwise, you may infect them.

How Long Does It Take for Mono to Run Its Course?

There is considerable variability in how long it takes to fully recover from mono, with ranges from 15 weeks to 8 months, not including the incubation period before symptoms start, which can last from 4-6 weeks.

Fatigue is a significant symptom of mono and is often the one that lasts the longest. Even worse, some studies have shown that mono can cause chronic fatigue syndrome, leaving you with considerable fatigue even after your body has healed from mono.

In addition, some potential long-term complications can result from mono, the biggest being that mono and EBV leave the body in a vulnerable and weak position, which increases the possibility of being infected by other infections.

Other complications can also occur if there has been damage to the spleen or liver. Some potentially serious complications include:

• liver failure
• jaundice
• encephalitis
• peritonsillar abscess
• pleural effusion

These complications and their effects can last even after someone has recovered from mono.

While more research is needed, there may also be a connection between mono/EBV and multiple sclerosis, other autoimmune diseases, and lymphomas.

In rare cases, someone may develop a chronic active EBV (CAEBV) infection, which results when the EBV remains active in the body for a long time, extending how long it takes for mono to run its course.

How to Treat Mono?

There is no cure or treatment specific for mono, and there is not much you can do to speed along how quickly your body gets over mono.

When you have mono, the best thing you can do for your body is support it as it fights off the virus. Some ways to do this include:

• drinking plenty of fluids
• resting
• using over-the-counter (OTC) or prescription medication for fever or pain
• taking medication for inflammation

For those with a severe case of mono, a healthcare provider may prescribe a corticosteroid. This is most effective when the infection is noticed during the prodrome stage since it can help boost the body’s natural immune system.

Because of the risk of spleen rupture, it is also recommended to avoid contact sports until you have fully recovered.

How to Prevent Mono?

There is no vaccine to protect against mono, so the greatest way to prevent this infection is by refraining from kissing or sharing personal items (e.g., utensils, toothbrushes, cigarettes), drinks, or food with people who have mono.

It’s also important to follow good hand hygiene and to wash your hands frequently whenever you are around someone who has mono.

Putting your body in the best position to fight infection can also help prevent mono. You can do this by maintaining a healthy lifestyle through regular exercise and a well-balanced diet.

When to See a Doctor?

In most cases, mono does not require medical intervention and will run its course on its own. However, if your symptoms have lasted longer than ten days, or if you have a sore throat for two or more days (or it is getting worse), it is recommended to see a doctor.

Your doctor can help perform some tests to rule out other illnesses that can cause similar symptoms, such as the flu or strep throat.

Additionally, if at any point in your illness, you have difficulty breathing or a fever that persists for a few days, reach out to your doctor.

Those with mono are at an increased risk of rupturing their spleen, so it is crucial to seek immediate medical attention if you ever notice a sharp and sudden pain in your abdomen or side.

For non-emergency cases, DrHouse can help you manage your symptoms of mono. While they are not often severe, they can still impact your daily life. With DrHouse, you can meet with an online doctor in 15 minutes to discuss at-home remedies that can help relieve your symptoms and aid your body as it fights the virus.

In Conclusion

Mononucleosis (mono), also known as the kissing disease, is spread most often through saliva and is caused by the Epstein-Barr Virus. When first infected with mono, the body goes through an incubation period, which can last for 4-6 weeks before symptoms start appearing.

There are three stages of mono: prodrome, acute, and convalescent. The prodrome phase may show mild symptoms, while in the acute phase, additional symptoms may appear, and existing symptoms may worsen. In the convalescent stage, the body heals from mono, which can take months.

Recovery from mono is a long process that can’t be sped up too much, but an online doctor can discuss remedies to your symptoms and how you can help your body build a stronger immune system. 

Sources:

• Rasa, S., Nora-Krukle, Z., Henning, N., Eliassen, E., Shikova, E., & Harrer, T. et al. (2018). Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Journal Of Translational Medicine, 16(1). Doi: https://www.doi.org/10.1186/s12967-018-1644-y.
• Balfour, H. H., Jr, Dunmire, S. K., & Hogquist, K. A. (2015). Infectious mononucleosis. Clinical & translational immunology, 4(2), e33. Available from: https://doi.org/10.1038/cti.2015.1.
• Won, A., & Ethell, A. (2012). Spontaneous splenic rupture resulted from infectious mononucleosis. International Journal Of Surgery Case Reports, 3(3), 97-99. Doi: https://www.doi.org/10.1016/j.ijscr.2011.08.012.
• Rasa, S., Nora-Krukle, Z., Henning, N., Eliassen, E., Shikova, E., & Harrer, T. et al. (2018). Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Journal Of Translational Medicine, 16(1). Doi: https://www.doi.org/10.1186/s12967-018-1644-y.
• Pizzigallo, E., Racciatti, D., & Gorgoretti, V. (2010). EBV CHRONIC INFECTIONS. Mediterranean Journal Of Hematology And Infectious Diseases, 2(1), e2010022. Doi: https://www.doi.org/10.4084/mjhid.2010.022.
• About Infectious Mononucleosis. (2020). Centers for Disease Control and Prevention (CDC). Available from: https://www.cdc.gov/epstein-barr/about-mono.html.