Mononucleosis, or mono, is a condition caused by acquiring a viral infection. Most of the time, a person will have mononucleosis once. However, it is possible to experience mono twice.

Since the body develops immunity to the virus after contracting the infection, most people do not experience mono twice. However, in some cases, symptoms can reoccur months after acquiring the initial infection.

Treating the symptoms can help a person recover from mononucleosis. People who experience recurring symptoms should see their doctor for a full diagnosis, even if the symptoms seem familiar.

Keep reading to discover if it is possible to experience mono twice, including the treatment options.

Woman coughs with mono.Share on Pinterest
Image credit: Brothers91/Getty Images

Infectious mononucleosis, commonly called mono, is a disease that occurs when a person acquires a virus.

The Centers for Disease Control and Prevention (CDC) note that the Epstein-Barr virus (EBV) is the most common cause of mono, though other viral infectious may also trigger the condition.

The condition is most common among young adults and teenagers, while at least 25% who acquire an EBV infection will develop mononucleosis. However, it can also occur in adults and children.

Symptoms usually appear about 4–6 weeks after acquiring the infection. This long incubation period can make it easy to transmit mono to another person. The viruses that cause the disease typically spread through bodily fluids, of which transmission by saliva is the most common. The virus can also pass to another person through blood or semen.

A person may still transmit EBV after their symptoms clear. Research notes that a person may have saliva containing the virus for around 6 months after the onset of their illness.

Viruses, such as EBV, can easily pass on to other people by sharing objects, such as drinking glasses, toothbrushes, or lip balm.

Symptoms of mono may vary from person to person. The typical indicators include:

  • fever
  • sore throat
  • swollen lymph nodes.

Mono can also trigger severe fatigue in many cases. Other symptoms can include:

  • body aches
  • headache
  • rashes on the skin
  • loss of appetite
  • lesions on the inside of the mouth

In less common cases, a person may develop a swollen liver or spleen. Some may also experience high liver enzymes or other abnormal markers on a blood test.

Much of the time, after a person develops mono from a virus, such as EBV, they will not get it again once symptoms disappear.

This is because EBV, the common virus that causes mono, stays in the body. It remains inactive, meaning it cannot trigger the condition again.

The body continues to make antibodies against the virus throughout a person’s life, giving them immunity. Even if the virus reactivates, people will likely experience no symptoms.

However, it is possible to experience mono twice.

People with compromised immune systems may be more at risk of experiencing mono twice if the virus reactivates within the body.

In other cases, a person may feel the symptoms go away and then worsen. This may be due to symptoms of the initial illness not yet fully resolving.

In rare cases, mono can lead to a recurring condition called chronic active Epstein-Barr (cEBV) disease. This rare illness can cause persistent symptoms that do not go away, requiring regular treatment.

Much of the time, what appears as a relapse of mono symptoms is actually due to a different illness.

Many of the common symptoms of mono, such as fatigue, fever, and sore throat, are common indicators of other conditions.

Common infections, such as strep throat or the influenza virus, can trigger similar symptoms. Experiencing these conditions after having mono may make a person feel as if they have mono again.

People with compromised immune systems may experience an actual relapse of mono symptoms. This could occur during an especially difficult moment in the immune system, such as when the body is fighting off other infections. However, it is not completely clear what causes mono to reactivate.

People should not self-diagnose based solely on the similarity of symptoms, as several health issues may trigger similar symptoms.

Anyone with symptoms of mono for a second time should speak with a doctor for a complete diagnosis.

Mononucleosis is extremely common. As research from Clinical & Translational Immunology notes, over 90% of the world’s population have EBV, the virus that commonly causes mono. There is no vaccination for the virus.

People with concerns about their risk of mono or its effects may take some simple steps to avoid bodily fluids that contain the virus however possible, including:

  • regularly washing the hands
  • sanitizing shared objects or surfaces
  • avoiding shared items such as cups and utensils
  • avoiding shared personal items such as lip balms or lipsticks
  • avoiding kissing or sharing saliva with people who may have mono
  • avoiding unprotected sex with people who may have mono

Many cases will not require medical treatment. Mono symptoms usually pass over time, and most people get better within 2–4 weeks. However, some people may need more time to recover, with symptoms lasting for more than 6 months.

Additionally, some symptoms may linger. People may feel fatigued for weeks after initial symptoms end. In those whose symptoms include an enlarged liver or spleen, their organs may stay enlarged even after other symptoms resolve.

Treatments usually focus on relieving symptoms and preventing complications. It is important to stay hydrated and get plenty of rest during recovery.

Over-the-counter drugs, such as ibuprofen (Advil) and acetaminophen (Tylenol) may help ease symptoms.

As mono occurs from acquiring a viral infection, antibiotics are not effective treatments. Therefore, do not take antibiotics, such as amoxicillin or penicillin, for mono.

In severe cases affecting organ systems, doctors may have more targeted treatments to help control these symptoms.

EBV is extremely common and the most prevalent reason for mononucleosis. The condition typically requires no treatment, while managing symptoms may help the body recover.

While it is possible to experience mono twice, most people will develop a lifetime immunity, yet the virus will remain inactive in the body.

People with compromised immune systems may experience mono twice. Additionally, other infections and conditions may trigger similar symptoms. People who have a reoccurrence of mono symptoms should see a doctor or healthcare provider for a full diagnosis.