Glandular Fever

Overview

Glandular fever (also called infectious mononucleosis) is a viral infection that can make you feel very tired and cause a sore throat, fever, and swollen glands. It is caused by the Epstein-Barr virus (EBV) and is most common in teenagers and young adults. Most people get better on their own with rest, fluids, and time.

Yes, glandular fever is quite common, especially among people aged 15 to 24. Many people carry the virus without ever having noticeable symptoms.

It most often affects teenagers and young adults, but anyone of any age can get it. Young children may have only very mild symptoms or no symptoms at all.

Symptoms

Common symptoms

• Very sore throat with red, swollen tonsils
• High temperature (fever)
• Swollen lymph nodes (glands) in the neck, armpits, or groin
• Extreme tiredness and weakness
• Headache
• Muscle aches
• Loss of appetite
• Discomfort or fullness in the left upper belly (from an enlarged spleen)
• Sometimes yellowing of the skin or eyes (jaundice)

Symptoms in children

• Mild fever or tiredness that may look like a cold
• Often no symptoms at all

Symptoms in older adults

• Less typical symptoms, such as prolonged fever, fatigue, and muscle aches
• The classic sore throat and swollen glands may be absent, which can make it harder to recognise

Causes

Main causes

• Infection with the Epstein-Barr virus (EBV)
• The virus passes from one person to another through saliva – kissing, sharing drinks, utensils, toothbrushes, or through coughs and sneezes

Risk factors

• Being aged 15 to 24
• Living in close groups such as university halls, boarding schools, or military camps
• Sharing personal items like drinking cups, toothbrushes, or cutlery
• Having intimate contact with someone who has the virus (EBV can also be found in genital fluids, though less commonly)

When to see a doctor

See a doctor urgently if:

• Contact your GP or local medical service on the same day if you have a severe sore throat and cannot drink enough fluids, a high fever, or worsening tiredness after a week.
• Also get urgent medical advice if you have left-sided belly pain, yellow skin or eyes, or any symptoms that worry you.

Book a routine appointment if:

• Make a routine GP appointment if your symptoms are not improving after 2 to 3 weeks.
• Ask for a check-up if you have missed a lot of school or work and need a recovery plan.
• See your doctor before returning to contact sports or heavy exercise.

Diagnosis

A doctor will ask about your symptoms and examine your throat, neck, and tummy. They may gently feel for an enlarged spleen or liver. If glandular fever is likely, they can arrange a blood test to confirm it.

Tests that may be done

• A Monospot blood test, which checks for antibodies to the Epstein-Barr virus
• A full blood count to see if your white blood cells are higher than usual
• Liver function tests to check whether your liver is affected

What to expect at your appointment

The doctor may advise you to rest and drink plenty of fluids while waiting for results. Many people can be diagnosed from symptoms alone, but blood tests help rule out other causes of a sore throat and fever.

Treatment

Glandular fever is caused by a virus, so antibiotics do not help. There is no specific cure. Treatment focuses on helping your body fight off the infection while easing symptoms and avoiding complications.

Self-care at home

• Rest as much as you need – your body is using energy to fight the virus
• Drink plenty of fluids (such as water, or diluted juice) to stay hydrated
• Gargle with warm salt water (half a teaspoon of salt in a glass of warm water) to soothe your throat
• Take over-the-counter pain relief as recommended by your pharmacist or doctor to help with fever and aches
• Avoid alcohol while unwell, to protect your liver
• Avoid contact sports, heavy lifting, and vigorous exercise for at least 4 to 6 weeks to reduce the risk of splenic injury

Medical treatments

Some people with very swollen tonsils or severe symptoms may need a short course of corticosteroid tablets prescribed by a doctor, to reduce swelling. If a bacterial infection is also present, a doctor might prescribe an antibiotic, but antibiotics will not kill the Epstein-Barr virus.

When is surgery considered?

Surgery is not a treatment for glandular fever itself. In a rare emergency where the spleen has ruptured, urgent surgery may be needed, but this is highly unusual.

Living with this condition

Plan your days around rest. Break activities into small, manageable chunks and listen to your body. If you feel tired, rest. You may need to take time off school, college, or work for a week or two.

Lifestyle tips

• Sleep and rest as much as you need
• Sip fluids throughout the day
• Avoid alcohol and smoking while recovering
• Start gentle activities, like short walks, when you feel ready
• Follow your doctor's advice about when it is safe to resume sports or exercise

Diet and exercise

There is no special diet needed, but eating healthy meals supports your immune system. Soft foods like soups, yoghurt, and scrambled eggs may be easier to swallow if your throat is sore. Gentle exercise can begin when you feel up to it, but avoid intense or contact sports until your doctor says it is safe.

Mental health and emotional wellbeing

Feeling ill for weeks, missing out on social plans, and dealing with extreme tiredness can be frustrating and can affect your mood. It is common to feel low, anxious, or isolated. Talking to a trusted friend, family member, or your GP can help. If these feelings persist, ask about counselling options.

Prevention

You cannot completely prevent glandular fever, but you can reduce the chances of catching it by not kissing or sharing personal items (such as cups, utensils, toothbrushes, or lip balm) with someone who has the infection, and by washing your hands regularly.

Vaccines

There is no vaccine for glandular fever. Good hygiene and avoiding saliva contact are the main ways to lower your risk.

Screening programmes

There is no routine screening for glandular fever. Blood tests are only used when a doctor needs to confirm a suspected diagnosis.

Complications

If left untreated

• Ruptured spleen – a rare but very serious emergency
• Anaemia (low red blood cells) or low blood platelets
• Liver inflammation (hepatitis) or jaundice
• Severe tonsil swelling that can make breathing difficult
• Prolonged fatigue lasting several months

Long-term outlook

Most people with glandular fever recover fully within 2 to 4 weeks of rest. Tiredness can sometimes continue for a few months, but it gradually improves. With careful self-care and avoiding contact sports during recovery, the outlook is very good. If symptoms become severe or persistent, doctors can help you manage them.

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