Glandular fever

Symptoms of glandular fever 

Glandular fever is caused by the Epstein-Barr virus (EBV). Symptoms are thought to take about one to two months to develop after infection with the virus.

The most common symptoms of the condition include:

• a high temperature (fever)
• a sore throat – this is usually severe, but in an older adult, or very young child, the infection may be present without a sore throat
• swollen glands (lymph nodes) in your neck and possibly in other parts of your body, such as under your armpits
• fatigue (extreme tiredness)

Glandular fever can also cause:

• a general sense of feeling unwell
• aching muscles
• chills
• sweats
• loss of appetite
• pain around or behind your eyes
• swollen tonsils and adenoids (small lumps of tissue at the back of the nose), which may affect your breathing
• the inside of your throat to become very red and there may be a whitish coating
• small red or purple spots on the roof of your mouth
• a rash
• swelling or ’puffiness’ around your eyes
• a tender or swollen tummy
• jaundice (yellowing of the skin and whites of the eyes)

Some of these symptoms may develop a few days before the main symptoms mentioned above.

While the symptoms of glandular fever can be unpleasant, most of them should pass within two to three weeks. Fatigue, however, can occasionally last several months.

When to seek medical advice

You should contact your GP if you think you or your child has glandular fever, or has a sore throat that is not settling (see sore throat).

They can provide advice and support to help you control your symptoms and reduce the risk of passing the infection on to others.

You should go to your nearest emergency department or dial 999 for an ambulance if you have glandular fever and you develop a rasping breath (stridor), have any difficulty breathing or develop a severe abdominal pain.

You should see your GP or call the GP out of hours service if:

• difficulty swallowing fluids is making you dehydrated
• you have abdominal pain (though this can occur with other viral infections that cause a sore throat)
• you become very unwell

These symptoms can be a sign of a complication of glandular fever that may need to be treated in hospital.

Treating glandular fever 

There is no cure for glandular fever. However, there are a number of simple treatments and measures that can help reduce the symptoms. These include:

• drinking plenty of fluids
• taking over-the-counter painkillers, such as paracetamol or ibuprofen
• getting plenty of rest and gradually increasing your activity as your energy levels improve

Occasionally, if your GP thinks this is necessary, other treatments may be needed if you develop complications of glandular fever.

Some people with particularly severe symptoms may need to be looked after in hospital for a few days.

How glandular fever is diagnosed 

To diagnose glandular fever, your GP will first ask about your symptoms and examine you.

Your GP may also recommend a blood test. This can help confirm the diagnosis. It can also help rule out infections that can cause similar symptoms, such as cytomegalovirus (CMV), rubella, mumps and toxoplasmosis.

Causes of glandular fever

Glandular fever is caused by the Epstein-Barr virus (EBV). This virus is found in the saliva of infected people and can be spread through:

• kissing – glandular fever is often called the "kissing disease"
• exposure to coughs and sneezes
• sharing eating and drinking utensils, such as cups, glasses and unwashed cutlery

If you have EBV, it's a good idea to take steps to avoid infecting others while you are ill, such as not kissing other people.

How the condition progresses

The information below outlines how glandular fever usually progresses:

• in most people, the disease usually lasts 2-3 weeks
• the sore throat is usually severe for 3-5 days and then resolves (gets better) over the next 7-10 days
• most symptoms tend to get better in 2-4 weeks, however, 20 per cent of people have a persistent sore throat at 4 weeks
• fatigue is common and usually lasts for a few weeks
• a minority of people (up to 10 per cent) have persistent fatigue that may last several months (most people with persistent fatigue recover within 2 years)
• Epstein-Barr virus (EBV) remains in the body lifelong

Possible complications 

Complications associated with glandular fever are not common. However, when they do occur they can be serious (see when to seek medical advice above). They can include:

• further infections of other areas of the body, including the brain, liver and lungs
• severe anaemia (a lack of oxygen-carrying red blood cells)
• difficulty breathing as a result of the tonsils becoming significantly swollen
• a ruptured (burst) spleen, which may need to be treated with surgery

• Find out more about glandular fever on the NHS website

More useful links

• How to use your health services