[Question #4932] Mono illness

27 months ago
Hello,

11-12 months ago STI panel performed including HIV, results negative. Since then, had protected sex with two different escorts from escort agency but unprotected oral sex, the most recent of these two was approximately 8-9 weeks ago. 

This past week I become suddenly sick, fever chills worst sore throat ever, white patches in back of throat, unable to swallow water without cringing. Original doctor assumes Strept but I end up in ER over weekend as pain was too unbearable and they say I test positive for Mono. 

My general physician thinks it’s weird for someone my age to get mono (41). Can you please advise on strength of the test? Any chance these symptoms are from hiv and trigger a positive mono result? 

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome to the forum. Thanks for your question.

Indeed, infectious mononucleosis is uncommon at your age, but not unheard of. And at your age, many (most?) cases are the result of reactivation of infection acquired many years earlier. Epstein Barr virus (EBV), the cause of mono, is a lifelong infection -- once infected, EBV persists forever. Most infections are acquired in childhood to early 20s, usually without symptoms -- so even if you didn't have mono when young, it doesn't mean you weren't carrying the virus.

EBV is transmitted both through saliva (mono often is called "the kissing disease" among children and teens) and also sexually. Oral sex might transmit the virus -- no actual reported cases, but since EBV is carried in saliva, it probably can occur. Condom protected sex probably is an unlikely source. Another argument against catching it sexually is the time that has passed:  symptoms of new EBV mono start within 2-4 weeks of exposure.

The test itself is highly reliable. Some mono-like infections are caused by viruses other than EBV, but the standard test (called Monospot) usually is accurate.

So the bottom line is that this probably has nothing to do with your sexual exposures. I don't see any need to test for other STDs.

That said -- and I don't want to alarm you -- acute HIV infections cause almost identical symptoms as mono. For that reason, you should play it safe and have an HIV test; discuss it with your doctor. However, I definitely do not think that's the problem and you can expect a negative test result.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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27 months ago
Dr. Handsfield,

Thanks for your response. Your logic and reasoning has always been a calming influence over the years on this board. Based on all of your past comments I suppose I was hoping to be assured that what I’m going through is likely just mono symptoms... 

With that said I am ok having another test. I am just shaking at the thought, not because of my fear of having hiv but knowing that I likely have given it to my wife as well. No one to blame but myself. 

Is those rapid test places where they prick your hand ok to go to? 

The fact that I’m still fully dealing with mono symptoms won’t affect the test? 

Thanks



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
There are no medical conditions or symptoms that interfere with HIV testing. Your mono won't have any effect on HIV testing. The rapid HIV blood tests are OK, but not the rapid oral fluids test. But the gold standard is a lab-based blood test. You should discuss this with the doctor who diagnosed your mono and let him or her refer you to the right lab for the best test. Most likely, they'll just draw a blood specimen in the office.

I'm not sure whether your concern you "likely have given it to [your] wife" refers to HIV or mono. As discussed, almost certainly you don't have HIV; that shouldn't be a significant concern. If EBV/mono is on your mind, your wife probably isn't at risk. As noted above, >90% of all persons are infected in childhood. Even though such persons may occasionally develop recurrent mono at older ages, which probably is what happend to you, they are immune to infection from new exposures.
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27 months ago
Thanks Doctor. I know this is my last follow up so I’ll keep it brief and again thank you for what you do. 

To be clear, I was in the ER so an ER doctor ultimately said i had mono. I have scheduled an appt for a blood test tomorrow for the hiv. 

At the ER they ran a full blood work of me, unfortunately HIV never came up but they said my blood all looked good etc. 

Would the fact that My incident was 8-9 weeks ago decrease my chances that these mono symptoms are HIV. I’ll find out soon enough after tomorrow’s test, just tryin to ease my mind best I can I suppose. 

Lastly, assuming the test comes back fine, when can I have sex with my wife again and not risk giving her mono? I have read so many different inconsistent things online about being able to potentially get her sick for months and months after.  

Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
"Would the fact that My incident was 8-9 weeks ago decrease my chances that these mono symptoms are HIV?" Yes, that's in fact the main reason I think there is essentially no chance your symptoms are due to HIV. Symptoms of new HIV infections start within 1-3 weeks. Onset 8-9 weeks after your last potential HIV exposure is strong evidence against HIV as the cause.

See my last reply:  you can safely assume your wife has had EBV and is immune to it. To be maximally safe, maybe avoid unprotected sex and open mouth kissing until your symptoms clear up, probably a couple of weeks. Even before then, the transmission risk probably is very low.

That usually would conclude this thread, but I'm going to leave it open in case you want to let me know your HIV test result. But I won't have any further comments until then OK?
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27 months ago
Dr. Handsfield,

Just wanted to let you know everything came back fine. Thanks for all your advice and calming words. 

How will I know when it’s safe to drink alcohol again with the mono? I’m feeling better but have read that my spleen could be affected... what can I do to know it’s safe again? It’s not life or death that I drink, but don’t want to cause more harm then the mono already has. 

You may close this thread now. Thanks again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
I'm not aware of any guidelines or standard advice to avoid alcohol with mononucleosis. I certainly have neverso  advised my mono patients. Any risk of splenic rupture is solely from getting blind drunk and therefore increased risk of trauma (falls, vehicular accidents, etc). But alcohol in moderation isn't a problem. And the actual frequency of splenic rupture in people with mono is very low.

But I'm glad all is well. Presumably "everything" being fine includes a negative HIV test.

Thanks for the thanks. I've enjoyed the discussion.
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