Addressing Epstein Barr Virus


You probably have been exposed to the Epstein Barr Virus (EBV), AKA human herpesvirus 4. It’s common and found all over the world. EBV spreads mostly through saliva, and can cause infectious mononucleosis, AKA mono, AKA the kissing disease. Most are exposed during childhood with symptoms indistinguishable from other viruses. Exposure during the teenage years likely results in symptoms that resolve in two to four weeks. After EBV exposure, the virus becomes inactive, however it can reactivate. 

Common sIgns and symptoms of Epstein Barr Virus 

  • Fatigue

  • Fever

  • Inflamed throat

  • Swollen lymph nodes in the neck 

  • Enlarged spleen and/or swollen liver

  • Rash

This topic has become relevant to my practice, with several patients presenting with chronic, unexplainable symptoms, accompanied with positive EBV lab findings. Chronic infection is often underlying and perpetuating disease and unwanted symptoms. This week I share with you my recent learnings from Dr. Paul Anderson, and my clinical approach to dealing with acute, reactivation, and chronic reactivation of EBV.

EBV virus can live in the nervous tissue causing symptoms like nerve pain (2). Interestingly, 90% of those with Multiple Sclerosis tested positive for EBV (3). It’s also known to cause a myriad of autoimmune conditions such as lupus, Hashimoto’s thyroiditis, and rheumatoid arthritis (4). The virus has an affinity for mucus membranes, including the gut mucosa, and has been implicated in IBD development as well (5).

EBV blood testing is controversial because once exposed there will be positive antibodies. I do not typically evaluate for EBV to start but reserve this for those resistant to initial treatments. Testing provides a pattern that can help stratify the severity of disease. This helps determine the level of treatment necessary (the four-part panel includes: EBV VCA Ab IgG and IgM, EBNA IgG, and EBV Early Antigen IgG). 

Provided clinical presentation and lab testing are consistent with EBV, the patient is categorized into one of three groups and treatment is initiating dependent on severity. 

  1. First acute infection - this person is typically a teen or in their early 20’s and presents with the most common signs and symptoms. Treatment addresses the acute infection, pain, and immune support. It’s important to rule out a co-infection with strep. 

  2. Early, or clean reactivator - there is a past exposure (early antigen IgG elevated) with a variety of signs and symptoms. Hallmark symptoms are body pains, fatigue, headaches, and mild sore throats. Treatment is a bit broader for this group compared to the first group because something is run down to allow the reactivation. 

  3. Chronic complicated reactivators. These people are reactivating yearly, if not multiple times a year, or any time they are under stress; they are the most sick of all three categories. There is often co-infections, biofilm build up, mitochondrial damage, toxic overload, and hormonal imbalances so the treatments take longer and are more complex. 


Dr. Paul Anderson