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Epstein-Barr Virus (EBV): Trouble On The Horizon

A quick blood test will verify that 98% of you are carrying an inactive form of Epstein-Barr virus (EBV), one of several herpesviruses (human herpesvirus 4, to be exact) that can rest quietly in your body.

You hope.

That high percentage is confirmed by testing large populations for the presence of EBV antibodies, produced by the immune system in response to the presence of a foreign substance. I well remember a medical school professor saying, “Everybody has them.”

EBV is not the same herpes as the villain of cold sores (herpes simplex 1) or genital herpes (herpes simplex 2). EBV is a cousin to the herpes virus that causes chickenpox (the varicella-zoster virus), which can lie dormant for years and then appear as shingles.

As you’re reading this Health Tip, all but 2% of you carry EBV as a fellow traveler, nestling inside billions of your cells. And while you needn’t lie in bed at night plaintively asking “Why me?” you’ll soon learn that EBV, tiny as it is, merits your attention and respect. It’s a potential troublemaker.

First, let’s talk about how you got it
Once upon a time you were a horny adolescent, coping with the rising tides of either estrogen or testosterone. You met that seriously cute whatever-your-preference, engaged in some deep kissing, and a few days or weeks later noticed respiratory symptoms that ranged from an uncomfortable scratchy throat to full-fledged mono (infectious mononucleosis, also called the “kissing disease”) with fever, a really painful throat, swollen lymph glands in your neck, and exhaustion like you’d never felt in your life.

You may have been a student and had to drop out for a semester, but then, slowly, you did manage to recover.

Just about everyone who’s had mono, mild or severe, recovers uneventfully. But there is a small population that can date their lifetime of chronic fatigue to their mono. In fact, for a while the original chronic fatigue syndrome (also called myalgic encephalomyelitis) was attributed solely to EBV. However, when everyone, including doctors themselves, began testing positive for EBV, researchers took it off the table of chronic fatigue suspects.

They then made two errors, which they’ve thankfully reversed. First, since no test can diagnose chronic fatigue, they decided that patients were hypochondriacs and wrote it off as the yuppie flu. It’s a common and regrettable ploy: if you can’t make a diagnosis, then somehow twist it around and blame the patient (“See a psychiatrist”).

Second, they wrote off all those EBV antibodies as completely harmless, evidence of the immune system’s prowess, positing that once your acute EBV infection was behind you, you’d never be bothered again.

Word also spread among the healthcare profession that no one could get mono twice. The presence of EBV antibodies was thought to be an immunization against future EBV infections.

More to EBV than meets the eye
But evidence mounted that there was more to EBV. The bodies of one small group of people, mainly of Asian extraction, were overwhelmed by EBV and without major treatment, such as bone marrow transplants, many died. This condition is called chronic active Epstein Barr (CAEB) and classified as a rare disease, which fortunately it is.

Later, EBV began to be linked with a host of other problems. Some were truly debilitating (causing fatigue, muscle aches, fever, etc), indistinguishable from chronic fatigue syndrome, with no chance for positive test results except those pesky and persistent EBV antibodies.

Researchers have proposed that for some genetically predisposed people, chronic fatigue syndrome is caused by reactivation of dormant EBV. There are, of course, other known causes of chronic fatigue including chronic Lyme, toxic metal exposure, and mold exposure, but reactivated EBV is high on the list.

Reactivated EBV
And then, quite spookily, the list of conditions associated with reactivated EBV began to grow.

For example: multiple sclerosis, Parkinson’s, and a whole slew of autoimmune diseases, including lupus, rheumatoid arthritis, scleroderma, ulcerative colitis/Crohn’s, and Hashimoto’s thyroiditis, and an equally frightening list of cancers (Hodgkins disease, non-Hodgkin’s lymphoma, nasopharyngeal carcinoma, stomach cancer). Even breast cancer and cervical cancer.

With so many apparently unrelated conditions, maybe that dormant EBV isn’t so dormant after all.

The pharmaceutical industry has not yet developed an antiviral medication that works against acute EBV (mono) and there’s no vaccine on the horizon. We’ve got safe and effective antivirals against herpes simplex (cold sores, genital herpes), HSV (shingles), influenza, and even HIV, but nothing consistently effective against EBV. As a result, researchers are focusing on the triggers that reactivate dormant EBV and convert it to disease.

What those triggers are and how you can safely keep your personal EBV in check (because, sorry, but you probably have it inside you somewhere) will be the subject of next week’s Health Tip.

Be well,
David Edelberg, MD

Leave a Comment


  1. Laura Dominick says:

    Dear Dr Edelberg
    Have u ever treated someone who had rope worms?
    Did u cure them?
    Best wishes
    Laura Dominick
    630-820-6666

  2. Samantha Burgan says:

    One word. Stress.

  3. Sara says:

    Hello,
    Thanks for this interesting information. I have read that having mono can make you more susceptible for other chronic illness. I had mono when I was 14…Should I get tested further? I was told my “tiredness” was adrenal fatigue syndrome, too much stress, etc. Can that also be valid vs. having had mono and having a potential dormant virus flare-up? Thanks.

  4. Jules Arbor says:

    Hi Dr. E.,

    Is there a test for EBV antibodies?

    Thanks and enjoy your day!

  5. Dr E says:

    Hi Laura
    “Ropeworms” don’t exist. They are long pieces of intestinal lining that look like pieces of rope mixed into feces but after careful analysis were determined to be just intestinal tissue

  6. Dr E says:

    Hi Sara
    97% of us seem to get EBV one way or another. For most of us, its first appearance was a “bad sore throat” that went away on its own. For others, a full blown case of mono. Even with that, most people recover uneventfully although a few can date years of chronic fatigue from their bout with mono. You should get a full EBV test panel and also inflammatory markers like sed rate, hsCRP and C4a. If your EBV test is postive for activated EBV, use DrKasia Kines book on EBV as your bible

  7. Kari kinnard says:

    does Epstein Barr have a link to seizures? Lymes?

  8. Dr E says:

    Yes, the link with seizures is well documented for both EBV and Lyme

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