Mononucleosis Transmission: Beyond Kissing

Infectious mononucleosis (EBV) spreads primarily through saliva, but not exclusively via kissing.

Transmission Routes

• Direct saliva contact: Kissing (classic), sharing drinks, utensils, water bottles, lip balm, toothbrushes.
• Respiratory droplets: Coughing, sneezing in close contact.
• Fomites: Contaminated objects (toys, cups) – virus survives hours on moist surfaces.
• Sexual: EBV detected in semen/cervical secretions; sexual transmission documented.
• Blood/organ transplant: Rare; screened in donors.
• Vertical: Mother-to-child during delivery (rare).

Prevention

• Don't share items that contact saliva.
• Hand hygiene after contact with secretions.
• No vaccine available.

Epidemiology

• Peak incidence: 15–24 years (college, military).
• Childhood infection often asymptomatic → lifelong immunity.
• Reactivation in host ≠ transmission risk (low viral load in saliva).

"Kissing disease" is a misnomer—it's a "saliva-sharing disease."