Glandular fever causes one of the most severe sore throats a person can experience, often far beyond what most people would associate with a common throat infection. It is frequently mistaken for a bacterial sore throat in the early stages, which matters because the management is quite different.
This article explains the symptoms of glandular fever in adults and younger people, how to distinguish it from other causes of a sore throat, what treatment involves, and when to seek medical help.
What Is Glandular Fever?
Glandular fever, known clinically as infectious mononucleosis, is caused by the Epstein-Barr virus (EBV), a member of the herpesvirus family. It is extremely common; the majority of people in the UK are infected with EBV at some point in their lives, though many experience no symptoms or only a mild illness.
The classic symptomatic illness tends to occur when infection happens in adolescence or early adulthood, which is why it is sometimes called the kissing disease, though it spreads through any close contact with saliva, including shared drinks and cutlery, and through coughing and sneezing.
Glandular Fever Symptoms: What to Look For
Glandular fever has a fairly distinctive cluster of symptoms, though the severity varies between individuals. The most common symptoms of glandular fever in adults and teenagers include:
- A severe sore throat, often with large, red, swollen tonsils covered in white or grey patches or pus
- Extreme fatigue, which is frequently described as unlike any tiredness previously experienced
- A high temperature, typically above 38°C, often lasting several days
- Significantly swollen lymph nodes, particularly in the neck, but also in the armpits and groin
- Swelling of the spleen (splenomegaly), felt as a fullness or discomfort on the upper left side of the abdomen
- Swelling of the liver in some cases, occasionally causing mild jaundice
- A rash, which appears in a proportion of patients and is more likely to occur if amoxicillin or ampicillin is taken
- Headache, muscle aches, and a general feeling of being seriously unwell
Symptoms typically develop over several days, and the illness usually lasts between two and four weeks in the acute phase, though fatigue can persist for weeks or months afterwards in some people.
Glandular Fever Sore Throat vs Strep Throat: How to Tell the Difference
The glandular fever sore throat is often the symptom that prompts people to seek help, and it can look similar to a bacterial strep throat on first inspection. The table below sets out the key distinguishing features:
| Feature | Glandular fever | Strep throat |
| Cause | Epstein-Barr virus | Group A Streptococcus bacteria |
| Sore throat severity | Often extreme; may make swallowing very difficult | Severe but typically less extreme |
| Fatigue | Profound and prolonged | Present but less severe |
| Swollen glands | Very prominent; often widespread | Usually confined to the neck |
| Spleen involvement | Common | Not typical |
| Rash with antibiotics | Yes, if amoxicillin or ampicillin given | No |
| Responds to antibiotics? | No, it is a viral infection | Yes |
| Duration | 2 to 4 weeks acutely; fatigue may persist longer | Usually resolves within a week with antibiotics |
The rash that develops if amoxicillin is taken during glandular fever is not a true allergy to the antibiotic; it is a reaction specific to EBV infection. However, it is one of the reasons why a diagnosis of glandular fever should be confirmed before antibiotics are prescribed for a severe sore throat.
Is Glandular Fever Contagious?
Yes. The glandular fever virus spreads primarily through saliva, which is why close contact such as kissing is a common transmission route. It also spreads through shared food, drinks, or utensils, through coughing and sneezing, and potentially through blood transfusion, though the latter is rare.
People with glandular fever are most contagious during the acute illness but can shed the virus in their saliva for months after recovery. Most adults carry the virus lifelong and may shed it intermittently without symptoms.
There is no specific period of isolation required, but it is sensible to avoid kissing and sharing utensils while symptomatic, and to follow standard hygiene practices such as covering coughs and washing hands regularly.
Glandular Fever Treatment: What Helps?
There is no antiviral treatment licensed specifically for glandular fever in standard clinical practice. Glandular fever treatment focuses on managing symptoms and allowing the body to recover:
- Rest is essential; pushing through significant fatigue can prolong recovery
- Paracetamol or ibuprofen for fever, sore throat pain, and muscle aches
- Adequate hydration, which can be difficult when swallowing is very painful
- Throat lozenges or sprays for short-term symptomatic relief of the sore throat
- Avoiding alcohol, as the liver is frequently affected and alcohol places additional strain on it
- Avoiding contact sports or heavy physical activity until the spleen has returned to normal size, typically confirmed by a clinician, given the small but serious risk of splenic rupture
The advice to avoid contact sports until spleen size has normalised is an important safety point. Splenic rupture following glandular fever is rare but life-threatening and tends to occur with physical trauma to the abdomen.
When Should You See a GP?
See your GP if you suspect glandular fever, particularly if symptoms are severe or you are unsure of the diagnosis. A GP can arrange a blood test to confirm the diagnosis and rule out other causes.
Seek urgent medical help if you experience:
- Difficulty breathing or a significantly swollen throat that is affecting your airway
- Severe abdominal pain, particularly on the upper left side, which could indicate splenic rupture
- Chest pain or severe shortness of breath
- Extreme weakness or difficulty standing
- Jaundice, a yellowing of the skin or whites of the eyes
Splenic rupture and airway compromise are rare but serious complications that require emergency care. If in any doubt, call 999 or go to A&E.
How Pharmacy To My Door Can Help
Glandular fever itself is managed with rest and symptomatic care rather than prescription medication in most cases. However, if you or a family member has been prescribed medication during or after glandular fever, Pharmacy To My Door can manage your prescription and deliver it directly to your home.
Our GPhC-registered pharmacy team is also happy to answer questions about over-the-counter symptom relief and to signpost you to the right service if you are unsure whether your symptoms need medical assessment.
Need a prescription managed or advice on symptom relief? Book an appointment with Pharmacy To My Door today. We deliver NHS and private prescriptions free across the UK.
Frequently Asked Questions (FAQ’s)
How do I know if I have glandular fever or a normal sore throat?
Glandular fever causes profound fatigue, widespread swollen glands, and often a much more severe sore throat than a standard infection. A GP blood test can confirm the diagnosis.
How long does glandular fever last?
The acute illness typically lasts two to four weeks. Fatigue can persist for several weeks or months afterwards. Most people recover fully, though the timeline varies considerably.
Can glandular fever be treated with antibiotics?
No. A virus causes glandular fever and does not respond to antibiotics. Amoxicillin should specifically be avoided, as it commonly causes a rash when taken during EBV infection.
Is it safe to exercise with glandular fever?
No, not during the acute illness. The spleen is often enlarged and at risk of rupture with physical impact. Avoid contact sports until a clinician has confirmed the spleen has returned to normal size.
Is glandular fever contagious after recovery?
The virus can be shed in saliva for months after recovery. Most adults carry it lifelong. Standard hygiene practices reduce the risk of transmission to others.
