Mono Symptoms?

[busy1929]

Hello,
I was diagnosed with Mono at the end of November 2008.  I was symptomatic until late February 2009.  I went out drinking and got very drunk and was bitten on the neck (produced a lot of blood) by an overzealous “fan.”  Since the incident, I have developed painful glands around my neck, upper left and right abdominal pain, and I have a sore throat.  These symptoms started to appear about 2 – 2.5 weeks after the incident.  The bite site does not look to be infected; in fact, it has completely healed.  
As you can guess, I am pretty excited about the development of these symptoms.  While these symptoms are exactly what I experienced with Mono, there are other possible causes.  First off, can Mono go away and come back in the fashion described, due to the consumption of a ridiculous amount of alcohol?  With a weakened immune system, due to Mono, does that make me more susceptible to HIV, hepatitis B, hepatitis C, and syphilis?  Swollen glands around the neck after 2.5 weeks – could that be due to hepatitis B/C?  My spleen has become painful again – can that happen with hepatitis B/C?  Your opinion – Mono or other?  
What should I do at this point in time?  Is there a way to get fast accurate test results, faster than standard STD tests – like liver enzyme tests?  When are these diseases detectable?  

[Edward W Hook, MD]

The majority of these illnesses will be detectable at 6 weeks.  For several (Hepatitis in particular, a small proportion of tests may not be positve until as far out as 4 months but the majority of infections are detectable long before that

EWH

[busy1929]

Thank you for the advice.  I will schedule an appointment.  I was diagnosed with the EBV.  
Can any of these diseases produce symptoms in 2.5 weeks?  I believe HIV is detectable after 6 weeks and the results are pretty accurate.  How accurate are hepatitis B/C tests after 6 weeks?  How accurate is the test for syphilis at 6 weeks?

Thank you, again.

[Edward W Hook, MD]

.  Mononucleosis can refer to an infection caused by one of two viruses, EB virus or CMV virus, or to describe a more non-specific syndrome due to many other viruses.  It is not clear to me which of these you had/have.  Generalized, not localized swelling of lymph nodes tend to characterize mono syndromes and the spleen (a lymphatic organ and thus, from one perspective, a large lymph node) can be swollen as part of mono but it is very uncommon for people to be able to detect their own splenic swelling.  While most people who get EBV or CMV are asymptomatic, a minority do get the symptoms of mono and, of those, a still smaller minority may get recurrent symptoms. This is more often a sign of incomplete recovery from the original infection than from new infection with a different virus (with most, if not all of the viruses mentioned above, people tend to only get them once).  Hepatitis viruses, particularly hepatitis B are among the uncommon causes of mono syndromes.  Some of the other STDs you mention are sometimes associated with mono syndromes but for any of them to be transmitted by a bite would be just about unheard of –whether your current complaints are related to the bite is unclear and probably coincidence rather than cause and effect.  Your complaint warrant another trip back to your doctor that diagnosed your original mono for a thorough check up and evaluation - this would include blood tests for some of the infections mentioned.  Evaluation may take more than a single visit to the doctor.  In answer to your specific questions:

1.    See above.  Recurring mono symptoms occur although not often.  It sounds as though you were pretty wiped out by your mono and thus may be at increased risk for recurrence although, to be honest, I suspect what you are talking about may be in part due to over exertion before you were completely well rather than a recurrence of your original mono in the classical sense.
2.  Consumption of alcohol, even in “ridiculous” amounts, does not weaken the immune system over the short term.  Activities associated with heavy alcohol use (poor nutrition, disordered sleep, physical exhaustion) however may be but, even then, are only minor contributors to risk for any infections.
3.  Swollen glands in your neck would be a rare manifestation of hepatitis B or C, both of which can be readily tested for if your doctor feels testing is indicated.
4.  Hepatitis B and C would not normally cause a swollen spleen, if yours is swollen (see above).
5.  What to do- go see your doctor.  Tell him/her the story and get things evaluated.

Good luck.  EWH