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Can You Get Mono and Strep at the Same Time?

Infectious Mononucleosis Basics

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Updated April 02, 2007

Can you get mono and strep at the same time?

When kids get sick, pediatricians usually like to diagnose them with one single thing, so they usually won't diagnose strep and mono at the same time.

Both strep and mono do have similar symptoms, including a sore throat, fever, and swollen glands. Typically, a child who has already had a negative strep test returns to their pediatrician four or five days later because he isn't getting better, and is then tested for mono.

Or a child who test positive for strep is put on an antibiotic, such as amoxicillin, and develops a bad rash a few days later, which is characteristic of mono. But even if a child with strep doesn't get a rash, he may just not get better, and still get tested for mono anyway.

So it is possible to have strep and mono at the same time, although one doesn't necessarily cause the other. The more common scenario is that your child got infected with both by chance. The incubation period is four to six weeks for mono and three to five days for strep, so your child would have had to be around someone with mono and strep at the right times, got infected, and then show symptoms of both infections at the same time.

Strep Carriers

A more likely scenario is that your child with mono and strep is just a strep carrier. These are kids who had a strep throat infection and even though they are better and have no strep symptoms, the strep bacteria continues to live in the back of their throat. Strep carriers are not thought to be contagious and they can test positive for strep for months or years, even when they have a sore throat that is being caused by a virus.

Some experts do believe that you can have both strep and mono at the same time because these infections have a 'synergistic effect' on a child's inflamed throat and tonsils, for example, making it more likely that you could become infected with mono while having strep. But while older studies found that 30 percent of patients with mono also had strep, some newer studies have found rates that were much lower, at only three or four percent.

Antibiotics for Strep with Mono

Although it is hard to tell if a child has mono and strep, or if he has mono and is a strep carrier, if he tests positive for strep, he will need antibiotics to prevent getting rheumatic fever. And since he has mono, this is one of the few situations in which it is important that your pediatrician carefully chooses which antibiotic to prescribe to your child. This is because amoxicillin or Amoxil, the antibiotic that is often used to treat kids with strep, can cause a bad rash if you take it when you have mono.

Sources:

Infectious mononucleosis: return to play. Auwaerter PG - Clin Sports Med - 01-JUL-2004; 23(3): 485-97, xi

Occurrence of Epstein-Barr virus illness in children diagnosed with group A streptococcal pharyngitis. Rush MC - Clin Pediatr (Phila) - 01-JUN-2003; 42(5): 417-20.

Epstein-Barr virus infectious mononucleosis. Ebell MH - Am Fam Physician - 1-OCT-2004; 70(7): 1279-87.

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