Can EBV Be Transmitted Person to Person?
Yes, Epstein-Barr virus (EBV) is transmitted person-to-person primarily through saliva, making it highly contagious through close oral contact. 1, 2, 3
Primary Transmission Routes
Saliva is the dominant transmission route for EBV. The virus spreads through:
- Direct oral contact including kissing, which is why infectious mononucleosis is colloquially known as the "kissing disease" 3, 4
- Sharing drinking vessels, food utensils, mouth guards, towels, and other personal items that come into contact with oral secretions 1
- Indirect contact with contaminated surfaces in group settings where saliva may be present 1
The virus infects epithelial cells of the oropharynx initially, then spreads to B cells which become the major reservoir for lifelong infection 2, 4
Secondary Transmission Routes (Rare)
While saliva is the primary route, EBV can occasionally be transmitted through:
- Sexual contact, though this is not a major transmission route. Studies show EBV DNA is present in only 7% of cervical samples, 5% of male urethral samples, and 3% of semen samples from asymptomatic individuals, with viral levels below 10 genomes per microgram of DNA—far lower than saliva 5
- Blood transfusions and organ transplantations, though this is uncommon 2
Sexual partners of patients with infectious mononucleosis show significantly more sharing of identical EBV isolates compared to non-sexual contacts (P = 0.0012), but the low viral levels in genital secretions suggest sexual transmission is infrequent 5
Clinical Context and Timing of Infectivity
Primary infection typically occurs during early childhood and is usually asymptomatic. 3, 4 When infection is delayed until adolescence or adulthood, it frequently manifests as infectious mononucleosis with fever, pharyngitis, lymphadenopathy, and malaise 3, 6
Infected individuals shed virus in saliva intermittently throughout their lifetime, even when asymptomatic, which explains why over 90% of the global population becomes infected by middle age 2, 4
Prevention Strategies
To reduce transmission risk:
- Avoid sharing personal items including drinking vessels, eating utensils, mouth guards, towels, and personal protective equipment 1
- Practice good personal hygiene with frequent handwashing and proper disposal of oral and nasal secretions 1
- Regular cleaning of facilities and equipment in group settings, particularly those involving adolescents and young adults 1
Common Pitfalls to Avoid
Do not assume casual contact poses significant risk. Unlike some other viruses, EBV requires relatively close contact with saliva for transmission—it is not spread through airborne droplets from coughing alone 1
Do not overlook the role of asymptomatic shedding. Individuals who have recovered from infectious mononucleosis or who were infected asymptomatically can still transmit the virus through saliva, making complete prevention impossible in real-world settings 4
Do not confuse EBV transmission with hepatitis B transmission patterns. The evidence provided includes extensive information about HBV, which has different transmission dynamics including blood and sexual routes—this is not applicable to EBV 7