Also Known As
EBV Antibodies
Formal Name
Epstein-Barr Virus Antibody to Viral Capsid Antigen, IgM; Epstein-Barr Virus Antibody to Viral Capsid Antigen, IgG; Epstein-Barr Virus Antibody to Nuclear Antigen, IgG; Epstein-Barr Virus Antibody to Early D Antigen, IgG; Heterophile Antibodies (see Monospot)
This article was last reviewed on
This article waslast modified on 27 January 2019.
At a Glance
Why Get Tested?

To help diagnose glandular fever (also known as Infectious Mononucleosis); to help evaluate susceptibility to EBV infection; to distinguish between an EBV infection and another illness with similar symptoms

When To Get Tested?

When you have symptoms of glandular fever but a negative Monospot test; when a pregnant woman has flu-like symptoms; sometimes when an asymptomatic person has been exposed to EBV

Sample Required?

A blood sample taken from a vein in your arm

Test Preparation Needed?

No test preparation is needed.

On average it takes 7 working days for the blood test results to come back from the hospital, depending on the exact tests requested. Some specialist test results may take longer, if samples have to be sent to a reference (specialist) laboratory. The X-ray & scan results may take longer. If you are registered to use the online services of your local practice, you may be able to access your results online. Your GP practice will be able to provide specific details.

If the doctor wants to see you about the result(s), you will be offered an appointment. If you are concerned about your test results, you will need to arrange an appointment with your doctor so that all relevant information including age, ethnicity, health history, signs and symptoms, laboratory and other procedures (radiology, endoscopy, etc.), can be considered.

Lab Tests Online-UK is an educational website designed to provide patients and carers with information on laboratory tests used in medical care. We are not a laboratory and are unable to comment on an individual's health and treatment.

Reference ranges are dependent on many factors, including patient age, sex, sample population, and test method, and numeric test results can have different meanings in different laboratories.

For these reasons, you will not find reference ranges for the majority of tests described on this web site. The lab report containing your test results should include the relevant reference range for your test(s). Please consult your doctor or the laboratory that performed the test(s) to obtain the reference range if you do not have the lab report.

For more information on reference ranges, please read Reference Ranges and What They Mean.

What is being tested?

Epstein-Barr virus (EBV) antibodies are a group of tests that are requested to help diagnose a current, recent, or past EBV infection. EBV is a member of the herpes virus family. Passed through the saliva, the virus causes an infection that is very common. As many as 95% of people in the United Kingdom will have been infected by EBV by the time they are 40 years old. After exposure to the virus, there is an incubation period of several weeks. EBV then causes an infection followed by resolution and then dormancy. EBV remains in the person’s body for the rest of their life, reactivating intermittently, but causing few problems unless the person’s immune system is significantly compromised.

Most people are infected by EBV in childhood and experience few or no symptoms, even during the infection. However, when the initial infection is delayed until adolescence, EBV causes glandular fever in about 35 – 50% of those infected. Glandular fever is a condition that is associated with tiredness, fever, sore throat, swollen lymph nodes, an enlarged spleen, and, sometimes, an enlarged liver. Those who have glandular fever usually have symptoms for a month or two before the infection gets better. A few people can have symptoms that last many months, but this is uncommon.

Patients with glandular fever are diagnosed by their symptoms and the findings of a full blood count (FBC) and a Monospot test (which tests for a heterophile antibody). A certain percentage of those who have glandular fever will have a negative monospot test; this is especially true with children. EBV antibodies can be used to find out whether or not the symptoms these patients are experiencing are due to a current infection with the EBV virus.

It can be important to distinguish EBV from other illnesses. For instance, the enlarged spleen of those with an EBV infection is vulnerable to rupture. Patients who have glandular fever should not be involved in contact sports for several weeks to months after infection, as a ruptured spleen can be a medical emergency. Also, pregnant women with symptoms of a viral illness need to be able to distinguish a primary EBV infection, which has not been shown to affect the baby, from a cytomegalovirus (CMV), herpes simplex virus, or toxoplasmosis infection, as these illnesses can cause complications during the pregnancy and may damage the growing baby. It can also be important to rule out EBV and to look for other causes for the symptoms. Patients with streptococcal sore throat, for instance, need to be identified and treated with antibiotics. A patient may have a streptococcal sore throat instead of EBV infection, or they may have both conditions at the same time.

There are several EBV antibodies. They are proteins produced by the body in an immune response to several different Epstein-Barr virus antigens. They include IgM and IgG antibodies to the viral capsid antigen (VCA), IgG antibodies to the D early antigen (EA-D), and antibodies to the nuclear antigen (EBNA). During a primary EBV infection, each of these EBV antibodies appears independently on its own time schedule. The VCA-IgM antibody appears first and then tends to disappear after about 4 to 6 weeks. The VCA-IgG antibody emerges, is at its maximum at 2 to 4 weeks, then drops slightly, stabilizes, and is present for life. The EA-D antibody appears during the acute infection phase and then tends to disappear within 3 to 6 months, but about 20% of those infected will continue to have detectible quantities of the EA-D antibody for several years after the EBV infection has resolved. The EBNA antibody does not usually appear until the acute infection has disappeared. It usually develops about 2 to 4 months after the initial infection and is then present for life, although it can fall to undetectable levels in elderly persons. Using a combination of these EBV antibody tests, a doctor is able to detect an EBV infection and to determine whether it is a current, recent, or past infection.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

Accordion Title
Common Questions
  • How is it used?

    Epstein-Barr Virus (EBV) antibodies are used to help diagnose glandular fever if you have symptoms but have a negative Monospot test. The antibodies tested in this situation are:

    • Viral capsid antigen (VCA)-IgM, VCA-IgG and D early antigen (EA-D) - to detect a current or recent infection
    • VCA-IgG and Epstein Barr nuclear antigen (EBNA) - to detect a previous infection

    In pregnant women with symptoms of a viral illness, one or more of these EBV antibodies may be requested along with tests for CMV, toxoplasmosis, and other infections to help distinguish between EBV and conditions that may cause similar symptoms. Occasionally, a VCA-IgG or other EBV antibody may be repeated 2-4 weeks after the first test, either to see if a test changes from negative to positive or to measure changes in antibody concentrations to see if they rise or fall.

    A VCA-IgG test, and sometimes an EBNA test, may be used on a patient without symptoms to see if that person has been previously exposed to EBV or is susceptible to a primary EBV infection. This is not routinely done, but it may be requested when a patient, such as an adolescent or an immune compromised patient, has been in close contact with a person who has symptomatic EBV infection.

  • When is it requested?

    EBV antibodies may be requested when you have symptoms suggesting glandular fever, but a negative Monospot test and when a pregnant woman has flu-like symptoms and the doctor wants to determine whether the symptoms are due to EBV or another microorganism. Signs and symptoms may include:

    • Tiredness
    • Fever
    • Sore throat
    • Swollen lymph glands
    • Sometimes enlarged spleen and/or liver

    VCA-IgG and EBNA may be requested whenever your doctor wants to establish previous exposure. Testing may occasionally be repeated when your doctor wants to track antibody concentrations and/or when the first test was negative, but your doctor still suspects that your symptoms are due to EBV.

  • What does the test result mean?

    If you have positive VCA-IgM antibodies, then it is likely that you have a current, or had a very recent, EBV infection, especially if you do not have detectable EBNA antibody. If you also have symptoms associated with glandular fever, then it is most likely that you will be diagnosed with EBV infection, even if your Monospot test was negative. If you also have positive VCA-IgG and EA-D IgG concentrations, then it is highly likely that you have, or recently had, an EBV infection.

    If the VCA-IgM is negative but the others and an EBNA antibody are positive, then it is likely that you had a previous EBV infection. If you do not have symptoms and are negative for VCA-IgG, then you have not been previously exposed to EBV and are vulnerable to infection. In general, rising VCA-IgG levels tend to indicate an active EBV infection, while falling concentrations tend to indicate a recent EBV infection that is resolving. However, care must be taken with interpreting EBV antibody concentrations, as the amount of antibody present does not correlate with the severity of the infection or with the length of time it will last. High levels of VCA-IgG may be present and may persist at that concentration for the rest of your life.

    Below, results are provided in table form.

    Test results most likely indicate the following:
    EBV antibody test susceptile to ebv current ebv infection Past ebv infection comments
    VCA-IgM   + + Appears first, gone in 4-6 weeks
    VCA-IgG + + If negative susceptible, it appears within a week of infection, then present for life
    EBNA-IgG     + Becomes positive in 2 – 4 months, then present for life
    EA-D IgG   + + Positive in about a week, usually gone in 2 weeks, persists in 20% of people
    Heterophile IgM (Mono test)   +   Associated with Mono, false positives with other conditions, false negatives common in children
  • Is there anything else I should know?

    There are at least two other antibodies that arise during an EBV infection - an IgA antibody to the EBV viral capsid antigen (EBV VCA-IgA) and an IgG antibody to the EBV early antigen restricted (EA-R IgG). While it is possible to test for these antibodies as part of the EBV diagnostic workup, it is rarely necessary to do so.

    The most common complication of glandular fever is a ruptured spleen. Other complications of EBV infection that can occur include trouble breathing due to a swollen throat, streptococcal sore throat at the same time, and, rarely, jaundice, skin rashes, pancreatitis, seizures, and/or encephalitis. EBV is also associated with, and may play a role in, several rare forms of cancer, including Burkitt’s lymphoma and nasopharyngeal carcinoma.

    Reactivation of the virus is rarely a health concern unless the patient is significantly and persistently immune compromised, as may happen in those who have HIV/AIDS or in those who have received an organ transplant. Primary infections in these patients can be more severe, and some may experience chronic EBV-related symptoms.

  • How is EBV infection/Mono treated?

    Care is largely supportive, rest, treating the symptoms, and avoiding any contact sports or heavy lifting for several weeks to months to avoid spleen rupture. There are no anti-viral medications or vaccines available to speed healing or prevent infection.

  • Do adults get glandular fever?

    They do, but it is rare because most have already been infected at an earlier age. When they do, they tend to have less lymph node swelling and sore throat and more liver enlargement and jaundice.

  • Do EBV infection and glandular fever occur throughout the world?

    Yes. In less developed nations, however, glandular fever is not as common because most of the population is infected with EBV earlier in life when symptoms are minimal.

  • Can EBV be prevented?

    Not at this time. It is too common in the population and, because the virus will reactivate intermittently in a previously infected person, usually without causing any symptoms, almost everyone is infectious at one time or another.

  • If I have had EBV infection, can I still get glandular fever?

    No. Once you have had an EBV infection, you will not get glandular fever. You could, however, experience similar symptoms from another viral illness.

  • Why is glandular fever sometimes called “the kissing disease”?

    This is because EBV does not pass through the air; it is present in saliva and is passed through mouth-to-mouth contact and, in the case of children, through saliva transfer to hands and/or toys, etc.

  • Are there other types of tests available for EBV?

    Yes. There are molecular tests that can detect and measure EBV DNA. They can be helpful in diagnosing and monitoring EBV-related diseases such as Burkitt’s lymphoma, Hodgkin’s lymphoma and post-transplant lymphoproliferative disease (PTLD).

  • How is EBV infection/Mono treated?

    Care is largely supportive, rest, treating the symptoms, and avoiding any contact sports or heavy lifting for several weeks to months to avoid spleen rupture. There are no anti-viral medications or vaccines available to speed healing or prevent infection.