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HOUSE Calls: Mononeucleosis, Painful Urination

August 28, 2012 by Rose Hoban in HOUSE Calls

This week we respond to questions about mononucleosis and questions about painful urination.

Dear HOUSE Calls,    

House calls logoI was told by my doctor that I have mono. I saw her because I was fatigued and I had a mono test that was positive. But I have not had fever or sore throat. Do I really have mono?

This is a complicated question because when we refer ‘mono’ we are generally revering to a set of conditions with common clinical features.

We used to call this the ‘kissing disease’. The most common cause of mono in adolescents and young adults is Ebstein Barr Virus, or EBV. The hallmarks are fever, sore throat, and swollen lymph nodes.

After recovery from the acute infection, fatigue can lasts for weeks or longer. This is probably why your doctor checked you for mono. It would be unlikely to have had mono without at least some of the hallmark symptoms, perhaps you mentioned you had them several weeks ago?

To really answer the question in full, we would need to know more about your symptoms, your exam, and what kind of mono test your doctor ordered. There is a test known as the mono-spot test which is a simple positive or negative test that usually remains positive for many years after infection. There are specific antibody titers which can show more recent or past infections with somewhat more clarity. There are also supportive blood tests like liver function tests and some characteristics of the blood count that indicate infection with EBV.

It is also important that you and your doctor keep in mind that there are 100’s of cause for fatigue—anemia, sleep apnea, depression, diabetes, and thyroid conditions to name a few. Keep track of your symptoms, and if you are not feeling better, go back and see your doctor.

Dear HOUSE Calls,    

I went to the doctor recently with burning when I urinate. My urinalysis came back negative though for a urinary tract infection.  What do I have?

That is another good question. Usually a urinary tract infection (UTI) is fairly easy to diagnose from a urinalysis.  Occasionally, however, the tests are indeterminate and a urine culture helps us to be more certain.

However, there a number of other conditions that can burning with urination.  Other causes include: inflammation from a recent UTI (which your body recovered from without treatment), dehydration, urethritis from sexually transmitted infections (gonorrhea, chlamydia, and herpes most commonly), vaginal irritation from yeast or bacterial vaginitis (if the writer is a woman), trauma or direct irritation, and interstitial cystitis.

If the symptoms persist or recur, go back and see your doctor. Perhaps she or he can localize the symptoms. You may need other testing or referral to a specialist.

HOUSE Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page, and Dr. Adam Zolotor on behalf of YOUR HEALTH™ and the UNC Department of Family Medicine.

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Physicians from the UNC Department of Family Medicine’s YOUR HEALTH™ media bring you weekly information in response to your questions about health and medicine. Send us your questions or comments to

The HOUSE Calls staff:

Cristy Page Headshot Dr Cristy Page is an Assistant Professor of Family Medicine at the UNC School of Medicine. A former Morehead scholar, Dr. Page completed degrees in Medicine, Public Health and Family Medicine at UNC. Dr. Page practices full scope family medicine including obstetrics, and she is recognized for important innovations in maternal health, preventive medicine and group well-child care.

Adam Goldstein Headshot Dr. Adam Goldstein is a Professor of Family Medicine at the UNC School of Medicine. As a leading U.S. expert in primary care, Dr. Goldstein has a 20-year history in clinical practice, teaching, and research. He has published over 150 articles, essays, book chapters, and books.

Adam Zolotor Headshot Dr. Adam Zolotor is an Assistant Professor of Family Medicine at the UNC School of Medicine.  Dr. Zolotor Completed his training at the University of Michigan and the University of North Carolina.  He has been in practice for 10 years and and is a nationaly recognized expert in child abuse and child injury prevention.  He directs the Department of Family Medicine maternal and child health services. He is the author of more than 50 articles and book chapters.

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