"We may be seeing an individual at different clinical stages of the disease," Rosenthal says. "I've seen people with just a sore throat. We say 'keep us informed' and a week later they say 'I still feel lousy.' Now they have a palpable spleen and swollen glands [and we give the spot test]."
"It's really the follow-up," he adds. "We can't tell you where you are on the [mono] continuum."
Some students come in the first day they feel sick, before developing symptoms, while others go to UHS with obvious mono symptoms after feeling ill for a month, Rosenthal says.
He says the mono spot test is "sensitive but not exactly specific." The test result can be positive due to very similar viruses, which cause mono like symptoms and are treated in the same way.
Rosenthal says testing for strep throat is actually the proper first step, as nearly one out of three mono sufferers also have strep throat.
But according to students who say they spent extra weeks or months sick because a nurse refused a mono test, the "proper procedure" should be changed. "I just wanted to find out what I had," Harkavy says. "I was sick all the time."