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Q. How can I treat the Epstein-Barr virus infection?

Answered by
Dr. Manish Purohit
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 22, 2018

Hello doctor,

I have a history of anxiety and panic issues. I was trying to find out the root cause of it and I have found that I have IgG antibodies against Epstein-Barr Virus and a Streptococcal infection (Anti-DNase B Test) in my throat.

I also seem to have OCD issues and always remember having throat and tonsil infections during my teenage days. Azithromycin used to help me calm down the infection.

I also have an overgrowth of Streptococcus in my small intestine. This is called SIBO. My symptoms are all matching up with the signs of a possible adult PANDAS-like situation. I would like to take your advice on how I should treat the EBV and Streptococcus.

Dr. Manish Purohit



Welcome to

As I understand you are having antibody against EBV (Epstein–Barr virus) and Streptococcal infection but you have never suffered from EBV disease.

You only had some episode of Streptococcal throat infection in the past. So first I wish to explain you that

  • The presence of antibody does not indicate a disease.
  • The presence of IgG (Immunoglobulin G) indicates a past infection. The IgM (Immunoglobulin M) antibody indicate an acute infection.
  • Once IgG antibody develops in the body, it persists for years.
  • There is no need to treat EBV infection as it is a viral infection and the presence of IgG indicate past infection. The immunity develops after the infection.
  • The Anti-DNase B antibody develops after a streptococcal infection. But, there may be chances of repeated streptococcal throat infections. So if you still having doubt of throat infection with streptococcus you need to undergo culture and sensitivity examination of your throat swab for confirmation
  • Streptococci are sensitive to many antibiotics and can be treated easily. Penicillins and cephalosporin group of drugs are mainly used in this treatment. It requires a long treatment if you are having recurrent throat infection episodes with streptococcus.
  • If you are having a confirmation of SIBO (small intestinal bacterial overgrowth), it may be responsible for your problem of anxiety. So it should be treated.

Rifaximin is a newer drug and can be used to treat it. However many other antibiotics like Cephalosporins, Tetracyclines, Macrolides etc. can be used to treat it. Consult your specialist doctor, discuss with him or her and with their consent take the medicines.

You also need to take a rich fibrous diet with vegetables and fruits to balance your gut flora. Probiotics and prebiotics are also available in the market that can be taken.

Limit ingestion of sugar, animal fat, and animal protein. I suggest to consult a gastroenterologist and take treatment.

For more information consult a family physician online -->

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Thank you doctor,

I will get myself treated for SIBO with a gastroenterologist at my local place. I have used Rifaximin earlier as well but it is effective only for a few days. The SIBO keeps recurring. I am not sure why it keeps recurring.I have a few questions and need your help.on them.

From my understanding, SIBO is only a symptom and there is something else that is causing it. I also seem to have subclinical low thyroid symptoms. Can hypothyroidism be another reason for SIBO?

Please tell me what is the test for Streptococcus throat culture and sensitivity called in the diagnostic lab? I will get this test done.

Also, I am pretty sure that I have Streptococcus pyogenes as I get severe gastritis when I have a throat infection.

Azithromycin seems to help reduce the throat infection and the gastritis issue. There is definitely a connection between my strep throat, the SIBO bacteria and the anxiety issues that I have.

I have read many research articles that Strep bacteria can induce autoimmunity. In my case, my immune system seems to react to all foods containing lectins like gluten, wheat, corn, egg, nightshade and dairy products etc. which can in turn trigger anxiety. I am not sure how I should handle this.

Dr. Manish Purohit



Welcome back to

There is no definite cause for SIBO (small intestinal bacterial overgrowth) but a number of predisposing conditions may lead to SIBO.

Hypothyroidism may decrease gut motility and may cause an alteration in the gut flora and lead to SIBO.

There are different species of Streptococci responsible for producing different kinds of illnesses.

Streptococcus pyogenes is mainly implicated in throat infection and its sequel leads to autoimmune damage to host tissue because antibody develops against its antigens are crossreacting with our body tissue and produces immunological damage to our tissues.

Mainly it causes damage to the tissue of heart, skin, kidney, joints etc. They do not lead to the development of psychological illness.

Other Streptococci are present as a normal gut flora along with other bacterial flora.

Alteration in gut flora may lead to many dyspeptic symptoms, altered absorption of food and alteration in digestion and metabolism of food that may lead to an anxiety and depression disorder.

For Streptococcal throat infection you need to consult a microbiology laboratory or a clinical microbiologist and request them for detection of Streptococcus pyogenes in your throat swab.

There is no direct relation between Streptococcus infection and SIBO but there may be chances of Streptococcus overgrowth in the colon and also SIBO may develop following prolonged or frequent use of antibiotics.

For more information consult a family physician online -->

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