Erythrocyte Sedimentation Rate (ESR) in Epstein Barr Virus (EBV) Infectious Mononucleosis Normal Erythrocyte Sedimentation Rate (ESR) is 1-13mm/hr and 1-20 mm/hr in males and females respectively. The values vary with respect to patient’s age. In case of EBV infectious mononucleosis, group A streptococcal pharyngitis is a common differential diagnosis. ESR is useful in distinguishing EBV infection from streptococcal pharyngitis as it is elevated in EBV infection and normal in pharyngitis. However, elevated ESR only distinguishes EBV infection from group A streptococcal pharyngitis but does not differentiate from conditions which are heterophile-negative. Heterophile antibody test is recommended.