Lyme Disease Symptoms: What You Need to Know

What is Lyme Disease?

Lyme disease (also known as Lyme borreliosis) is a bacterial infection and tick-borne disease. It is caused by Borrelia burgdorferi bacteria (and, less commonly, Borrelia mayonii). The bacteria spread to humans through the bite of an infected black-legged tick found in wooded, grassy, and shrubby areas and overgrown fields. The ticks get infected with Borrelia bacteria from animals such as deer and rodents and act as carriers to pass the infection to humans.

Notably, Borrelia burgdorferi is responsible for most Lyme disease cases in the U.S. and Europe, while Borrelia mayonii is primarily found in the Upper Midwest region of the U.S., including Minnesota, Wisconsin, and North Dakota.

Lyme disease symptoms occur in stages, starting with a bump at the site of the tick bite and progressing to a skin rash, systemic (body-wide) symptoms, severe joint pain, and neurological and heart complications in some people.

How Common is Lyme Disease?

In recent years, the Centers for Disease Control and Prevention (CDC) has received reports of approximately 20,000 to 30,000 confirmed cases of Lyme disease in the U.S. each year. However, the total number of cases is much higher, with Johns Hopkins estimating more than 300,000 cases per year.

The Northeastern States, Mid-Atlantic States, and Upper Midwest are tick-infested areas in the U.S. The name comes from Lyme, Connecticut, where it was first identified in the 1970s. It is also prevalent in Southeastern Canada and south-central Europe.

What Are The Stages of Lyme Disease?

Lyme disease can develop in stages, with specific symptoms marking each one. The three stages of Lyme disease are:

Early localized Lyme disease (3 to 30 days from tick bite)
Early disseminated Lyme disease (3 to 10 weeks from tick bite)
Late disseminated Lyme disease (2 to 12 months from tick bite)
Post-treatment Lyme disease syndrome (PTLDS)

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What Are the Symptoms of Lyme Disease?

Early Localized Lyme Disease

The first symptom of Lyme disease is a tick bite, which is often a small, itchy bump on the skin that looks like a mosquito bite.

Within 3 to 30 days of a tick bite, the bite location may turn into a circular or oval red rash that spreads outwards from the tick bite site. This is called erythema migrans. It can become clear in the center, making it look like a bull’s eye. There is often warmth in the area of the rash, but pain and itchiness are not common.

In addition to the Lyme disease rash, early symptoms of Lyme disease also include flu-like symptoms, such as:

Fever
Swollen lymph nodes
Extreme fatigue
Severe headache
Muscle aches
Joint pain and stiffness

Learn more about how to identify a tick bite.

Early Disseminated Lyme Disease

As Lyme disease progresses, it can involve other parts of the body and cause signs and symptoms including:

Rashes in other parts of the body
Neck pain and neck stiffness (which may be signs of meningitis)
Pain in the back and hips, which may spread to the legs
Numbness, weakness, or pain in the hands and feet
Facial palsy (muscle weakness on one or both sides of the face)
Painful swelling in the eye or eyelid
Immune system activity in the heart which can cause cardiac arrhythmias (palpitations and irregular heartbeats)
Immune system activity in the nerves of the eye which can cause eye pain, swelling, and loss of vision
Severe joint pain, affecting particularly the knees, in late Lyme disease

Late Disseminated Lyme Disease

Symptoms in this stage of Lyme disease in the United States typically include joint pain, swelling, and stiffness, affecting particularly the knees and other large joints. The joint pain can come and go or continue for a long time.

The type of Lyme disease in Europe can cause discoloration and swelling of the skin of the hands and feet, called acrodermatitis chronica atrophicans (ACA). This can occur many months or even years after an infected tick bite. Damage to the joints and other tissues can occur in more severe cases.

Post-Treatment Lyme Disease Syndrome (PTLDS)

Some people who have been diagnosed with Lyme disease develop post-Lyme disease syndrome, also called post-treatment Lyme disease syndrome (PTLDS) or chronic Lyme disease. This can occur due to:

Incomplete treatment of Lyme disease.
Additional tick bites and reinfection.
Fragments of dead bacteria in the body that trigger an immune response.
Autoimmunity where the body’s immune system starts targeting healthy tissues.
Not the same disease (other conditions besides Lyme disease that remain undiagnosed).

What to Do After a Tick Bite

If a tick has bitten you or someone you know, it is important to know that the tick must remain attached to human skin for 24 hours and fill with blood before the bacteria are transmitted. Therefore, it’s crucial to recognize and remove the tick within the first 24 hours. If you see a tick on your body, take these immediate actions:

Wear medical gloves, if available.
Use fine-tipped tweezers to grab the tick near its mouth. Try to grip as close to your skin as possible.
Slowly pull the tick's body away from your skin in a slow and steady motion with even pressure. Avoid jerks or twists. If some parts of the tick remain on your skin, remove them with clean tweezers.
Kill the tick by putting it in rubbing alcohol. Do not crush it, as this can expose you to bacteria.
Store the tick in a sealed bag in the freezer until it is evaluated for tick-borne diseases by a healthcare provider. Label the bag with the date and place.
Discard the dead tick by flushing it down the toilet. You can also wrap it in tape and throw it in the trash.
Wash your hands and the site of the tick bite with soap and water, then apply rubbing alcohol.

Do not apply fingernail polish or petroleum jelly on the tick bite site. Also, do not put a hot match on the tick.

After removing the tick from your body, watch for symptoms of Lyme disease for 30 days. Call your healthcare provider if you develop fever, rash, headache, fatigue, muscle pain, or joint pain.

How is Lyme Disease Treated?

If you are diagnosed with Lyme disease, the clinical practice guidelines for treatment are 10 to 14 days of oral antibiotics. The antibiotics most commonly used to treat Lyme disease are doxycycline, amoxicillin, or cefuroxime axetil. Your healthcare provider may prescribe intravenous (IV or into a vein) antibiotics for Lyme arthritis or other complications.

Most Lyme disease infections respond well to antibiotic treatment. Early diagnosis and Lyme disease treatment can prevent more severe symptoms and complications affecting the heart and nervous system.

Can Lyme Disease be Prevented?

The best way to prevent Lyme disease is to avoid tick bites. Ticks typically attach themselves to your legs and feet when you are outdoors. Risk factors include spending time in grassy, wooded, or overgrown areas, which can increase tick exposure.

Here are some tips to prevent tick bites:

Tick Repellents:

Use tick repellent with 0.5% permethrin on your clothes, shoes, and camping gear.
Spray exposed skin (except the face) with insect repellent. Choose a product endorsed by the Environmental Protection Agency. Effective insect repellents contain ingredients such as DEET, IR3535, picaridin, para-menthane-diol (PMD) or 2-undecanone, and oil of lemon eucalyptus (OLE). Check the label before using a product on young children (especially those under 3 years old)

Clothing and Footwear:

Wear light-colored clothing, which makes it easier to spot ticks.
Wear long-sleeved shirts.
Wear long pants and tuck them into your socks.
Wear closed shoes.

Preventive Antibiotics:

The CDC does not recommend preventive antibiotics after tick bites. However, in some cases, your healthcare provider may prescribe a single dose of doxycycline after a tick bite to lower the risk of Lyme borreliosis. Preventive antibiotic doxycycline is given if:

The tick that bit you is identified as a black-legged tick.
You live in an area where Lyme disease is prevalent.
The tick remained attached to your skin for 36 hours or longer.

Tick Inspection and Other Tips:

Stay on clear paths in wooded areas.
Shower soon after returning from the outdoors. This can help remove ticks from your skin before they can burrow deeper.
Check your skin for signs of ticks. Use a mirror to find unseen ticks. Pay special attention to your ears, hair and hairline, underarms, waist, inside your belly button, inner thighs, and back of the knees.
Inspect your gear for signs of ticks. Before washing outdoor clothes, put them in the dryer on a hot setting for 10 minutes.

Read more about the prevention and treatment of tick bites.

How is Lyme Disease Diagnosed?

Your doctor can diagnose Lyme disease based on your signs and symptoms, history of tick exposure, and lab tests, including a blood test for antibodies to the Borrelia bacterium.

What is Life with Lyme Disease Like?

Most people recover well from Lyme disease, but some can develop long-lasting symptoms. Chronic Lyme disease refers to symptoms that continue long-term. Many people believe these symptoms are linked to an earlier illness with Lyme disease. However, research has not found any link between Borrelia bacteria and ongoing long-term symptoms. Therefore, the term chronic Lyme disease is not well-understood or well-defined. Studies have shown that continued use of antibiotics does not help these symptoms.

Common Questions About Lyme Disease

Can Lyme Disease Go Away on Its Own?

Yes, Lyme disease can go away on its own in some people. In fact, in most people bitten by a tick carrying Lyme disease bacteria, the infection clears on its own. The immune system fights off the bacteria, and there are no further complications. However, leaving Lyme disease untreated can put you at risk of complications such as severe joint pain, heart inflammation, and nervous system problems. Therefore, healthcare providers recommend Lyme disease treatment with antibiotics.

Is Lyme Disease 100% Curable?

In most cases, Lyme disease is 100% curable with a short course of antibiotics. However, in some cases, prolonged symptoms can occur if the infection is left untreated, or sometimes, even after treatment. The phenomenon is called chronic Lyme disease and is not fully understood or well-defined.

Is Lyme Disease Really Serious?

Yes, Lyme disease can be serious if left untreated. Complications can include heart problems (Lyme carditis), neurological symptoms (meningitis, encephalitis, facial palsy), and Lyme arthritis (knee pain, stiff neck, and other symptoms).

Can I Live A Long Life With Lyme Disease?

Most people with Lyme disease can live a normal life if they get early treatment. While Lyme disease is rarely fatal, untreated Lyme disease can cause long-term health problems in some people.