Most people who develop Lyme disease recover fully following a course of antibiotics. In rare cases, Lyme disease symptoms may persist for weeks, months, or even years after antibiotic treatment.
According to the Centers for Disease Control and Prevention (CDC), Lyme disease is the most common vector-borne disease in the United States. A vector-borne disease is one that a blood-feeding arthropod, such as a mosquito, flea, or, in the case of Lyme disease, a tick spreads.
This article describes the various treatment options available for Lyme disease. We also outline its symptoms and stages and provide tips on preventing tick bites.
People who develop Lyme disease require antibiotics to kill the bacteria that an infected tick transmits when it bites. The CDC indicate that a person will recover quicker if they begin antibiotic treatment soon after receiving the tick bite. Most people make a complete recovery after finishing the antibiotic course.
A doctor will prescribe oral antibiotics during the early stages of Lyme disease. For adults and children over 8 years of age, a doctor may prescribe a 10–21-day course of doxycycline.
For younger children, and pregnant or women who are breastfeeding, a doctor may prescribe a 14–21-day course of amoxicillin or cefuroxime.
If the disease involves the central nervous system, a doctor may prescribe intravenous antibiotics for 14–28 days. While this method is effective, it can lead to side effects and complications, such as:
- reduced white blood cell count
- infection from bacteria unrelated to Lyme disease
Blacklegged, or deer, ticks, carry the bacteria that cause Lyme disease, and the ticks can spread it to humans and animals. A tick must remain attached to the skin for at least 36 hours to infect a person.
Most tick bites resemble a small bump on the skin. If the tick does not carry the infection, the bump should disappear within a few days.
Some people who get Lyme disease may develop a characteristic bullseye rash. Doctors refer to this rash as erythema migrans. The rash may feel warm when a person touches it but is rarely painful or itchy. Not everyone who is bitten by an infected tick develops the bullseye rash.
Without treatment, Lyme disease may progress through three stages:
- early localized
- early disseminated
- late disseminated
Each stage may trigger different symptoms. However, the stages can overlap, and some symptoms are common to all three.
Stage 1: Early localized Lyme disease
Stage 1 or early localized Lyme disease occurs 1–28 days following a tick bite.
Some people with stage one Lyme disease do not experience any symptoms. If symptoms do occur, they may include the following:
- a skin rash that may or may not resemble a bulls-eye
- flu-like illness, including chills and a fever
- a headache and stiff neck
- swollen lymph nodes
Stage 2: Early disseminated Lyme disease
If stage 1 Lyme disease remains undiagnosed and untreated, it can progress to stage 2, or early disseminated, Lyme disease. This stage occurs 3–12 weeks after the initial tick bite.
The term disseminated indicates that the bacteria have spread throughout the body. At this stage, the infection may affect the following tissues:
- the skin
- nervous system
A person who has progressed to stage 2 Lyme disease may develop new symptoms alongside those from stage 1. These new symptoms may include:
- new rashes across the body
- conjunctivitis or vision problems
- swelling in large joints, such as the knee
- pain, weakness, or loss of sensation in the arms or legs
- facial paralysis (Bell’s palsy)
- heart palpitations and chest pain
- shortness of breath
- poor memory and concentration
Stage 3: Late disseminated Lyme disease
Stage 3 or late disseminated Lyme disease is the final stage of the disease. A person may enter this stage if they did not receive treatment for Lyme disease in the early stages, or if their symptoms persisted despite treatment. As such, doctors sometimes refer to this stage as chronic or post-treatment Lyme disease (PTLDS).
Stage 3 Lyme disease can occur months or years after an infected tick bites a person.
A person with stage 3 Lyme disease may experience additional symptoms, including:
- severe joint pain and swelling, known as chronic Lyme arthritis
- heart palpitations or irregular heartbeat, due to Lyme carditis
- inflammation of the brain and spinal cord
- mental fogginess
- severe fatigue
The National Health Service (NHS) in the United Kingdom states that two types of blood tests can help diagnose Lyme disease. These tests detect specific antibodies that develop in response to Borrelia burgdorferi or Borrelia mayonii.
However, antibodies can take several weeks to develop. If a person has only recently received a tick bite, a blood test may return a negative result despite the presence of bacteria in the bloodstream.
If a person’s symptoms persist despite a negative test result, their doctor may repeat the blood test a week or two later.
A small number of people continue to experience symptoms of Lyme disease years after completing a course of antibiotic treatment. These symptoms may include:
- reduced energy levels
- tiredness and fatigue
- body aches
- problems with concentration and memory
- difficulty sleeping
Lyme disease may also exacerbate existing health conditions in some people.
Around 1 in every 100 people who develop Lyme disease go on to develop Lyme carditis. This occurs when the bacteria responsible for Lyme disease enter the heart muscle and interfere with the heart’s electrical signaling.
This can lead to symptoms such as chest pain, heart palpitations, and heart block resulting from a conduction abnormality. The CDC state that the vast majority of people recover from Lyme carditis following appropriate antibiotic treatment; although it can be fatal, this is very rare.
The medical term for chronic Lyme disease is post-treatment Lyme disease syndrome (PTLDS). A doctor will diagnose a person with PTLDS when they continue to experience symptoms of Lyme disease 6 months or more after finishing antibiotic treatment.
Around 10% of people who develop Lyme disease go on to develop PTLDS. The condition tends to occur when there has been a delay between the initial infection and the antibiotic treatment.
Experts have not yet identified the exact cause of PTLDS. A 2015 review notes that an auto-immune response in the body, which causes symptoms long after the infection has gone, may trigger it. A similar reaction sometimes occurs following other types of infection.
There is no specific treatment for PTLDS. Lengthy courses of antibiotics can cause serious complications, so people may need to wait for the condition to resolve. Most people with PTLDS make a full recovery, although an article in Reumatologia indicates that it can take months to feel completely well.
Ticks are most prevalent in wooded, grassy, or brushy areas and are most active between April and September.
There are certain precautions a person can take to prevent being bitten by a tick. These include:
- using an insect repellent
- wearing long pants and long sleeves when walking in tick-infested areas
- keeping to the center of hiking trails, and avoiding walking through wooded, grassy, or brushy areas.
- using a hand-held or full-length mirror to check the body for ticks after coming indoors
- showering soon after coming indoors
The CDC recommend using insect repellents that contain one of the following active ingredients:
- oil of lemon eucalyptus
How to remove a tick
A tick must remain attached to the skin for at least 36 hours to spread Lyme disease. The best way of preventing Lyme disease is to remove a tick as soon as possible.
The blacklegged tick that spreads disease-causing bacteria resembles a tiny spider. Young ticks are around the size of a poppy seed, while adult ticks are around the size of a sesame seed. Ticks of all ages are reddish-brown.
Below are some steps for tick removal.
- Step 1: Use fine-tipped tweezers to gently grasp the tick near its head or mouth. Avoid squeezing the tick.
- Step 2: Using the tweezers, pull the tick carefully and steadily away from the skin. Avoid yanking or twisting the tick, as this could cause its mouthparts to remain in the skin.
- Step 3: After removing the tick, dispose of it by putting it in some alcohol or flushing it down the toilet.
- Step 4: Apply antiseptic to the tick bite.
A person should see a doctor if they have recently received a tick bite. It is not possible to know whether a tick is carrying Lyme disease, and the symptoms may take weeks to appear.
The earlier a person receives a diagnosis and treatment, the higher the likelihood of a quick and complete recovery.
It is not always possible for a person to tell if a tick has bitten them. As such, people should also see a doctor if they experience any Lyme disease symptoms. A doctor will ask about the person’s symptoms and duration and whether the person has spent time in tick-infested areas.
Usually, tick bites do not lead to Lyme disease. People who do develop Lyme disease often make a full recovery after taking a course of antibiotics.