Lyme disease is a bacterial infection. Although some people get temporary immunity from their first Lyme infection, this immunity quickly disappears. Therefore, people can develop Lyme disease twice. There is no evidence that Lyme disease is better or worse the second time.

Experts note that antibiotics are highly effective at treating Lyme disease, which develops due to a type of tick bite.

This article discusses Lyme disease reinfection, Lyme disease immunity, preventing reinfection, and more.

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Scientists define Lyme disease as an infectious condition.

Individuals can develop Lyme disease after infection from Borrelia burgdorferi bacteria, which survive inside certain tick species. When an infected tick bites, these bacteria can spread to the tick’s host.

Over time, an individual can receive multiple bites from infected ticks. As a 2020 study explains, people can contract Lyme disease multiple times. It is certainly possible to get Lyme disease twice.

Scientists are unclear about the potential differences between first and second Lyme disease. For instance, there is no scientific evidence that Lyme disease is better or worse the second time around.

PTLDS is when people continue to have Lyme disease symptoms even after taking oral antibiotics for 2–4 weeks. These symptoms can last for 6 months or even longer in some cases.

This could cause a person to suspect a second Lyme disease infection.

Some common symptoms of PTLDS include:

As the Centers for Disease Control and Prevention (CDC) explain, scientists continue to debate the causes of PTLDS.

Some scientists think that B. burgdorferi may sometimes induce autoimmune responses. These responses cause symptoms even after the infection disappears.

Other scientists believe that PTLDS occurs due to unusually persistent B. burgdorferi infections.

According to a 2022 article, Lyme disease has many possible symptoms. These develop in stages. Within the first few weeks of Lyme disease, individuals may develop:

Within subsequent weeks or months, Lyme disease symptoms include:

There is no evidence that these symptoms differ upon reinfection from B. burgdorferi.

There is anecdotal evidence that people with PTLDS experience symptom flares.

These are periods during which symptoms suddenly worsen. However, scientists have not investigated symptom flares in Lyme disease. They do not know what might trigger them or how common they are.

Jarisch Herxheimer reaction (JHR)

In some cases, antibiotic treatment for Lyme disease can cause symptoms known as JHR. Evidence notes that JHR can present with the following symptoms:

JHR begins within 24 hours of antibiotic treatment. Scientists are unsure about what causes it.

One theory is that JHR arises when bacteria start dying. This process releases toxins, which may cause inflammation. However, further research is necessary.

According to the aforementioned 2020 study, people can develop some immunity to Lyme disease from a first infection.

However, as with other bacterial infections, natural immunity to Lyme disease does not last.

Vaccines provide an artificial form of immunity from infectious diseases. Scientists are working on creating safe and effective vaccines for Lyme disease. There is currently no vaccine for Lyme disease approved by the Food and Drug Administration (FDA).

When it comes to first and second Lyme infections, there is ample evidence that antibiotics are highly effective at eradicating B. burgdorferi.

In children under 8 years of age, amoxicillin is the ideal option. By contrast, the best antibiotic for pregnant individuals is ceftriaxone. In all other people, doxycycline is the antibiotic of choice for treating Lyme disease.

Doctors will also take into account the stage of Lyme disease when prescribing medication.

As the CDC explains, antibiotics do not tend to help with PTLDS. Long-term antibiotic use for PTLDS can cause serious health issues. Scientists do not yet understand how to treat this condition.

The CDC gives some recommendations for reducing the chances of getting Lyme disease.

This guidance should also help with preventing reinfection. For instance, the CDC recommends the following preventive measures:

  • avoiding bushy or grassy areas
  • walking in the center of trails
  • treating clothes with 0.5% permethrin-containing products
  • using insect repellents
  • checking clothing, equipment, and pets for ticks

The CDC also suggests taking a shower after returning from the outdoors. This can help wash off any ticks.

It is important to perform a full-body tick check after showering. If an individual finds any ticks, they should remove these safely.

Learn more

Find out more about ticks and Lyme disease.

This section answers some common questions about Lyme disease reinfection.

How many times can you get Lyme disease?

There is evidence that people can get Lyme disease more than once. Scientists do not know what the maximum amount might be.

Why does my Lyme disease keep coming back?

Scientists are unsure about why Lyme disease symptoms recur. It could be immune system malfunction, persistent infections, or even Lyme disease reinfection.

How do doctors treat recurrent Lyme disease?

The CDC explains there is no standard treatment for recurrent Lyme disease symptoms, such as in those with PTLDS.

According to the National Institute of Allergy and Infectious Diseases, additional courses of antibiotics do not seem to work for PTLDS and can even be dangerous.

However, experts are currently researching potential treatments for PTLDS.

It is possible for an individual to get Lyme disease twice.

However, scientists remain unsure about how common this is, and about how serious second Lyme infections might be. There is no evidence to suggest that Lyme disease is worse or better the second time.

Antibiotic therapy is useful in most cases of Lyme disease, but if symptoms persist — such as in PTLDS — further antibiotic treatment may not be helpful and could be dangerous.