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DEFINITIVE GUIDE

Lyme disease symptoms and treatment

Lyme disease occurs following a bite from an infected tick and can drastically affect people’s lifestyles and daily activities when left untreated.

Lyme disease can result in flu-like symptoms, fatigue, joint pain and cognitive impairment. It is typically easy to treat with a course of antibiotics if it is diagnosed early.

Not all ticks spread Lyme disease. However, you should be cautious when spending time in wooded or grassy areas.

Written by Dr Sufian Ali and Dr Saira Goheer. Last reviewed on 20/04/2020. Next review date 20/04/2023.

Fast facts

Is Lyme disease infectious?

Lyme disease is passed on to humans and animals from an infected tick. Lyme disease is not contagious and cannot be transmitted from one person to another.

What is the first sign of Lyme disease?

The first sign of Lyme disease may be an oval expanding rash (erythema migrans) which is usually non-itchy. This rash will appear around the area where you have been bitten. You may also experience joint pain and stiffness. Your joints may be swollen and painful to touch.

CHAPTER ONE

Lyme disease signs and symptoms

Lyme disease is progressive and if left untreated, it can cause complications to the heart, brain and nervous system.

There are different stages of Lyme disease and a classic rash may not always be present. This chapter has some useful information to help you understand the symptoms of Lyme disease. We can help with:

  • What does Lyme disease do?
  • What is the first sign of Lyme disease?

What is Lyme disease?

Lyme disease or Lyme borreliosis is an infection caused by a group of spiral-shaped bacteria (spirochetes) which are transmitted to humans following a bite from an infected tick. Ticks are commonly found in grassy and wooded areas, including urban gardens and parks.

Tick activity increases in spring and peaks between April to June, reducing over the summer months. However, it can increase again in early autumn and continues at low levels throughout the winter.

How prevalent is Lyme disease?

The true incidence of Lyme disease is unknown. However, Public Health England estimates that there are 2,000-3,000 new confirmed cases of Lyme disease each year in England and Wales, although not all cases are confirmed by laboratory testing (PHE, 2018). About 15% of cases are acquired when people are abroad.

Infection occurs most frequently in the New Forest, Salisbury Plain, Surrey and West Sussex, Exmoor, the South Downs, parts of Wiltshire and Berkshire, the Lake District, the North York Moors, the Thetford Forest (Norfolk), and the Scottish Highlands, but any area harbouring Ixodes ticks may have the potential for Lyme borreliosis transmission.

Lyme disease may be more prevalent in central, eastern and northern Europe (including Scandinavia) and parts of Asia, the US and Canada.

What are the symptoms of Lyme’s disease?

Some symptoms of Lyme disease can include:

  • Erythema migrans (Lyme disease rash)
  • Fatigue
  • Fever and sweats
  • Swollen glands
  • Headache
  • Malaise
  • Migratory joint or muscle aches and pain
  • Neck pain or stiffness
  • Paraesthesia
  • Impaired vision
  • Facial palsy
  • Cognitive impairment, such as memory problems and difficulty concentrating

What are the 3 stages of Lyme disease?

Lyme disease typically occurs in 3 stages.

Early localised

This is the initial stage of Lyme disease and can occur within hours or weeks after a bite from an infected tick. Symptoms in this phase include an oval skin rash at the point of the bite, fever, fatigue, muscle and joint pains, flu-like symptoms and swollen lymph nodes.

Early disseminated

This stage may occur weeks or months after the tick bite and shows that the bacteria is starting to spread around the body. In addition to the symptoms in the first stage, you may also experience inflamed and painful joints, headache, neck stiffness, difficulty concentrating or sleeping, weakness or numbness in the arms and legs, vision changes, heart problems and facial paralysis.

Late disseminated

This stage occurs when Lyme disease is left untreated. This can occur months or even years after the initial bite and can result in inflammatory migratory arthritis, severe headaches or migraines, severe fatigue, dizziness, irregular heart rhythm and worsening cognitive impairment.

Lyme disease is easiest to treat and cure in its early stage. Stages can sometimes overlap and not all patients may experience all three stages of Lyme disease.

What does Lyme disease look like?

In the initial stage of Lyme disease, a rash will appear around the bite of the tick. This rash usually doesn't itch but is a sign of the infection spreading through skin tissues. Up to a third of people with Lyme disease don’t have a rash.

What does Lyme disease rash look like?

The Lyme disease rash, known as erythema migrans that appears on infected individuals, has the following features:

  • Appearance - round or oval target-like appearance with a central red spot surrounded by a clear circle and then a red circle on the outside. Pink, red, or purple in colour. Usually flat but may be slightly raised, a vesicle or pustule is present at the centre in 5% of people.
  • Size - usually expands over days to weeks. The diameter is usually larger than 5cm (median 16cm) and can sometimes be as large as 70cm.
  • Location - a solitary lesion at the site of a tick bite. Often on the legs, at flexor creases (knees, axillae, and groins), around the waistband, under the breasts, near to straps (which impede the forward progress of ticks), or(particularly in children) at the hairline or the upper parts of the body.
  • Timing - it usually becomes visible from 1-4 weeks (but can appear from 3 days to 3 months) after a tick bite and lasts for several weeks.

How to test for Lyme disease?

To test for Lyme disease your doctor will first ask you about your medical history and if you have spent time outdoors recently. Your doctor will also perform a physical exam to check for the presence of a rash (erythema migrans). However, there is not always an obvious rash. Two types of blood tests can also be carried out to confirm the presence of Lyme disease but are not always accurate in the early stages of the disease. These include:

  • The Enzyme-linked immunosorbent assay (ELISA) test
  • The Western blot test
CHAPTER TWO

Lyme disease causes

Lyme disease occurs when you are bitten by a tick carrying the Lyme bacteria. You may be at risk if you spend a lot of time in areas where ticks such as deer ticks are present.

This chapter has some useful information to help you understand the risk factors contributing to Lyme disease and how you can prevent coming into contact with ticks. We can help with:

  • How do you get Lyme disease?
  • Can I catch Lyme disease from my partner?

What causes Lyme disease?

Lyme disease is caused by an infected tick passing the bacteria, Borrelia burgdorferi, to a human during its feeding cycle. The tick can become infected during its larval or nymph stage after it feeds on small animals like mice, squirrels and birds that carry the bacteria causing Lyme disease. When the infected tick gets onto you and bites, the bacteria can enter your skin and eventually make its way into your bloodstream.

What are the risk factors of Lyme disease?

Where you live can increase your risk of coming into contact with an infected tick. Some common risk factors of Lyme disease include:

  • Spending time in grassy, weedy or wooded areas
  • Having exposed skin when you spend time in grassy areas
  • Not removing an attached tick properly from your skin within 36 hours

Is Lyme disease contagious?

Lyme disease is not passed on from person to person. It has not been shown that Lyme disease can be spread from person to person through blood transfusions, infected animals, kissing and is not sexually transmitted.

Can I get Lyme disease again?

If you have had Lyme disease once and have been treated with antibiotics and recover, it is possible to get it again if you get bitten by an infected tick. You will have to see your doctor again to get diagnosed and prescribed appropriate treatment.

Can Lyme disease be passed genetically?

Lyme disease cannot be passed on genetically. Lyme disease is not inherited but if more than one member of a family contracts Lyme disease, this may be due to the environment they share.

Can you get Lyme disease from a dog tick?

You may get Lyme disease from a tick on a dog if the dog has picked up a tick that is carrying the Lyme disease bacterium, Borrelia burgdorferi. This carrier tick can get onto your skin and bite and infect you with Lyme disease. Not all ticks carry Lyme disease, however. The Lone star tick, American dog tick, Rocky Mountain wood tick and brown dog tick do not carry Lyme disease bacteria and cannot transmit the disease.

Can I test myself for Lyme?

NHS testing is available for Lyme disease through local service providers and the Rare and Imported Pathogens Laboratory (RIPL). To test for Lyme disease, a blood test will be carried out to detect antibodies produced to fight off the Lyme disease bacteria.

CHAPTER THREE

Lyme disease treatment

Lyme disease is typically treated with a course of antibiotics prescribed by your doctor. Your GP can diagnose you and carry out tests to determine if you have Lyme disease

This chapter has some helpful information on how Lyme disease is treated and prevented. We can help with:

  • Can Lyme disease be cured?
  • What is the best treatment for Lyme disease?

Is Lyme disease curable?

Lyme disease can be easily treated and cured in its early stages with a prescription of antibiotics from your doctor. If Lyme disease is left untreated, it can cause serious complications to your heart, joints and nervous symptoms. However, Lyme disease can also be treated and cured in its later stages.

How to treat Lyme disease

For people diagnosed with Lyme disease (or with a high suspicion of Lyme disease awaiting test results) a doctor may prescribe oral antibiotics. Usually an antibiotic such as Doxycycline, Amoxicillin or Azithromycin would be prescribed for 2 to 4 weeks.

How to manage Lyme disease

There are different approaches your doctor may take to help you manage your Lyme disease:

  • For all people with an erythema migrans rash who have no evidence of focal symptoms (for example, eye, cardiac, neurological, or joint involvement), the doctor will start treatment with a prescription of oral antibiotics
  • If Lyme disease is suspected in people without erythema migrans, a doctor may offer a blood test called enzyme-linked immunosorbent assay (ELISA). If there is a high clinical suspicion of Lyme disease, a doctor may consider starting treatment with antibiotics while waiting for the results
  • A doctor may discuss the diagnosis and management of Lyme disease with a specialist

Is exercise good for Lyme disease?

If you are in the early stages of Lyme disease, light and moderate exercise can be good for alleviating joint aches and pains. However, if you are experiencing flu-like symptoms, it is not recommended that you exercise.

How to prevent Lyme disease?

To reduce your risk of getting Lyme disease you can:

  • Avoid wooded or grassy areas where deer ticks live
  • Cover up exposed skin if you are in these wooded, grassy areas with long-sleeved tops and trousers
  • Consider using insect repellent
  • Tick-proof your garden by mowing the grass and clearing bushes and leaves where ticks live
  • Check yourself for ticks if you have been in a location that is prevalent to infected ticks
  • Remove a tick as soon as possible (within 36 hours)
  • Tick repellents sprayed on clothing or directly on the skin may be used on adults
  • Pets can develop Lyme disease and can carry ticks. Inspect your own skin after playing with outdoor pets. You could consider a tick collar for your pets.
CHAPTER FOUR

Complications associated with Lyme disease

Depending on the stage of infection, Lyme disease can seriously affect one’s memory, heart and joints. It’s important to see a doctor for diagnosis and treatment if you have noticed symptoms of Lyme disease.

This chapter will give you more information on the complications that could arise from untreated Lyme disease. We can help with:

  • How serious is Lyme disease?
  • What are the complications of Lyme disease?

What happens if you go untreated for Lyme disease?

If Lyme disease is not caught in its early stages and treated with antibiotics, it can cause serious complications. If left untreated, the infection can spread to your joints, heart and nervous system. This can cause an array of symptoms such as:

  • Headaches
  • Neck aches
  • Heart palpitations
  • Inflammatory arthritis
  • Serious joint pain
  • Facial palsy
  • Neuropathy
  • Cognitive defects (impaired memory)

Can Lyme disease cause weight gain?

Lyme disease may cause weight gain, weight loss and skin disorders due to a buildup of toxins in the body.

What is Lyme carditis?

Lyme carditis occurs with untreated Lyme disease or in situations where treatment has been unsuccessful. It is a progressive complication that affects the heart. Symptoms of Lyme carditis include chest pain, heart palpitations and ECG changes. All parts of the heart can be affected by Lyme bacteria.

Can Lyme disease cause liver problems?

Amongst other complications people may experience, it is possible that Lyme disease contributes to liver problems as it may cause inflammation of the liver (hepatitis).

CHAPTER FIVE

Lyme disease FAQs

If you think you have developed Lyme disease, your doctor can accurately diagnose you and give you more information on the disease.

This chapter has some more helpful answers to frequently asked questions about Lyme disease. We can help with:

  • Can I get Lyme disease from an animal?
  • Can symptoms of Lyme disease come and go?

Can Lyme disease go away on its own?

Lyme disease may not go away on its own without antibiotic treatment. Initial symptoms of Lyme disease may go away on their own within a few weeks, however, additional symptoms may appear days to months later.

Can you die from Lyme disease?

Lyme disease is not fatal and can be treated and cured with a course of antibiotics. However, untreated Lyme disease can lead to serious complications which can affect your brain, heart and joints.

Do all ticks carry Lyme disease?

Not all ticks carry Lyme disease. Only some species of ticks can carry the Lyme disease bacteria and pass it on to humans. The ticks that carry Lyme disease are referred to as Ixodes and include:

  • Blacklegged tick
  • Deer tick
  • Pacific tick

Can you get Lyme disease from a dog bite?

It is not possible to get Lyme disease from a dog bite. Lyme disease is only passed on to people through an infected tick bite. A dog may, however, have picked up a carrier tick and this tick could latch onto you.

How long do Lyme disease symptoms last?

Lyme disease can be treated and cured with a course of antibiotics within 2 to 4 weeks. However, it is possible for symptoms of Lyme disease to last for months or years after treatment. These symptoms include fatigue, joint or muscle pains, headaches, hearing loss, dizziness, mood changes, paresthesia, difficulty sleeping and difficulty thinking. They can disrupt a person’s normal daily activities, however, not all cases of Lyme disease will result in post-treatment Lyme disease syndrome.

Can mosquitoes carry Lyme?

Mosquitoes can carry Lyme disease but there is no evidence that they spread the infection to humans.

What to do if bitten by a tick?

If you have been bitten by a tick and it is still attached to the skin, remove it as soon as possible.

Do

  • Grasp the tick as close to your skin as possible using fine-toothed tweezers or a tick removal device
  • Pull upwards slowly and firmly, away from the skin, without twisting

Do not

  • Squeeze, crush or puncture the body of the tick
  • Burn the tick off (eg. using a cigarette end or match head)
  • Apply petroleum jelly, alcohol, nail varnish remover, or other substances

After removal, clean the skin with soap and water or skin disinfectant and wash your hands.

Seek immediate medical advice if you develop any signs or symptoms of Lyme disease.

CHAPTER SIX

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CHAPTER SEVEN

About the authors

Written by Dr Sufian Ali and Dr Saira Goheer. Last reviewed on 20/04/2020. Next review date 20/04/2023.

Dr Sufian Ali

Dr Sufian Ali is a Medicspot GP based in the West of Scotland, having attended Aberdeen Medical School and completed his GP training in Glasgow. He has enjoyed working in a number of specialties including paediatrics, psychiatry and emergency medicine; while also working in a variety of settings.

Dr Saira Goheer

Dr Saira Goheer grew up in Glasgow and attended Hutchesons' Grammar. She qualified from Aberdeen University Medical School in 2010. She returned to Glasgow for her GP training. Saira is now based in Edinburgh working as a qualified GP. She started working for Medicspot in 2019 and has a real passion for travel and fitness.

Disclaimer

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.