All About Lyme Disease

Virtually unknown a few decades ago, today Lyme disease is a cause for concern for many, especially for those who live near wooded areas. Spread by the bite of the deer tick, this bacterial infection causes flu-like symptoms in its early stage, often accompanied by a bullseye-shaped red rash. And while it usually can be eradicated with a course of antibiotics, for a handful of unlucky people the symptoms persist for months or even longer. Untreated, Lyme can cause a host of serious complications.

Approximately 30,000 cases of Lyme are reported in the U.S. each year, according to the Centers for Disease Control and Prevention (CDC).

Here are the questions—and answers—about Lyme that you should know.

1. Where Is Lyme Common?

The disease is seen mostly in the Northeast, mid-Atlantic, and upper Midwest states. Ninety-six percent of the cases in the U.S. originate in just 14 states: New York, New Jersey, Pennsylvania, Connecticut, Massachusetts, Vermont, New Hampshire, Maine, Rhode Island, Maryland, Delaware, Virginia, Wisconsin, and Minnesota. In fact, Lyme disease got its name because it was first identified in Lyme, CT in the 1970s, when a group of children exhibited symptoms that were eventually linked to deer-tick bites.

2. What Are the Symptoms?

The earliest symptoms of Lyme infection are similar to those of the flu. You may run a fever, feel achy, have a headache, and have swollen lymph nodes. However, about three-quarters of those with Lyme also exhibit a very distinctive rash that resembles a bullseye, with a red center. The rash may get bigger and spread over a matter of days, as well as seem warm to the touch. The appearance of a rash—along with the flu-like symptoms—is a clear indicator that what you have is likely to be Lyme disease, especially if you remember finding a tick on your skin or have recently been in a wooded or grassy area.

But spotting the rash is not always easy: "It may not be in the place where you expect to see it," notes Michael Zimring, MD, director of travel medicine at Mercy Medical Center in Baltimore. Although you may pick up a tick on your exposed leg or arm while walking through the woods, the critters do crawl—and they’re attracted to out-of-the-way locations such as the groin or underarm. That’s where they may attach to your skin and where the rash may be located, which is why it’s critical to check your entire body, including your scalp, if you’ve been in outside in an area known to have Lyme disease.

3. What Should I Do if I Think I Have Lyme?

Because Lyme disease is much more easily cured when caught early, it’s imperative that anyone with symptoms consult a doctor as soon as possible. But don’t rely on blood tests at this early stage, because chances are your body hasn’t developed antibodies to Lyme just yet. "Lyme is a clinical disease," says Zimring, adds says that flu-like symptoms and a rash along with a positive travel history (i.e., the patient spent a week in the Maine woods) are enough for him to make a diagnosis of Lyme. "You treat; you don’t wait for the test. The longer you wait, the worse it’ll be."

4. What Does Treatment Involve?

An antibiotic—most often doxycycline in the case of adults—taken for two or three weeks is usually enough to knock out the infection. If symptoms haven’t completely resolved within three weeks, Zimring recommends a second course of antibiotics.

For a very small percentage of patients, a standard course (or two) of antibiotics will not kill the infection. When symptoms last for six months or more, the condition is known as post-treatment Lyme disease syndrome (some people call it chronic Lyme). According to the CDC, repeated courses of antibiotics are unlikely to help and in fact have some undesirable side effects. Generally, people with post-treatment Lyme disease syndrome will improve on their own. Symptoms may, however, take months to resolve.

5. What if I Don’t Catch Lyme Disease Early?

Lyme disease that’s never detected and treated can cause major problems months or years later as the bacteria spreads. Patients may experience issues with their nervous system, joints, heart, eyes, or brain. Lyme disease can go unnoticed if the patient never develops a rash, or fails to see it. Some patients spend years dealing with unexplained arthritis, or heart palpitations, or numbness and tingling, until Lyme disease is finally considered as the cause.

Although not 100 percent accurate, blood tests can assist in making a diagnosis of Lyme disease when other symptoms suggest it. In these situations, doctors may want to check for other tick-borne illnesses such as babesiosis and anaplasmosis, which can occur along with Lyme disease or on their own. Depending on the parts of the body involved, treatment for late-stage tick-borne illnesses may call for intravenous antibiotics.

6. How Can I Prevent Lyme Disease in the First Place?

The best way to reduce your chance of contracting Lyme disease is to avoid contact with ticks. If you're going to be in the woods or anywhere with high grass, wear long pants and tuck them into your socks. Wear bug repellent that contains 20 percent to 30 percent DEET, a chemical known to be effective against bug bites, and apply permethrin-containing products to your clothing. It's also important to check your body thoroughly for ticks as soon as you remove your clothing. Pay special attention to those often-overlooked areas such as the groin, ears, and scalp.

Michael Zimring, MD, reviewed this article.


Zimring, Michael, MD. Phone conversation with source. May 5, 2016.

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