Lyme Disease: Symptoms, Tick Bites, Treatment and Prevention

Lyme disease, also called Lyme borreliosis, is a bacterial infection transmitted to humans through the bite of certain infected ticks.

It is caused by bacteria belonging to the Borrelia burgdorferi sensu lato group.

Different Borrelia species cause Lyme disease in different parts of the world. Lyme disease occurs mainly in parts of:

• North America,
• Europe,
• and temperate regions of Asia.

Not every tick carries Lyme disease bacteria, and being bitten by a tick does not automatically mean that you will develop Lyme disease.

However, recognizing and removing an attached tick promptly can reduce the risk of infection.

Early Lyme disease is usually successfully treated with appropriate antibiotics.

Without treatment, however, the infection can sometimes spread to the:

• nervous system,
• joints,
• heart,
• and other tissues.

Understanding tick exposure, early symptoms and correct tick removal is therefore important.

What Causes Lyme Disease?

Lyme disease is caused by bacteria belonging to the Borrelia burgdorferi sensu lato complex.

In North America, Borrelia burgdorferi is the main cause.

Several Borrelia species cause Lyme borreliosis in Europe and Asia.

These bacteria circulate naturally between certain ticks and animals.

Humans become infected when an infected tick attaches to the skin and feeds.

Which Ticks Transmit Lyme Disease?

Lyme disease is transmitted primarily by Ixodes ticks.

These are known by different names in different regions.

For example:

• blacklegged ticks transmit Lyme disease in parts of North America,
• Ixodes ricinus is an important vector across much of Europe,
• and other related Ixodes species occur in parts of Asia.

The ticks responsible can be extremely small, particularly during their nymph stage.

A person may therefore not notice being bitten.

How Do Ticks Become Infected?

Ticks can acquire Borrelia bacteria while feeding on infected wildlife.

Important animal hosts can include certain:

• small mammals,
• birds,
• and other wildlife.

The bacteria can then be transmitted when an infected tick later feeds on a person.

Large animals such as deer can play an important role in maintaining tick populations, but the ecology of Lyme disease is complex and varies geographically.

Can Ticks Fly or Jump?

No.

Ticks do not fly or jump.

They commonly wait on:

• grass,
• leaves,
• shrubs,
• vegetation,
• and other surfaces.

They can climb onto a person or animal that brushes past them.

This behaviour is sometimes called questing.

Ticks then move across the skin until they find a suitable place to attach and feed.

Where Are Ticks Commonly Found?

Ticks that transmit Lyme disease may be found in:

• woodland,
• forests,
• grassy areas,
• brushy vegetation,
• heathland,
• parks,
• gardens,
• and other suitable outdoor environments.

You do not necessarily have to be deep in a forest to encounter a tick.

Risk varies considerably according to geographical location, season and local tick populations.

Where Do Ticks Attach to the Body?

Ticks can attach almost anywhere.

After spending time in tick habitats, check areas including:

• scalp and hairline,
• behind the ears,
• neck,
• armpits,
• waist,
• groin,
• behind the knees,
• between the legs,
• around the ankles,
• and other skin folds.

In young children, pay particular attention to the head, scalp and neck.

Do Tick Bites Hurt?

Often, they do not.

A tick can remain attached without causing significant pain.

This is one reason people may develop Lyme disease without remembering a tick bite.

Finding no tick does not necessarily mean there was no previous exposure.

Does a Tick Immediately Transmit Lyme Disease?

Usually not.

The risk of Lyme disease generally increases the longer an infected tick remains attached.

Transmission is considered unlikely during the earliest hours of feeding, which is why prompt tick removal is important.

However, it is not useful to assume that every bite follows an exact universal number of hours.

Transmission risk depends on factors including:

• the tick species,
• its life stage,
• whether it carries Borrelia,
• how long it has been attached,
• and geographical circumstances.

Therefore, remove an attached tick as soon as you discover it rather than waiting.

What Are the Early Symptoms of Lyme Disease?

Early symptoms can develop days to weeks after an infected tick bite.

They may include:

• fever,
• chills,
• headache,
• tiredness,
• muscle aches,
• joint aches,
• and swollen lymph nodes.

A characteristic expanding skin rash called erythema migrans is one of the most recognizable signs.

However, not everyone develops or notices a rash.

What Is an Erythema Migrans Rash?

Erythema migrans (EM) is the characteristic skin rash associated with early Lyme disease.

It typically:

• begins near the site of the tick bite,
• gradually expands,
• develops over several days,
• and may eventually become quite large.

It is generally not very itchy, painful or hot.

The appearance can vary considerably between people.

Does a Lyme Rash Always Look Like a Bull's-Eye?

No.

This is an important misconception.

Some erythema migrans rashes develop central clearing and may resemble a bull's-eye or target.

Many do not.

The rash may instead appear:

• uniformly red,
• pink,
• reddish-purple,
• oval,
• irregular,
• or differently coloured depending on the person's skin tone.

On darker skin, the colour change may be less obviously bright red.

Do not dismiss an expanding rash simply because it does not have the classic bull's-eye appearance.

Is Every Red Mark After a Tick Bite Lyme Disease?

No.

A small area of redness or irritation can occur immediately around a tick bite.

This local reaction can:

• appear relatively quickly,
• be itchy or uncomfortable,
• and disappear within a short period.

Erythema migrans behaves differently.

It usually appears after a delay and gradually expands over time.

If you are uncertain about a rash following a possible tick bite, seek medical assessment.

What Happens If Lyme Disease Is Not Treated?

Untreated infection can sometimes spread beyond the original bite site.

Later manifestations can affect the:

• nervous system,
• heart,
• joints,
• and skin.

Symptoms vary substantially between people.

Lyme Disease and the Nervous System

Lyme disease can sometimes affect the nervous system, causing Lyme neuroborreliosis.

Possible manifestations include:

• facial weakness or facial palsy,
• severe nerve pain,
• numbness or tingling,
• meningitis-like symptoms,
• severe headache,
• and neck stiffness.

A person may develop weakness on one or both sides of the face.

Neurological symptoms following possible tick exposure require medical assessment.

Lyme Disease and Facial Palsy

Lyme disease can affect nerves controlling facial muscles.

This can result in:

• drooping on one side of the face,
• difficulty closing an eye,
• difficulty smiling,
• or weakness affecting both sides in some cases.

However, Lyme disease is only one possible cause of facial paralysis.

New facial weakness requires prompt medical assessment because other important conditions can produce similar symptoms.

Lyme Disease and the Heart

Lyme disease can occasionally affect the electrical system controlling the heartbeat.

This is called Lyme carditis.

Possible symptoms include:

• palpitations,
• dizziness,
• fainting,
• chest discomfort,
• shortness of breath,
• or an unusually slow or irregular heartbeat.

Some cases can cause serious disturbances in the heart's electrical conduction system.

Seek urgent medical attention for:

• fainting,
• significant breathing difficulty,
• severe chest symptoms,
• or symptoms suggesting a serious heart rhythm problem.

Lyme Arthritis

Untreated Lyme disease can sometimes cause arthritis.

It often produces:

• noticeable swelling,
• pain,
• warmth,
• and reduced movement

in one or more joints.

Large joints, particularly the knee, are commonly affected.

Joint swelling may appear months after the original infection.

How Is Lyme Disease Diagnosed?

Diagnosis is based on several factors, including:

• symptoms,
• physical findings,
• likelihood of tick exposure,
• geographical location,
• travel history,
• and laboratory testing when appropriate.

There is no single approach appropriate for every stage of Lyme disease.

Does an Erythema Migrans Rash Need a Blood Test?

A typical erythema migrans rash can often be diagnosed clinically without waiting for a blood test.

This is important because antibody tests can be negative during the early stage of infection.

Treatment should not necessarily be delayed while waiting for antibodies to develop when the clinical diagnosis of erythema migrans is clear.

How Is Lyme Disease Blood Testing Done?

When laboratory testing is appropriate, blood tests look for antibodies produced in response to Borrelia infection.

Testing methods and algorithms vary somewhat between countries.

A healthcare professional interprets results together with:

• symptoms,
• timing,
• exposure history,
• and other clinical information.

Testing too early can sometimes produce a negative result because the immune system has not yet produced detectable antibody levels.

Should Healthy People Be Tested After Every Tick Bite?

Generally, simply finding a tick does not automatically mean Lyme disease testing is required.

Testing people without compatible symptoms can produce misleading results.

After a tick bite:

• remove the tick promptly,
• note approximately when and where the exposure occurred,
• monitor for symptoms,
• and seek healthcare advice when appropriate.

Recommendations can differ according to local Lyme disease prevalence and the circumstances of the bite.

How Is Lyme Disease Treated?

Lyme disease is treated with antibiotics.

The antibiotic selected and length of treatment depend on factors such as:

• the person's age,
• symptoms,
• stage of disease,
• pregnancy,
• allergies,
• and whether the nervous system, heart or joints are involved.

Commonly used antibiotics can include:

• doxycycline,
• amoxicillin,
• cefuroxime,
• and, for certain manifestations, intravenous antibiotics such as ceftriaxone.

Treatment should be prescribed by an appropriate healthcare professional.

Can Lyme Disease Be Cured?

Most people treated appropriately for Lyme disease recover.

Early diagnosis and treatment reduce the risk of later complications.

People with more advanced disease can also benefit from treatment, although recovery may take longer when inflammation or tissue injury has already occurred.

Can Symptoms Continue After Lyme Disease Treatment?

Some people experience persistent symptoms after completing recommended antibiotic treatment.

These can include:

• fatigue,
• body aches,
• or difficulty thinking and concentrating.

The reasons are not completely understood.

Persistent symptoms deserve proper medical evaluation because many conditions can cause similar problems.

Current evidence does not support prolonged or repeated courses of antibiotics simply because nonspecific symptoms continue after appropriately treated Lyme disease, unless there is evidence of an active infection requiring further treatment.

How Should You Remove a Tick?

If you find an attached tick, remove it promptly.

Use fine-tipped tweezers or an appropriate tick-removal tool.

Step 1

Grasp the tick as close to the surface of the skin as possible.

Step 2

Pull upward using steady, even pressure.

Step 3

Do not deliberately twist, crush or jerk the tick.

Step 4

After removing it, clean:

• the bite area,
• and your hands

with soap and water or another appropriate cleansing method.

What If Part of the Tick Remains in the Skin?

Occasionally, the tick's mouthparts can break off and remain embedded.

If they can be easily removed with clean tweezers, they may be removed.

If not, do not aggressively dig into the skin.

The skin will often naturally expel remaining superficial material as it heals.

Seek medical advice if the area becomes increasingly:

• painful,
• swollen,
• red or discoloured,
• or shows other signs of infection.

What Should You NOT Do to an Attached Tick?

Do not try to remove an attached tick by:

• burning it,
• applying a hot match,
• crushing it while attached,
• covering it with petroleum jelly,
• applying nail polish,
• or using other substances intended to make it detach.

These methods can delay proper removal.

Use tweezers or an appropriate tick-removal tool and remove the tick promptly.

Should You Save the Tick?

Recommendations vary.

You may wish to:

• photograph the tick,
• record the date,
• and note where you were when you may have acquired it.

Routine testing of ticks for Borrelia is generally not a reliable substitute for medical evaluation.

A positive result does not prove that the bacteria were transmitted, and a negative result does not necessarily exclude other tick-borne infections.

Should You Take Antibiotics After a Tick Bite?

Not everyone bitten by a tick needs preventive antibiotics.

In some regions and under specific circumstances, a healthcare professional may recommend preventive antibiotic treatment after a high-risk tick bite.

The decision can depend on:

• local Lyme disease prevalence,
• tick species,
• how long it was attached,
• degree of engorgement,
• timing since removal,
• age,
• pregnancy,
• allergies,
• and local clinical guidelines.

Do not take leftover antibiotics after a tick bite.

Seek professional advice when concerned.

How Can You Prevent Lyme Disease?

The most effective approach is to reduce tick bites and remove attached ticks promptly.

Avoid Direct Contact With Tick Habitats When Practical

When walking through areas with significant tick activity:

• stay on clear paths where practical,
• avoid brushing directly against dense vegetation,
• and be particularly aware in long grass and woodland edges.

You do not need to stop enjoying outdoor activities.

The aim is to reduce exposure.

Wear Protective Clothing

In tick-prone areas, consider:

• long trousers,
• long sleeves,
• closed shoes,
• and socks.

Light-coloured clothing can sometimes make crawling ticks easier to see.

In appropriate circumstances, clothing treated with permethrin can provide additional protection.

Always follow product instructions.

Use an Effective Tick Repellent

Use an approved insect repellent appropriate for your location.

Depending on the country, effective active ingredients may include products containing:

• DEET,
• picaridin,
• IR3535,
• oil of lemon eucalyptus,
• PMD,
• or other approved repellents.

Availability and regulatory approval vary internationally.

Follow the label instructions, particularly when using repellents on children.

Check Your Body After Outdoor Activities

After spending time in tick habitat, perform a full-body tick check.

Use a mirror or ask another person to help inspect difficult-to-see areas.

Pay particular attention to:

• scalp,
• behind the ears,
• armpits,
• waist,
• groin,
• behind the knees,
• and between the legs.

Parents and caregivers should carefully check children.

Shower After Being Outdoors

Showering relatively soon after returning from tick habitat may help wash away ticks that have not yet attached.

It also gives you an opportunity to perform a thorough tick check.

Remember that an already attached tick still needs to be physically removed.

Check Clothing and Equipment

Ticks can be carried into the home on:

• clothing,
• backpacks,
• outdoor equipment,
• and other belongings.

Inspect these items after spending time in tick habitat.

Appropriate heat treatment of clothing may kill ticks, but follow fabric-care and local public-health recommendations.

Check Pets for Ticks

Pets can pick up ticks outdoors and carry them into the home.

Check pets regularly if they spend time outdoors in tick-prone areas.

Ask a veterinarian about appropriate tick-prevention products.

Never use a tick-control product intended for dogs on a cat unless a veterinarian specifically says it is safe, because some products can be highly toxic to cats.

Can You Get Lyme Disease From Your Pet?

Pets do not normally transmit Lyme disease directly to people.

However, they can bring unattached ticks into the home.

Protecting pets from ticks therefore helps protect both animal and human health.

Can Lyme Disease Spread From Person to Person?

Lyme disease is acquired primarily through the bite of infected ticks.

It is not spread through ordinary casual contact such as:

• touching,
• hugging,
• sharing food,
• or being near someone with Lyme disease.

A person with Lyme disease does not need to be isolated from family or friends.

When Should You Seek Medical Care After a Tick Bite?

Seek medical advice if, after possible tick exposure, you develop:

• an expanding rash,
• fever,
• unexplained fatigue,
• headache,
• facial weakness,
• unusual nerve symptoms,
• significant joint swelling,
• palpitations,
• dizziness,
• or other concerning symptoms.

Tell the healthcare professional about:

• recent tick bites,
• outdoor activities,
• where you live,
• and recent travel to tick-prone regions.

Even if you do not remember being bitten, Lyme disease may still be considered when symptoms and exposure history are compatible.

When Is Urgent Medical Care Needed?

Seek urgent medical attention for symptoms such as:

• fainting,
• severe chest symptoms,
• significant difficulty breathing,
• severe palpitations,
• new severe neurological symptoms,
• severe weakness,
• or symptoms suggesting meningitis or a serious heart rhythm disturbance.

Do not wait for a rash to appear before seeking urgent care for severe symptoms.

The Bottom Line

Lyme disease is a bacterial infection transmitted through the bite of certain infected Ixodes ticks.

Early symptoms can include:

• an expanding erythema migrans rash,
• fever,
• headache,
• fatigue,
• muscle aches,
• and joint aches.

The characteristic rash does not always look like a bull's-eye, and some people never notice a rash.

Untreated Lyme disease can sometimes affect the:

• nervous system,
• heart,
• and joints.

Most people can be successfully treated with appropriate antibiotics.

The best ways to reduce your risk are to:

• prevent tick bites,
• use appropriate repellent,
• wear protective clothing,
• check yourself after outdoor activities,
• check children and pets,
• and remove attached ticks promptly using fine-tipped tweezers.

Never burn or smother an attached tick.

If symptoms develop following possible tick exposure, seek appropriate medical assessment.

Medical Disclaimer

This article provides general health information for an international audience and does not replace diagnosis or treatment by a qualified healthcare professional. Lyme disease prevalence, tick species, testing procedures and recommendations for preventive antibiotics differ between countries and regions. Seek professional medical advice if you develop symptoms following a tick bite or possible tick exposure. Serious neurological, cardiac or breathing symptoms require urgent medical attention.

Sources and Further Reading

Centers for Disease Control and Prevention — About Lyme Disease

https://www.cdc.gov/lyme/about/index.html

Centers for Disease Control and Prevention — Signs and Symptoms of Untreated Lyme Disease

https://www.cdc.gov/lyme/signs-symptoms/

Centers for Disease Control and Prevention — Preventing Lyme Disease

https://www.cdc.gov/lyme/prevention/

Centers for Disease Control and Prevention — Chronic Symptoms and Lyme Disease

https://www.cdc.gov/lyme/signs-symptoms/chronic-symptoms-and-lyme-disease.html

European Centre for Disease Prevention and Control — Borreliosis (Lyme Disease)

https://www.ecdc.europa.eu/en/borreliosis-lyme-disease

NICE — Lyme Disease: Recommendations

https://www.nice.org.uk/guidance/ng95/chapter/Recommendations