Lyme disease: resources and guidance

The characteristics, diagnosis, management, surveillance and epidemiology of Lyme disease.

Lyme disease is a tick-borne bacterial infection that can be transmitted to humans when they are bitten by an infected Ixodes ricinus tick.

Lyme disease can be contracted anywhere in the UK but is more common in the south of England and the Scottish Highlands. Only a small minority of ticks in the UK are infected with the bacteria that cause Lyme disease. Being bitten by a tick does not necessarily result in Lyme disease.

Symptoms and differential diagnosis

Lyme disease most commonly presents as a spreading rash around the bite area (erythema migrans). In the UK, about a third of cases do not notice a rash and may present with fever, headache or neurological symptoms.

Clinical signs and symptoms of Lyme disease are described in detail in the 2018 NICE Lyme disease guideline.

Some of the symptoms of Lyme disease are non-specific and clinicians should consider a range of differential diagnoses.

Laboratory diagnosis

The 2018 NICE Lyme disease guideline provides advice about when a diagnosis of Lyme disease should be suspected, and which tests to use and when.

The PHE Rare and Imported Pathogens Laboratory (RIPL) provides Lyme disease laboratory testing services for England and Wales and issues detailed advice on sample testing.


Lyme disease is not common in the UK, with an estimated 2,000 to 3,000 new cases each year in England and Wales.

Official surveillance is based on laboratory confirmed diagnoses only, which are published quarterly in the zoonoses section of the Health Protection Report.

Clinical management

Transmission and prevention

Public information

Published 6 July 2014
Last updated 31 July 2018 + show all updates
  1. Updated and revised content to include new guidance pages.

  2. Added Lyme disease: signs and symptoms to collection.

  3. First published.