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Lyme disease: signs and symptoms

Updated 20 May 2022

About Lyme disease

Lyme disease, or Lyme borreliosis, is a bacterial infection that can be transmitted to humans when they are bitten by an infected tick.

There are around 1,500 laboratory-confirmed cases of Lyme disease in England and Wales each year, although it is estimated that there are 3,000 to 4,000 new cases each year, as many cases of Lyme disease will be treated by doctors without the need for laboratory tests.

About 15% of cases of Lyme disease cases are acquired abroad.

Lyme disease can be treated effectively if it’s detected early on but if it’s not treated , or if treatment is delayed, there’s a risk you could develop long-lasting symptoms.

How you get Lyme disease

Lyme disease can be transmitted by the bite of a tick infected with Borrelia burgdorferi bacteria.

Ticks survive in many habitats but prefer moist areas with leaf litter or longer grass, like in woodland, grassland, moorland, heathland and some urban parks and gardens.

Ticks don’t jump or fly but climb on to your clothes or skin if you brush past vegetation.

They then bite into the skin and start to feed on your blood. Being bitten doesn’t mean you’ll definitely be infected as not all ticks carry the bacteria that cause Lyme disease.

If bitten by an infected tick, you are more likely to become infected the longer the tick remains attached and feeding.

Ticks are very small and their bites are not painful, so you may not realise you have one attached to your skin. It is important to check yourself (or each other) for ticks after outdoor activities and remove any ticks promptly and safely.

Removing ticks

If you do get bitten by a tick, remove it as soon as possible.

The safest way to remove a tick is to use a pair of fine-tipped tweezers, or a tick removal tool.

Grasp the tick as close to the skin as possible.

Pull upwards slowly and firmly, as mouthparts left in the skin can cause local irritation.

Clean the bite area and monitor for several weeks for any changes.

A small red circular patch may appear at the site of a tick bite and persist for a few days; this is a common reaction to the bite and will fade over time. If the red patch does not disappear or begins to spread outwards, or if you begin to feel unwell with flu-like symptoms, contact your GP promptly. Remember to tell them you were bitten by a tick or have recently spent time outdoors.

Early symptoms of Lyme disease

Early symptoms will typically develop 1 to 4 weeks after being bitten, however, they can appear anytime between 3 to 30 days after exposure.

Many people with early-stage Lyme disease develop a distinctive circular red rash usually, but not always, at the site of the tick bite.

The rash is often described as looking like a bull’s-eye on a dart board and is known as ‘erythema migrans’. The affected area of skin will be red and the edges may feel slightly raised.

The size of the rash can vary significantly and it may expand over several days or weeks. Typically, it’s around 15cm (6 inches) across but it can be much larger or smaller than this.

Some people may develop several rashes on different parts of their body. However, around one in every 3 people with Lyme disease do not report seeing a rash.

As well as (or instead of) a rash, people with early Lyme disease may experience any of the following:

• flu-like symptoms such as fever and sweats, chills, fatigue, neck pain or stiffness, headaches, joint or muscle pains
• paralysis of the facial muscles, typically only on one side of the face (Bell’s palsy)
• nerve pains, which may be shooting, sharp or prickly and which follow the course of the nerve

Later symptoms

More serious symptoms may develop several weeks, months or even years later if Lyme disease is left untreated or is not treated early on. These can include:

• pain and swelling in the joints (inflammatory arthritis)
• problems affecting the nervous system, such as numbness and pain in your limbs, paralysis of your facial muscles, memory problems and difficulty concentrating
• inflammation of the membranes surrounding the brain and spinal cord (meningitis) which can cause a severe headache, a stiff neck and increased sensitivity to light

and rarely:

• eye problems, including redness, pain or altered vision
• patches of abnormal skin known as acrodermatitis chronica atrophicans
• heart problems – such as inflammation of the heart muscle (myocarditis) or the external lining of the heart (pericarditis), irregular heartbeat (heart block) and heart failure

Some of these problems will get better slowly with treatment, although they can persist if treatment is started late. A few people with Lyme disease go on to develop a range of chronic symptoms despite treatment.

It’s not known exactly why this happens, but researchers are looking into possible causes.

When to see your GP

You should contact your GP or dial NHS 111 promptly if you feel unwell with any of the symptoms described above after being bitten by a tick or after spending time in areas where ticks may live.

Take this leaflet with you if you are unsure what to say and remember to let your GP know if you’ve recently had a tick bite or spent time in areas where ticks may live.

Diagnosing Lyme disease can be difficult as many of the symptoms are similar to other conditions. A spreading ‘erythema migrans’ rash appearing some days after a known tick bite is characteristic and should be treated with antibiotics.

If you don’t have this rash but do have other symptoms of Lyme disease, blood tests can be carried out that look for antibodies against the borrelia bacteria.

Blood tests can be negative in the early stages of the infection as the antibodies take some time to reach levels that can be detected.

You may need to be re-tested if Lyme disease is still suspected 4 to 6 weeks after a first negative test result.

If you have long-lasting symptoms, you may be referred to a specialist in microbiology, infectious diseases, rheumatology, or neurology as appropriate for further investigation and management.

Treating Lyme disease

If you develop symptoms of Lyme disease, you will normally be given a course of antibiotics. Most people will require a 3-week course, depending on the stage of the illness.

If you are prescribed antibiotics, it’s important you finish the course even if you are feeling better, because this will help ensure all the bacteria are killed.

The best treatment for symptoms that persist after treatment of Lyme disease remains uncertain. If your symptoms are particularly severe or prolonged, you may be referred to a specialist for further investigation and management.

Be wary of internet sites offering alternative diagnostic tests and treatments that may not be supported by scientific evidence or be appropriate. The advice is to seek help through the NHS.

Further information

Information for medical professionals on the diagnosis and management of Lyme disease.

More detailed information for patients can be found on the NHS website.

UKHSA information leaflets on preventing tick bites and removing ticks.

Lyme Disease Action has a website with information for patients.