Lyme disease symptoms: early signs, later signs and what to do

Quick answer

Most people who are treated with antibiotics early recover quickly and completely. The hard part is recognizing Lyme in the first place, because the early signs are easy to mistake for something else and not everyone gets the rash.

Early symptoms (3 to 30 days after a bite)

Early Lyme disease can feel a lot like the flu, except it often happens in late spring and summer, when flu is rare. CDC lists fever, chills, headache, fatigue, muscle and joint aches and swollen lymph nodes. These can appear with or without a rash.

The erythema migrans (EM) rash

The rash is the most recognizable sign. CDC describes it this way:

• It starts at the site of the bite after a delay of 3 to 30 days (about 7 days on average).
• It slowly expands over several days and can reach 12 inches (30 cm) or more across.
• It often feels warm, but is rarely itchy or painful.
• It sometimes clears in the middle as it grows, giving a bullseye look, but many Lyme rashes are solid red.
• It can appear anywhere on the body.

A small red bump that appears right away and fades within a day or two is usually a reaction to the bite itself, not Lyme. See our guide to what the Lyme rash looks like.

Later symptoms (days to months after a bite)

Without treatment, the bacteria can spread through the body. CDC lists these later signs:

• severe headaches and neck stiffness
• more EM rashes on other parts of the body
• facial palsy (drooping on one or both sides of the face)
• arthritis with severe joint pain and swelling, especially in the knees and other large joints
• pain that comes and goes in tendons, muscles, joints and bones
• heart palpitations or an irregular heartbeat (Lyme carditis)
• episodes of dizziness or shortness of breath
• inflammation of the brain and spinal cord
• nerve pain, shooting pains, numbness or tingling in the hands or feet

Signs people miss

Lyme is often diagnosed late for ordinary reasons:

• No rash, or a rash nobody saw. About 20 to 30 percent of people with Lyme never get the EM rash or never see it, and it can sit on the scalp, behind a knee, in the groin or on the back.
• A rash that isn’t a bullseye. Many people expect rings and dismiss a plain red patch.
• A rash on darker skin. On brown and black skin, EM can look like a bruise or a darker patch, and redness is harder to see.
• No tick remembered. Young blacklegged ticks (nymphs) are about the size of a poppy seed, so many people never notice the bite.
• A “summer flu.” Fever and aches in June or July, after time outdoors, are worth mentioning to a doctor.

Just found a tick? What to do now

CDC’s advice is to remove an attached tick as soon as possible. Don’t wait to see a doctor first.

1. Grab it close to the skin with clean, fine-tipped tweezers.
2. Pull straight out with steady, even pressure. Don’t twist or jerk it.
3. If mouthparts stay in the skin and won’t come out easily, leave them. The skin usually pushes them out as it heals.
4. Clean the bite and your hands with soap and water, rubbing alcohol or hand sanitizer.
5. Get rid of the tick by putting it in alcohol, sealing it in a bag or container, wrapping it tightly in tape, or flushing it. Don’t crush it with your fingers.
6. Check the rest of your body for other ticks.

Then watch for symptoms

Write down the date and where you think you picked up the tick. Over the next few weeks, watch for a rash or a fever. According to CDC, a tick generally has to stay attached for more than 24 hours to pass on Lyme, so quick removal lowers your risk a lot. More on tick attachment time.

Should you take a preventive antibiotic?

CDC notes that in areas where Lyme is common, a single dose of doxycycline after a tick bite may lower the risk of Lyme disease in certain situations. It is usually considered only for a blacklegged tick and only within 72 hours of removing it, so if you want to ask about it, contact a healthcare provider soon. Whether it makes sense depends on the type of tick, how long it was attached and where you live.

Should you send the tick for testing?

CDC generally doesn’t recommend it. A positive result doesn’t mean you’re infected, a negative result can falsely reassure you, and results shouldn’t be used to make treatment decisions. If you feel sick, don’t wait for a tick test before seeing a doctor.

When to see a doctor

• You get a rash or fever within several weeks of a tick bite or time in tick country.
• You notice facial drooping, a severe headache with a stiff neck, numbness or shooting nerve pain.
• You feel heart palpitations, dizziness or shortness of breath.
• You have a swollen, painful joint, especially a knee, with no injury to explain it.

Tell the doctor about the bite, when it happened, and where you most likely picked up the tick. For chest pain, fainting or trouble breathing, call 911.

How Lyme disease is diagnosed

Doctors diagnose Lyme based on your symptoms, the chance you were exposed to ticks, and sometimes blood tests. A classic EM rash in someone who could have been bitten is often enough to diagnose Lyme without a test. Blood tests look for antibodies, which can take a few weeks to show up, so a test done very early can come back negative even if you are infected. CDC recommends a two-step blood test. Ask what test you are getting and what the result means.

How Lyme disease is treated

According to CDC, Lyme disease is treated with antibiotics, most commonly doxycycline, amoxicillin or cefuroxime axetil. Most cases are treated for 10 days to 4 weeks. Which drug and how long depends on your symptoms, age, allergies and whether you are pregnant, so your provider will decide. People treated early with the right antibiotics usually recover rapidly and completely.

Still sick after treatment?

Some people still have fatigue, body aches or trouble thinking months after finishing antibiotics. This is real, it can be exhausting, and it is one of the most debated topics in Lyme disease.

Why patients and some doctors disagree. Many patients and patient groups use the term “chronic Lyme disease.” They argue that some infections persist and that longer or different treatment should be considered. Some physician groups, such as ILADS, support individualized longer treatment. CDC says the cause is unknown, discourages the term “chronic Lyme disease,” and says extended antibiotics are no better than placebo and can cause serious harm. Most infectious-disease specialists share that view. We present both views here because you will meet both. Whatever the label, the symptoms deserve to be taken seriously.

CDC’s practical advice is to work with your provider to check for every possible cause, focus on the symptoms that affect your life most, and set goals together. It also suggests looking at coping strategies developed for ME/CFS, including pacing, sleep, pain and memory.

Frequently asked questions