Lyme Disease Symptoms and Tips on Prevention

Rebecca Reece, MD
Division of Infectious Diseases
University Medicine

Lyme disease is the most common tick-borne illness in the United States. Our entire region of New England is in an endemic area for the deer tick that carries Borrelia burgdorferi, the bacteria that causes Lyme disease. However, those that live near wooded areas or engage in outdoor activities such as gardening, hiking, or camping are at highest risk for acquiring Lyme disease.

The seasonal timing is late spring to early fall, with the highest incidence from late June through July. The reason for this seasonal predilection is that the nymphal stage of the tick life cycle usually occurs during this time period. When the tick is in its nymphal stage, it is quite small and thus easily missed by people and animals (i.e. deer/mice), and is searching for its blood meal for food. By late fall, the ticks are at adult stage so are much larger and more easily seen so that a person removes the tick before it bites. In order to transmit B. burgdorferi, the tick must remain attached to the skin for at least 36 hours.

Symptoms of Lyme disease can vary from the classic “bull’s-eye rash” to flu-like symptoms, or more targeted symptoms in early-disseminated disease (arthritis, heart block, meningitis, Bells’ palsy, etc.). Eighty percent of those infected with Lyme disease will develop a rash (erythema migrans) at the site of the tick bite (though only a third of people recall a tick bite). It is usually a single lesion that enlarges in size over days, but can be multiple lesions in some people, and does not always have a target appearance.

Flu-like symptoms can also occur with early disease. Fatigue, muscle and joint aches, headache, malaise, and fever can be hard to distinguish among symptoms of viral illness, Lyme disease, and other tick-borne illness. These symptoms can occur days to weeks after the tick bite, and in some people, symptoms do not develop until months later. You should see your primary care physician if you develop any of these symptoms and believe you may have had tick exposure (i.e. outdoor activity in grass or wooded areas), or if you removed from your skin a tick that was engorged.

Depending on your exposure risk, the time of year, and your symptoms, your doctor will decide to either treat you for Lyme disease or do additional testing. With erythema migrans, blood testing is not needed for confirming diagnosis, but for nonspecific symptoms, testing can be helpful in diagnosis.

Treatment of Lyme disease involves antibiotics (doxycycline, amoxicillin, and IV ceftriaxone for specific manifestations), as well as symptomatic therapy with anti-inflammatories. The length of therapy is dependent on the degree of infection. For localized disease with only skin involvement, treatment is 14 to 21 days. For more disseminated early disease including Bells’ palsy, meningitis, carditis, and arthritis, treatment is 14 to 28 days. In these instances, involvement with an infectious disease specialist is recommended to determine need for IV versus oral therapy, and to determine length of therapy.

In Lyme arthritis, sometimes a second 28-day course of antibiotics is needed for refractory disease. In all other presentations, one course of antibiotic therapy is successful in eradicating the infection. However, symptoms can persist beyond the treatment course in some individuals. Post-treatment Lyme disease syndrome occurs in about 10 percent of patients with symptoms continuing beyond six months from treatment including fatigue, joint pain and headaches.

Prevention of tick-borne diseases, including Lyme disease, is multi-factorial. The first level of prevention is to prevent a tick from attaching to a person. This can be done by wearing long pants, socks and long sleeves when outdoors in high grass or wooded areas, and wearing light colored clothing to aid your ability to see if a tick attaches.

Following any outdoor activity where you may have been exposed, it is important to check your skin for ticks (and for parents to do skin checks on their children). In addition, using repellant with DEET (10-30%) on exposed skin can help to prevent tick bites. The higher the concentration of DEET, the longer the duration of effectiveness; but greater than 30 percent is not recommended for use on skin. Permethrin is a spray that will kill ticks and other insects on contact, but it should not be used on skin. Instead, permethrin can be either sprayed on clothing or shoes. It is also available as a detergent product that can be used for multiple washings.


Dr. Rebecca Reece joined University Medicine’s Division of Infectious Diseases in January of 2015. Her clinical and research interests include tick-borne diseases, HIV adherence and retention, and health disparities. She serves as the lead physician for the Lifespan Center of Excellence for Tick-borne Diseases at Newport Hospital.

Established in 2000, University Medicine is a nonprofit primary care, specialty outpatient and sub-specialty medical group practice with over 200 physicians and over 20 patient care locations across the state of Rhode Island. The largest physician group in Rhode Island, University Medicine is affiliated with The Warren Alpert Medical School of Brown University, and employs most of the full-time faculty of Brown’s Department of Medicine. Specialties and clinical divisions include: general internal medicine; primary care (family and pediatrics); diabetes and endocrinology; infectious disease; hospital medicine; hypertension and kidney diseases; hematology/oncology; nephrology; pulmonary, critical care and sleep; gastroenterology; rheumatology and geriatrics. Over 100,000 patients are served annually from Rhode Island, Massachusetts, Connecticut and other states and countries. The three-part mission of University Medicine is high-level quality medical patient care, state-of-the-art clinical research studies, and dedicated teaching of more than 400 medical students, residents and fellows trained by University Medicine physicians annually. University Medicine is recognized as one of the “Best Places to Work” by Providence Business News. University Medicine is headquartered at 17 Virginia Avenue in Providence, RI 02905-4406; phone: 877-771-7401; web:

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