Lyme Disease

Overview

Lyme disease is a bacterial infection you can get from the bite of an infected tick. Ticks are tiny, spider-like creatures that live in grassy, wooded, or heathland areas. The infection is caused by a type of bacteria called Borrelia burgdorferi.

Lyme disease is relatively uncommon in the UK, but it is becoming more frequent. It is more common in parts of Europe, North America, and Asia. In the UK, it is most often found in grassy and wooded areas, including parks, gardens, and heathland.

Anyone who spends time outdoors in tick habitats can get Lyme disease. This includes hikers, campers, gardeners, and people who work in forests or parks. It can affect people of any age, including children and older adults.

Symptoms

Common symptoms

• A circular red rash that looks like a bull's-eye target – it often appears 3 to 30 days after the tick bite.
• Flu-like symptoms such as a high temperature, headache, tiredness, and muscle aches.
• Swollen glands (lymph nodes) near the bite site.
• Joint pain and swelling, especially in the knees.

Symptoms in children

• Children may show the same bull's-eye rash and flu-like symptoms as adults.
• They might be unusually irritable, tired, or complain of headaches.
• Joint pain in children often affects the knees and can come and go.

Symptoms in older adults

• Older adults may not notice the tick or rash, especially if they have poor vision or reduced sensation.
• Symptoms like fatigue, joint aches, and confusion can be mistaken for normal ageing or other conditions.
• They are at higher risk of more severe nerve problems, such as facial palsy or memory issues.

Causes

Main causes

• A bite from an infected tick that carries the Borrelia burgdorferi bacteria.
• Ticks become infected by feeding on infected animals, such as small rodents and birds.
• The bacteria enter your skin through the tick's bite and can spread to other parts of your body.

Risk factors

• Spending time in grassy, wooded, or heathland areas, especially in spring, summer, and autumn.
• Not removing ticks promptly or properly.
• Having a weakened immune system (for example, due to other medical conditions or treatments).
• Living in or visiting areas where Lyme disease is known to be more common.

When to see a doctor

See a doctor urgently if:

• You have a bull's-eye rash or any unexplained rash after a tick bite.
• You feel very unwell with a high temperature, stiff neck, or severe headache.
• You have weakness or numbness in your face or limbs.

Book a routine appointment if:

• You have joint pain that does not go away, especially in your knees.
• You have unexplained tiredness or memory problems that have lasted for weeks.
• You think you may have been bitten by a tick but have no symptoms yet – your doctor can advise about preventive measures.

Diagnosis

Your doctor will ask about your symptoms and whether you have been in tick habitats. They will also examine you for a rash or other signs. A blood test can help confirm the diagnosis, but it may take several weeks to become positive.

Tests that may be done

• Blood test (called a serology test) that looks for antibodies to the bacteria.
• Sometimes a polymerase chain reaction (PCR) test on a sample of fluid from a joint or spinal fluid, but this is less common.
• A skin biopsy of the rash in rare cases.

What to expect at your appointment

If your doctor suspects Lyme disease, they may start treatment before the blood test result comes back, especially if you have the typical rash. The blood test is usually done once your body has had time to produce antibodies, which can take 4 to 6 weeks after the bite. You may need a follow-up test if the first one is negative but symptoms continue.

Treatment

Lyme disease is treated with antibiotics, which are medicines that kill bacteria. The choice of antibiotic and how long you take it depends on the stage of the disease and your symptoms. Early treatment usually leads to a full recovery.

Self-care at home

• Get plenty of rest to help your body fight the infection.
• Drink enough fluids, especially if you have a fever.
• Take over-the-counter pain relievers (like paracetamol or ibuprofen) for aches and pains – always follow the directions on the label.
• Remove any attached ticks carefully using fine-tipped tweezers – grasp the tick as close to the skin as possible and pull upwards steadily without twisting.

Medical treatments

Doctors usually prescribe a course of antibiotic tablets for early Lyme disease. For more severe or later-stage disease, you may need a longer course of antibiotics, or antibiotics given through a drip (intravenously) in hospital. It is important to finish the full course as prescribed, even if you start feeling better.

When is surgery considered?

Surgery is very rarely needed for Lyme disease. In some cases, if you develop severe arthritis that does not improve with treatment, a doctor might consider joint drainage or other procedures, but this is not common.

Living with this condition

Most people recover fully from Lyme disease with treatment. However, some people may have ongoing symptoms like fatigue, joint aches, or memory problems for weeks or months after finishing antibiotics. This is sometimes called post-treatment Lyme disease syndrome. It is important to pace yourself and gradually return to normal activities.

Lifestyle tips

• Gradually increase your activity levels – do not rush back to exercise if you still feel tired.
• Keep a symptom diary to share with your doctor – this can help track any lingering issues.
• Avoid tick bites in the future by taking preventive steps when outdoors.
• Talk to your doctor if symptoms do not improve – you may need a referral to a specialist.

Diet and exercise

A balanced diet rich in fruits, vegetables, and whole grains can support your immune system. Stay active within your limits – gentle exercise like walking or stretching can help with joint stiffness and fatigue. Avoid intense exercise until you feel fully recovered.

Mental health and emotional wellbeing

Dealing with a prolonged illness can be stressful and may lead to anxiety or low mood. It is normal to feel frustrated if recovery takes longer than expected. Talking to family, friends, or a counsellor can help. Your doctor can also advise on support services.

Prevention

Yes, you can reduce your risk of getting Lyme disease by avoiding tick bites. This is especially important if you spend time in grassy, wooded, or heathland areas. Checking yourself, your children, and your pets for ticks after being outdoors is also crucial.

Vaccines

There is currently no vaccine for Lyme disease available to the general public in the UK. A vaccine has been used in some other countries, but it is not recommended here at this time. The best prevention is avoiding tick bites and removing ticks quickly.

Screening programmes

There is no routine screening test for people without symptoms. Testing is only recommended if you have symptoms or have been bitten by a tick and have signs of infection.

Complications

If left untreated

• Arthritis, especially in the knees, that can last for months or become chronic.
• Neurological problems, such as facial palsy (drooping on one side of the face), meningitis (inflammation of the lining of the brain and spinal cord), or nerve pain.
• Heart problems, including inflammation of the heart muscle (myocarditis) or irregular heartbeats (carditis).
• Memory and concentration difficulties that may last for months.

Long-term outlook

With early treatment, most people with Lyme disease recover completely without lasting problems. Even when treatment is delayed, most people still get better, though it may take longer. Ongoing symptoms can be challenging, but they often improve over time. Research continues to find better ways to treat and prevent Lyme disease. There is good reason to be hopeful.

Find support

International organisations

• World Health Organization (WHO) – Lyme disease information ↗
• Centers for Disease Control and Prevention (CDC) – Lyme disease ↗
• National Health Service (NHS) – Lyme disease ↗

Local organisations

• Lyme Disease UK ↗ · United Kingdom
• NHS 111 – for urgent medical advice ↗ · United Kingdom
• Health Protection Scotland – Lyme disease ↗ · Scotland

Helplines

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