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Lyme disease symptoms—and how to protect yourself

It’s not just the bull’s-eye rash that you need to be aware of to protect yourself

As summer gears up, so do the bugs. Before heading outdoors, plan how you can ward off those pesky insects—especially ticks. There are a variety of tick-borne diseases, but Lyme disease is the most common. More than 30,000 cases of Lyme disease are reported to the U.S. Centers for Disease Control and Prevention (CDC) each year, although experts suggest the numbers of actual cases are actually much larger.

In North America, when a particular kind of tick infected with a certain type of bacteria burrows into your body and bites, it may cause a bull’s-eye-shaped rash and flu-like symptoms—two hallmark Lyme disease symptoms.

In the northeast and mid-Atlantic regions, it’s spread by blacklegged ticks, or deer ticks, carrying Borrelia burgdorferi (B. burgdorferi) bacteria. On the West Coast, the western blacklegged tick is the vector for this infection. But in the Upper Midwest, the blacklegged tick may be spreading either the Borrelia mayonii (B. mayonii) bacteria or the B. burgdorferi bacteria.

Both kinds of bacteria can lead to Lyme, so wherever you live, be prepared as the weather warms up and you start spending more time outside.

Early signs of Lyme disease

The ticks that spread Lyme disease are so small that a tick bite might go unnoticed…until you start developing the early Lyme disease symptoms.

It’s usually the nymphs, or immature versions of these ticks, that are most likely to bite and spread the disease, according to the CDC—and they’re tiny. Blacklegged nymphs are less than 2 millimeters in size, about the size of a poppy seed. So, they’re extremely hard to see, especially since they tend to home in on areas like the groin, underarm, and scalp.

Since they’re easy to miss, even if you’re carefully scanning your body for ticks, be vigilant for the early symptoms of Lyme disease. The symptoms typically will begin somewhere between three and 30 days after an infected tick bites you.

The symptoms of Lyme disease may include:

  • Erythema migrans (EM) rash, also known as a bull’s-eye rash
  • Headache
  • Fever
  • Fatigue
  • Chills
  • Muscle pain and aches
  • Joint pain
  • Swollen lymph nodes

If you get bitten by a tick carrying the B. mayonii bacteria, you might also experience some nausea and vomiting, as well as more widespread rashes, according to the CDC.

The EM rash is the hallmark symptom of Lyme disease. It develops close to the site of the tick bite. It can expand over several times, and while the size can vary, in some people, the rash may eventually achieve a diameter of 12 inches.

As many as 70% to 80% of the people who get infected develop the erythema migrans rash. However, not everyone gets the bull’s-eye rash, cautions Eva Sapi, Ph.D., a professor of cellular and molecular biology at the University of New Haven in Connecticut and an expert in Lyme disease research. It might just look like a rash. It may be round, or it could be oval-shaped, and it may have a clear center, but it might not.

What other rashes look like Lyme disease?

Here’s where things can get a little tricky. Other rashes can mimic the bull’s-eye rash that’s typically associated with Lyme disease.

For example, you might have insect bite hypersensitivity and develop a large, itchy red rash at the site of a bite that may resemble erythema migrans. Other rashes that could be the culprit include:

  • Ringworm
  • Hives (also known as urticaria multiforme)
  • Pityriasis rosea rash
  • Granuloma annulare rash

RELATED: Ringworm vs. other rashes

Later symptoms of Lyme disease

The flu-like symptoms and bull’s-eye rash are usually considered stage 1 symptoms. The next stage of symptoms begins when the bacteria spreads around your body, according to the American Academy of Dermatology (AAD).  

During stage 2, you may develop small rashes on your arms, legs, and face—although the rashes can appear almost anywhere except your palms and soles of your feet. You might also develop a dark lump known as a borrelial lymphocytoma on an earlobe or near a nipple.

These symptoms may show up within 30-45 days after the tick bite, or it may take as long as six months for them to develop.

Along the way, you might also develop some other symptoms, such as fever, muscle aches, intermittent arthritis, headaches, dizziness, shortness of breath. Some people even develop a temporary droop on one side of their face, a condition known as Bell’s Palsy. Heart palpitations or an irregular heartbeat are other later-stage symptoms.

The AAD reports that these late stage symptoms should clear up within about three weeks if they’re treated. If untreated, they may continue to come and go indefinitely and/or cause permanent damage.

What is Lyme arthritis?

A few weeks after you become infected with Lyme disease, it’s possible that you may develop Lyme arthritis. Lyme arthritis makes up about 25% of every Lyme disease case reported to the CDC.

Lyme arthritis is essentially the effect of inflammation that can develop if the infection moves into the joints. The joint may feel warm, swollen, and tender to the touch. It might hurt when you move it.  Although it can affect more than one joint, the classic presentation is in the knee, notes Paul Auwaerter, MD, the clinical director of the division of infectious disease and professor of medicine at Johns Hopkins University School of Medicine.

The typical treatment for Lyme arthritis is a 28-day course of oral antibiotic treatment. A persistent case may necessitate a second round of antibiotics, usually intravenous antibiotics. “Usually younger people do very well,” Dr. Auwaerter says. “But some people do need that second round of antibiotics.”

You can take over-the-counter pain relievers at the same time if need be to reduce the pain you may feel, too, says Suzanne Soliman, Pharm.D., the founder of the Pharmacist Moms Group.

And if the pain and swelling don’t dissipate, you may want to see your doctor for further evaluation. Persistent inflammation could be the result of an autoimmune condition that could require its own specific treatment, says Dr. Auwaerter.

The infection can also spread into the peripheral or central nervous system, leading to a condition called neurologic Lyme disease. Depending on which nerves are affected, a person might experience some facial palsy, some numbness or tingling in their arms and legs, or develop Lyme meningitis, which can cause symptoms like headache, neck stiffness, fever, and sensitivity to light. Antibiotics are typically involved in treatment for this condition, too.

Can Lyme disease go away on its own?

Here’s some good news: It is possible that your body’s immune system will clear the disease all on its own, according to Dr. Auwaerter. But you might not want to count on it.

Medications for Lyme disease

You may need medication, specifically a round of antibiotics to knock out the infection, preferably in the early stages. Usually, doctors prescribe doxycycline, amoxicillin, or cefuroxime to treat the erythema migrans rash. People who can’t tolerate those antibiotics might be able to take macrolide antibiotics instead

Medications that treat Lyme disease

Drug name

Drug class When used

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Doxycycline Tetracycline antibiotic Used to treat early stage Lyme Disease symptoms, including erythema migrans rash Get coupon 
Amoxicillin Penicillin-like antibiotic Used to treat early stage Lyme Disease symptoms, including erythema migrans rash Get coupon
Cefuroxime Cephalosporin antibiotic Used to treat early stage Lyme Disease symptoms, including erythema migrans rash Get coupon
Azithromycin Macrolide antibiotic Used to treat erythema migrans in people intolerant of other antibiotics Get coupon
Clarithromycin Macrolide antibiotic Used to treat erythema migrans in people intolerant of other antibiotics Get coupon
Erythromycin Macrolide antibiotic Used to treat erythema migrans in people intolerant of other antibiotics Get coupon


Could you turn to a home remedy? Maybe to alleviate some discomfort at the site of the tick bite but not in an attempt to knock out the infection. “Personally, as a pharmacist, I would always recommend an antibiotic,” Dr. Soliman says.

If you’re uncertain, you can monitor the site of a tick bite, and if you notice that a rash is spreading, which is typical of erythema migrans, consult your healthcare provider. “If you’re unsure, draw a circle around the edges,” suggests Dr. Auwaerter. “If it’s substantially larger by the next morning, you might want to have a doctor look at it.”

Your doctor can run blood tests to look for antibodies in your blood, but it can take a few weeks for your body to start producing them. It’s also important to understand that those antibodies can linger for months or years after the infection clears up, according to the CDC. 

What if the symptoms stick around? Some people develop what is called post-treatment Lyme disease syndrome. Essentially, these people may have pain, fatigue, and difficulty concentrating or thinking for more than six months after they conclude their antibiotic treatment for Lyme disease. Why it happens, though, is not well understood. “That remains a mystery,” Dr. Auwaerter says.

You may also have heard some people call it “chronic Lyme disease” but the National Institute of Allergy and Infectious Diseases (NIAID) notes that experts typically don’t believe that term is clearly defined enough to use.

However, additional antibiotics are unlikely to be necessary at that point, says Dr. Auwaerter. The NIAID also notes that research has shown that long-term antibiotic therapy is not effective. There may be other conditions that could be the culprit for the fatigue and pain, and it’s worth getting checked out to make sure that you don’t have another condition.


Of course, as with other infectious diseases, the best way to deal with Lyme disease is to prevent Lyme disease from occurring in the first place. There is not currently a Lyme disease vaccine on the market.

So, you want to watch out for those blacklegged ticks (Ixodes scapularis and Ixodes pacificus). Here’s how to be proactive and (hopefully) ward off the ticks before they can infect you.   

  1. Avoid areas where ticks tend to lurk. But don’t assume that just because you’ve stayed out of wooded areas that you’re in the clear. Researchers recently found Western black-legged ticks that were carrying B. burgdorferi bacteria in beaches in northern California in numbers similar to those in wooded areas. They published their results of their study in the journal Applied and Environmental Microbiology.
  2. Wear the right clothes. Some experts call this approach dressing defensively. If you’re planning outdoor activities, especially in high grass or wooded areas or other places where you may be vulnerable, wear closed-toe shoes, long-sleeved shirts and long pants. In fact, some experts suggest tucking your pant legs into your shoes or socks to keep ticks from crawling up. You might also choose light-colored clothes, since ticks are more visible on the lighter-colored fabric.
  3. Use insect repellent. An EPA-registered product containing DEET can repel ticks. Dr. Soliman likes products containing picaridin as an alternative to DEET. You might also treat your clothes and your shoes with permethrin, an insecticide that’s highly toxic to ticks.
  4. Do a thorough tick-check when you come inside. “When we get home, our rule is that we take off all clothes and everyone showers and then all the clothes go straight into the washer and dryer,” Dr. Sapi says. “When you’re in the shower, check everything. You just don’t know where they might hide on your body.”
  5. Remove ticks carefully if you spot them. The CDC recommends using fine-tipped tweezers for tick removal. Grasp the tick as close to the skin as possible, pull steadily upward and make sure you remove all parts of the tick.

If you have any questions or concerns, seek out your healthcare provider for medical advice on how to proceed.