Lyme Disease: How to Prevent It, and What to Do if a Tick Bites You

You just came back from an invigorating, stress-busting spring hike. Or perhaps you’re feeling accomplished because you got some early-season yard work done. And then you notice a tick on your clothing and remember you forgot to apply bug spray. Your mood plummets as you remember ticks spread Lyme disease. 

Lyme disease gained notoriety when cases spiked in 2022 and 2023, over doubling between 2017 and 2023, according to the CDC. Reported cases went from about 42,700 to about 89,500 annually. These numbers may look scary, but they’re due to changes in definitions to better detect the disease, reports the Mayo Clinic. However, it’s still important to know about Lyme disease symptoms, prevention and treatment to keep yourself and your family safe and healthy. 

What is Lyme disease?

You can get Lyme disease when a tick bites you, spreading a specific type of bacteria. 

Dr. Bobbi Pritt, a pathologist who specializes in the laboratory diagnosis of vector-borne and parasitic diseases, explains the disease more in-depth: “Lyme disease is a bacterial infection spread to humans through the bite of infected blacklegged (deer) ticks. In the United States, it is caused primarily by Borrelia burgdorferi, and to a lesser extent, Borrelia mayonii. Lyme disease is the number-one cause of tick-transmitted disease in the United States.” 

However, the tick has to carry the bacteria to give you Lyme disease. Not all ticks carry the bacteria. According to the Global Lyme Alliance, anywhere from under 1% to over 50% of black-legged ticks may carry Borrelia burgdorferi, depending on location. However, they may have other pathogens. 

Dr. Donald Harker, wilderness medicine fellow at the University of Nevada, Reno, says, “Borrelia burgdorferi is a bacterial spirochete that lives in the midgut of infected ticks, typically requiring extended attachment of a tick to host for transmission to occur.”

Lyme disease symptoms 

“There are three stages of disease including early localized, early disseminated and late disseminated Lyme disease,” says Harker. 

Stage 1 Lyme disease symptoms

The Mayo Clinic lists symptoms of the early stage occurring three to 30 days after an infected tick has bitten you. 

Pritt says the early localized state can include “fever, fatigue, headache, muscle and joint pains and a characteristic ‘bull’s-eye’ rash (known as erythema migrans) at the tick bite site. The rash is seen in about 70% of infected people, but it may go unnoticed, especially if it is on a part of the body that isn’t easily seen, such as the scalp or back. The rash enlarges over time and sometimes clears to create the classic target or ‘bull’s-eye’ appearance.”

Dr. Omar Al-Heeti, an assistant professor of medicine at Southern Illinois University who practices internal medicine with a specialty in infectious diseases, and one of CNET’s medical reviewers, adds, “More common than not, there is not central clearing or ‘target’ appearance. The rash should be larger than 5 cm.” 

Stage 2 Lyme disease symptoms

Stage 2 of Lyme disease tends to happen three to 10 weeks after the tick bite. 

During stage 2, symptoms can already become serious or deadly. According to Harker, “During transition to early disseminated disease, multiple erythema migrans rashes may develop more distant from the original bite location, along with flu-like symptoms, cranial nerve palsy, meningitis or cardiac conduction abnormalities. While Lyme carditis [occurs when Lyme disease bacteria enter the heart’s tissue] is rare, it is a significant cause of Lyme disease-related mortality and has been documented to result in complete heart block in as little as four days after infection.” 

The Mayo Clinic lists additional symptoms like neck pain and stiffness, painful swelling around the eye or eyelid, eye nerve pain or vision loss, muscle weakness that can happen on one or both sides of the face and body pain. 

Stage 3 Lyme disease symptoms

Symptoms from earlier stages can persist into stage 3. But a host of new serious symptoms might arise, characterized most commonly by arthritis in large joints.

“The last stage, late disseminated Lyme disease, presents months to years after the initial tick bite,” Harker says. “Characteristic symptoms of late disseminated Lyme disease include Lyme arthritis with pain in one or more major joints and nervous system involvement including sleep disturbance, memory loss, mood swings, migraine, encephalopathy [a change in how your brain functions], vertiginous dizziness and peripheral paresthesia [the sensation of tingling, prickling or numbness].”  

Post-Treatment Lyme disease syndrome symptoms

“Some people experience fatigue, joint pain and brain fog lasting six months or more – this is called Post-Treatment Lyme Disease Syndrome (PTLDS), and it can be very debilitating for some people,” Pritt states.  

No one quite knows why symptoms may persist after treatment. According to Harker, “The etiology of PTLDS is unclear, though several mechanisms have been proposed, including microbial persistence, though no evidence has shown continued infection. Other proposed mechanisms include immune dysregulation, autoimmunity, residual inflammation or gut microbiome alterations, though further research is required at this point.” 

Lyme disease risk factors 

Since ticks transmit Lyme disease, it primarily affects people who spend the most time outside in certain regions. Pritt identifies the following risk factors: “Living or spending time in wooded or grassy areas, especially in the Northeast, upper Midwest and Pacific Northwest US, and not using protection against tick bites when outdoors.” 

Harker mentions other risk factors: “Seasonally, the risk of infection is highest during late spring, summer and early fall when nymphal ticks are most active, though climate changes have enabled tick expansion to regions that have historically not experienced as much tick-borne illness. House pets are also able to bring ticks into the home, with the largest risk associated with cats. Lastly, we do see an increased incidence of infection in certain age groups, including children less than 15 and individuals aged 50-70 years old.”

How is Lyme disease diagnosed?

Pritt outlines the whole diagnostic process: “Lyme disease is usually diagnosed through a review of the patient’s symptoms in conjunction with a history of tick exposure, and blood tests to detect the patient’s immune response to the bacteria (called serologic testing). When present, the bull’s-eye rash is considered diagnostic of Lyme disease in endemic areas and should prompt immediate treatment. However, not all cases of Lyme disease are straightforward, and laboratory testing can play a crucial role in making the diagnosis, particularly in the later stages of disease.”  

How is Lyme disease treated? Can it be cured?

Pritt states that doctors treat with antibiotic courses like doxycycline. Harker adds that treatment may vary based on how someone’s symptoms manifest, which organs are infected and what stage of infection the person is experiencing. Oral antibiotics tend to go to those who exhibit rashes. People with more serious symptoms like neurologic issues or heart problems might get IV antibiotics. People with a tick bite and potential exposure may get prophylactic postexposure antibiotics if it is noted that the tick is the deer tick, the bite occurred in a highly endemic area and the tick was attached for over 36 hours.

Treatments can get even more involved for the worst complications. According to Harker, “[For] cardiac manifestations, IV antibiotics [may be used], with a potential need for a pacemaker if [there is the] presence of a symptomatic heart block.” 

Pritt adds, “Lingering after-treatment symptoms can be very troublesome and challenging to treat. Rest, physical therapy, stress management and support from healthcare providers can help manage symptoms.” She adds that lingering symptoms might result from an overactive immune response or residual tissue damage, rather than ongoing infection.

Al-Heeti adds, “Long-term antibiotics are not recommended for PTLDS or chronic Lyme as sometimes prescribed.”

What to do if a tick bites you

Follow these steps if you notice that a tick has bitten you:

• Remove the tick immediately. “Mechanical removal is generally recommended by experts, and the CDC has endorsed removal with forceps [or tweezers]. During removal, forceps should be placed as close to the skin as possible and force should be applied steadily perpendicular to the skin surface, without twisting and with care used not to crush the tick,” says Harker.
• Clean the area. The CDC says rubbing alcohol or soap and water is OK. Also, make sure to clean both your hands and the bite area.
• Safely save the tick. “Save the tick, if possible, for identification,” recommends Pritt. The CDC advises that you dispose of the tick by “putting it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape or flushing it down the toilet.” Do not crush it with your fingers. 
• Watch for symptoms and keep in touch with your doctor. Keep an eye out for telltale symptoms like the bull’s-eye rash. If exposure is likely and you live in the Northeast, you might consider getting preventative antibiotics from a doctor.   

How to prevent Lyme disease 

There are currently no Lyme disease vaccines on the market. “A new vaccine is in development and could become available in the next few years, pending approval,” says Pritt. There are some in human trials at the moment, says Harker. 

Since Lyme disease can range from asymptomatic to deadly, it’s best to avoid ticks in the first place using a few easy preventative measures. 

Use tick repellent 

Harker recommends tick repellants like DEET or picaridin. He also suggests finding tick-resistant clothing treated with permethrin. 

Dress appropriately outdoors 

Pritt recommends wearing long sleeves and pants when outdoors. Harker reminds us that you can tuck clothing into the waist of pants and socks to minimize gaps that pests can get into.  

“Light-colored clothing may also aid in the early identification of ticks attached to clothing,” says Harker.

Perform tick checks 

“As transmission of the bacteria that causes Lyme disease typically requires a tick to be attached for 15 to 48 hours, frequent skin checks for possible tick exposure should be performed when in outdoor areas with risk of contact,” Harker says.   

You should also perform frequent tick checks while outside and after. “Showering after being in tick-prone areas can help to identify ticks on your body,” says Pritt. “Be sure to check all of the members of your group, including your pets.”

When to contact a doctor 

Pritt takes a pragmatic approach: “If you develop a rash, fever or flu-like symptoms within 30 days, or if the tick was attached for more than 24 hours, then you should contact your doctor to see if you should be tested for tick-borne diseases.” 

Harker also says you should contact your doctor if there is any concern, as he states that “prophylactic antibiotics may be indicated and are best administered within the first 72 hours after the tick bite.” 

The bottom line 

Lyme disease is caused by bacteria that live in the deer tick. People contract the disease after the tick has bitten them and been on their bodies for most of the day or longer. Symptoms go in three stages and may start with the signature bull’s-eye rash. Later stages can mean arthritis, heart problems, stiffness and pain in the body, eye pain or vision loss and muscle weakness. 

It’s best to prevent tick bites by covering as much skin as possible outdoors, with regular tick checks and by using tick repellant.

Lyme disease FAQs

Can Lyme disease go away on its own?

According to Cedars Sinai, if untreated, the Lyme infection may go away on its own. However, if untreated, you may have to deal with complications down the line. Watch out for symptoms and contact your doctor if there are any concerns. 

Can you live long with Lyme disease?

Yes, you can live a long life even if you contract Lyme disease – especially if it is diagnosed and treated early. Brown University Health reports that it is very unlikely for someone to die from Lyme disease.