Diagnosis

Many signs and symptoms of Lyme disease are often found in other conditions, so diagnosis can be difficult. What's more, ticks that transmit Lyme disease can also spread other diseases.

If you don't have the characteristic Lyme disease rash, your doctor might ask about your medical history, including whether you've been outdoors in the summer where Lyme disease is common, and do a physical exam.

Lab tests to identify antibodies to the bacteria can help confirm or rule out the diagnosis. These tests are most reliable a few weeks after an infection, after your body has had time to develop antibodies. They include:

  • Enzyme-linked immunosorbent assay (ELISA) test. The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it's not used as the sole basis for diagnosis.

    This test might not be positive during the early stage of Lyme disease, but the rash is distinctive enough to make the diagnosis without further testing in people who live in areas infested with ticks that transmit Lyme disease.

  • Western blot test. If the ELISA test is positive, this test is usually done to confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.

Treatment

Antibiotics are used to treat Lyme disease. In general, recovery will be quicker and more complete the sooner treatment begins.

Antibiotics

  • Oral antibiotics. These are the standard treatment for early-stage Lyme disease. These usually include doxycycline for adults and children older than 8, or amoxicillin or cefuroxime for adults, younger children, and pregnant or breast-feeding women.

    A 14- to 21-day course of antibiotics is usually recommended, but some studies suggest that courses lasting 10 to 14 days are equally effective.

  • Intravenous antibiotics. If the disease involves the central nervous system, your doctor might recommend treatment with an intravenous antibiotic for 14 to 28 days. This is effective in eliminating infection, although it may take you some time to recover from your symptoms.

    Intravenous antibiotics can cause various side effects, including a lower white blood cell count, mild to severe diarrhea, or colonization or infection with other antibiotic-resistant organisms unrelated to Lyme.

After treatment, a small number of people still have some symptoms, such as muscle aches and fatigue. The cause of these continuing symptoms, known as post-Lyme disease syndrome, is unknown, and treating with more antibiotics doesn't help.

Some experts believe that certain people who get Lyme disease are predisposed to develop an autoimmune response that contributes to their symptoms. More research is needed.

Alternative medicine

Antibiotics are the only proven treatment for Lyme disease. Some people who have unexplained signs and symptoms or chronic disease might believe they have Lyme disease even if it's not been diagnosed. There are a variety of alternative treatments that people with Lyme disease or people who think they have Lyme disease turn to for relief.

Unfortunately, these treatments either haven't been proved effective by scientific evidence or haven't been tested. In many cases, they can be harmful, even deadly. If you're considering any alternative treatments for Lyme disease, talk to your doctor first.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner who might refer you to a rheumatologist, infectious disease specialist or other specialist.

Here's some information to help you get ready for you appointment.

What you can do

If you know you've been bitten by a tick or have spent time in an area known to harbor ticks, be sure to tell your doctor. Make a list of:

  • Your symptoms, and when they began
  • All medications, vitamins and other supplements you take, including doses
  • Questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember the information you receive.

For Lyme disease, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • What is the best course of action?
  • What alternatives are there to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Sept. 20, 2018
References
  1. Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/index.html. Accessed Sept. 2, 2018.
  2. Pitt BS, et al. Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: A descriptive study. The Lancet Infectious Diseases. 2016;16:556.
  3. Hu L. Clinical manifestations of Lyme disease in adults. https://www.uptodate.com/contents/search. Accessed Sept. 2, 2018.
  4. Hu L. Treatment of Lyme disease in adults. https://www.uptodate.com/contents/search. Accessed Sept. 2, 2018.
  5. Ten facts you should know about Lyme disease. Infectious Disease Society of America. https://www.idsociety.org/Ten_Facts_About_Lyme_Disease/#. Accessed Sept. 6, 2018.
  6. Hu L. Diagnosis of Lyme disease. https://www.uptodate.com/contents/search. Accessed Sept. 6, 2018.
  7. Lantos PM, et al. Unorthodox alternative therapies marketed to treat Lyme disease. Clinical Infectious Diseases. 2015;60:1776.
  8. Alternative treatments for Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/treatment/alternative-treatments.html. Accessed Sept. 6, 2018.