Is Lyme Disease Curable?

The tick-borne illness can be treated with antibiotics, and most people make a full recovery within weeks or months. So why is there so much confusion?

In much of the country, spring and summer mean warmer weather and spending more time outdoors. Unfortunately, it also means that the ticks that carry Lyme disease bacteria may be out in full force, especially in wooded or grassy areas.

About 30,000 cases of Lyme disease are reported each year to the U.S. Centers for Disease Control and Prevention, although experts estimate that over 10 times that amount may actually be diagnosed and treated, based on health insurance data. That's concerning because if left untreated, Lyme disease can cause nerve damage, memory loss, dangerous inflammation around the heart, and other permanent health problems.

But the good news is that Lyme disease is also very treatable—especially when it's diagnosed soon after symptoms begin. "Lyme disease is always curable," Daniel Kuritzkes, MD, chief of the Division of Infectious Diseases at Brigham and Women's Hospital in Boston, told Health. The medications we have are very effective at getting rid of the infection." Here's what else you need to know.

Diagnosis and Treatment

Lyme disease is usually diagnosed when a person develops a bull's-eye rash, flu-like symptoms (like fatigue, fever, chills, and muscle pain), or both. These symptoms usually start a few days or weeks after the person is bitten by an infected tick.

bulls-eye rash lyme disease tick tick-bite skin health
Wikicommons / Hannah Garrison

According to the CDC, a two-step blood test can verify the presence of Lyme disease antibodies, although it does take a few weeks for those antibodies to develop. And despite what some physicians and advocacy groups claim, a blood test is the only way Lyme disease can be confirmed, Larry Zemel, MD, former Professor of Pediatrics at the University of Connecticut School of Medicine told Health. "Some healthcare providers say they can diagnose Lyme even when patients test negative repeatedly, but that has not been borne out by any scientific study," said Dr. Zemel.

When people are diagnosed with Lyme disease in its early stages, a 10- to 14-day course of oral antibiotics—usually with an antibiotic drug called doxycycline—will clear the infection and help them feel better fairly quickly. "This cures the vast majority of people, and they have a 100% recovery with no lasting effects," said Dr. Zemel.

If Lyme disease isn't diagnosed right away, it can cause more serious symptoms like arthritis and memory problems. People who have these complications may need a full month of oral antibiotics, said Dr. Zemel. About 20% of patients with complications will need IV antibiotics (if oral drugs don't help), and they may also need other medications to treat symptoms like pain and muscle stiffness, Dr. Zemel said.

Sometimes, one dose of antibiotics can be given preemptively, before symptoms of Lyme disease begin. Healthcare providers may prescribe this treatment if a person knows they were bitten by a tick within the last 72 hours, suspects that the tick was attached to their skin for at least 36 hours, and was in an area where Lyme disease is prevalent. "There's roughly a two-day window in which preventive antibiotics can work," said Dr. Zemel.

The CDC provides guidelines for prophylactic treatment—meaning treatment when there is a risk of infection, even if it's too soon to confirm an infection.

CDC guidelines:

  1. A person has no contraindications to taking doxycycline.
  2. The attached tick can be identified as an adult or nymphal I. scapularis tick.
  3. The estimated time of attachment is ≥36 h based on the degree of tick engorgement with blood or likely time of exposure to the tick.
  4. Prophylaxis can be started within72 h of tick removal.
  5. Lyme disease is common in the county or state where the tick bite occurred (i.e., CT, DE, DC, MA, MD, ME, MN, NH, NJ, NY, PA, RI, VA, VT, WI, WV).

Phases of Infection

Lyme disease symptoms can begin anywhere from three to 30 days after transmission of the infection from a tick. If treated early on with antibiotics, most people feel better within a few weeks, said Dr. Zemel.

It's certainly possible for people to get Lyme disease and to clear the infection on their own, without treatment, said Dr. Kuritzkes. "But it's better to be treated, because some of the complications—like arthritis and myocarditis and damage to the central nervous system—can be very serious," Dr. Kuritzkes said.

According to the CDC, it's not uncommon for people to experience lingering symptoms like fatigue and joint or muscle pain for a few weeks or months after treatment. Additional antibiotics won't help these symptoms, however, and most people improve on their own over time.

The type of bacteria that causes Lyme disease is in the same general family as the type that causes syphilis, said Dr. Kuritzkes. "That doesn't mean anything similar in terms of transmission, but syphilis has several different phases, with primary and secondary and tertiary symptoms," said Dr. Kuritzkes. "The infection can hide out in the body for a long time and can cause problems down the road if it's not treated," Dr. Kurtizkes explained.

Post Treatment Lyme Disease Syndrome

In a small percentage of cases, people continue to experience symptoms for more than six months after their recommended course of antibiotics is completed. This is sometimes referred to as chronic Lyme disease, according to the National Institute of Allergy and Infectious Diseases (NIAID) —but that name is misleading, said Dr. Kuritzkes, because there is no evidence that the bacteria that causes Lyme disease is still present in the body. Instead, the CDC refers to this condition as post-treatment Lyme disease syndrome (PTLDS).

"As with many other kinds of infectious diseases, some people are left with some debilitating symptoms that don't go away," said Dr. Kuritzkes. "I like to compare it to polio: Some people who had polio are left paralyzed, but that doesn't mean they have chronic polio; they have permanent damage from the infection, even after it's gone away," explained Dr. Kuritzkes.

"It's possible that Lyme infection leads to some damage that we don't fully understand yet," added Dr. Kuritzkes. "But we do know that long-term or repeated courses of antibiotics have no benefit in these cases." Be wary of healthcare providers who call themselves "Lyme literate" and recommend ongoing antibiotics or other unproven treatments, Dr. Kuritzkes adds, since these techniques are not backed up by science and can sometimes be harmful.

Follow Up and Prevention

If you're treated for Lyme disease and don't feel better after you've finished your treatment, talk to your healthcare provider. They may recommend a longer course of antibiotics or may be able to prescribe another medication to help with symptoms like joint or muscle pain.

You might also want to seek a second opinion, especially if your Lyme disease diagnosis was not initially confirmed via a two-step blood test. If you haven't improved with antibiotics, it's possible that something else besides the bacteria that causes Lyme disease is making you sick.

Even if you do recover completely from a Lyme disease diagnosis, your immune system may continue making antibodies to fight Lyme disease bacteria for months or even years after the infection is gone, according to a research study published in 2022 in Clinical Microbiology and Infection. Because of this, you may continue to test positive for these antibodies even if you are no longer sick. Those antibodies won't protect you from getting a second Lyme disease infection, however, so be sure to take steps to protect yourself from ticks in the future.

Get more on Lyme disease here.

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