Is Lyme Disease Curable?

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

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."

You can treat and cure Lyme disease by taking a course of oral antibiotics that lasts around two to four weeks. However, some people develop post-treatment Lyme disease syndrome (PTLDS), symptoms like pain, fatigue, and reduced ability to concentrate lasting as long as six months after completing treatment.

About 30,000 cases of Lyme disease are reported each year to the U.S. Centers for Disease Control and Prevention (CDC). However, the CDC's estimate based on insurance records suggests that each year approximately 476,000 Americans are diagnosed and treated for Lyme disease. 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.

Here's what else you need to know.

Diagnosis and Treatment

Lyme disease is usually diagnosed when a person develops a rash (often a bull's-eye rash, but not always), flu-like symptoms (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.

If left untreated, Lyme disease can cause a variety of other late symptoms:

• Severe headaches
• Stiffness in the neck
• Additional rashes on other parts of the body
• Drooping of one or both sides of the face
• Irregular heart beats or heart palpitations
• Spells of dizziness and shortness of breath
• Nerve pain
• Shooting pain, numbness, or tingling in hands and feet
• Pain that comes and goes in muscles, tendons, joints, and bones
• Arthritis with severe pain in joints, especially the knees, shoulder, ankles, and other large joints
  

The way to verify the presence of Lyme disease antibodies is through a two-step blood test. Although, it does take a few weeks for those antibodies to develop. So if you've been infected by Lyme disease a few weeks before your test, your body may not have enough antibodies to show up in the test and your results may not be accurate.

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," Dr. Zemel said.

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," Dr. Zemel said.

Timely Treatment

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.

According to a 2015 review, approximately 10% to 20% of people infected with Lyme disease can expect to develop post-treatment Lyme disease syndrome. The disease is characterized by neurological symptoms, fatigue, and muscle aches.

A 2021 study published in Frontiers in Medicine reported that over a period of five years, 31% of the patients went more than 30 days before coming in for treatment—and 10% of them didn't get treatment until more than six months later. One of the reasons the researchers cited was that many people mistake their symptoms for something else.

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

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. In other words, they have no medical conditions or other health reasons that would prevent them from taking that medicine.
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 within 72 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, Dr. Zemel said.

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, Dr. Kuritzkes said. "That doesn't mean anything similar in terms of transmission, but syphilis has several different phases, with primary and secondary and tertiary symptoms," Dr. Kuritzkes said. "The infection can hide out in the body for a long time and can cause problems down the road if it's not treated."

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).

However, Dr. Kuritzkes said that the name chronic Lyme disease is misleading 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," Dr. Kuritzkes said. "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.

"It's possible that Lyme infection leads to some damage that we don't fully understand yet," Dr. Kuritzkes added. "But we do know that long-term or repeated courses of antibiotics have no benefit in these cases."

Be wary of healthcare professionals who call themselves "Lyme literate" and recommend ongoing antibiotics or other unproven treatments, Dr. Kuritzkes added, since these techniques are not backed up by science and can sometimes be harmful.

Follow-Up

If you're treated for Lyme disease and don't feel better after you've finished your treatment, talk to your healthcare professional. 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.

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.

Preventing Tick Bites

There are several things you can do to prevent tick bites. The CDC offers many tips and strategies for protecting yourself from ticks.

Know where you're likely to find ticks. That includes grassy, brushy, and wooded areas. Avoid these areas when possible and stay in the center of trails to reduce your chances of encountering ticks. Or you may want to use tick repellent on your clothes or skin (and follow the product's instructions if you do).

Ticks can also be found on your pets. Check your pets after being outdoors. These are the key places to look:

• In and around the ears
• Around the eyelids
• Under the collar
• Under the front legs
• Between the back legs
• Between the toes
• Around the tail

Some states have more ticks that carry Lyme disease than others. Find out how common Lyme disease is in your state. There are CDC Lyme disease maps where you can check. Or you can contact your state health department.

Dress appropriately. The U.S. Environmental Protection Agency recommends wearing long pants, long-sleeved shirts, and high boots—and light-colored clothing makes ticks easier to spot. To lower your chances of tick bite even further, tuck your shirt into your pants and your pants into your socks. Doing this closes the gaps in your clothing where ticks can find their way in.

Even if you're properly dressed, ticks may find a way to hitch a ride. So when you get in from being outdoors, check yourself for ticks. The CDC recommends checking these parts of your body in particular:

• In and around the hair
• In and around the ears
• Under the arms
• Inside the belly button
• Around the waist
• Between the legs
• Back of the knees

If you find a tick attached to your skin, remove it the right way. The CDC offers four tips for disposing of a live tick: put it in rubbing alcohol, place it in a sealed bag or container, wrap it tightly in tape, or flush it down the toilet.

A Quick Review

Lyme disease is a tick-borne illness that can be cured. If you suspect you have Lyme disease, get treatment as early as possible. Early treatment can prevent you from developing serious complications.

Know what symptoms to look for. A rash may be a good indication, and it doesn't necessarily have to look like a bulls-eye. Fever or flu-like symptoms, may also signal Lyme disease—whether a rash is present or not.

Take steps to prevent tick bites in the first place. Check yourself, children, and pets after coming in from outdoors. And contact a healthcare professional if you notice any symptoms.