The Latest on Lyme Disease

Why your doc may miss the diagnosis—and how to protect yourself from Lyme disease this summer.

It’s tick season, which means Lyme disease is back in the news, putting hikers, gardeners, campers, and even beachgoers on high alert. Lyme is the number-one insect-borne disease in the United States—there are nearly 40,000 reported cases a year, and that number is on the rise—but there are still plenty of questions when it comes to diagnosis and treatment.

For smart answers, Health turned to world-renowned Lyme expert Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University Medical Center. Here, he answers the latest questions on the disease:

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Q: Is it true that you can have Lyme disease even if you don’t develop a bull’s-eye rash?


Yes. About 60 to 80 percent of Lyme cases reported to the Centers for Disease Control and Prevention have the rash, but not everyone gets it. It’s also important to know that the rash doesn’t always look like a bull’s-eye—it can appear elongated and oblong rather than round, and can sometimes even be raised like a spider bite rather than flat. The key with a Lyme rash is that it has crisp, clear margins that expand over time to at least 2 inches in diameter.

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Q: What makes Lyme so tricky to diagnose?


It’s not always difficult if you know what to look for. If you develop the Lyme rash, you should be put on antibiotics right away—you don’t need a blood test, which may come back negative in the early stages anyway. (The test detects antibodies to the bacteria, and your body doesn’t develop the antibodies until at least 10 days after you’ve been infected.)

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The problem

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The difficulty comes when a person doesn’t remember being bitten or developing the rash. For example, if you only have symptoms like fatigue, painful joints, and headaches, some doctors may think it’s the flu or stress.

The blood test isn’t foolproof, either. You can get a false negative or false positive—and not all strains of Lyme are picked up by the test. This is an area of current research, so hopefully in the next several years we’ll see newer, better tests.

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Q: Why do some people need to be treated for only a couple of weeks, while others are treated for longer?


If a person is treated right away, a two- to three-week course of oral antibiotics will usually eradicate the bacteria. However, if the bacteria has spread to your central nervous system (symptoms include bad headaches, confusion, and memory loss), you usually need a four-week course of intravenous antibiotics.

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Q: What if you’ve been treated and are still sick?


If you’ve been treated with the standard course and you relapse, seek a second opinion from a Lyme specialist. You’ll likely be tested for tick co-infections (other diseases ticks can transmit, such as babesiosis and ehrlichiosis, that mimic some symptoms of Lyme). These are on the rise in the United States, though still not as common as Lyme.

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Q: What’s the best way to protect myself and my family from Lyme?


Aside from applying repellents with DEET on exposed skin, using permethrin on clothing, and checking for ticks whenever you’ve been outside, research suggests that people who shower within two hours after being outdoors are less likely to develop the disease.

Clear away leafy debris around the edge of your lawn, and keep a crisp margin of wood chips, mulch, or gravel between your yard and the woods. Teach kids to stay away from the perimeters: Research has shown that 82% of ticks found on lawns are within 3 yards of the edge, particularly along woodlands and ornamental plantings.

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