What You Need to Know About the Stages of Lyme Disease

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Lyme disease, the most common tick-borne illness in the United States, is caused by an infection with the bacteria Borrelia burgdorferi. Infected deer ticks can transmit the disease when they bite people.

Two people hiking through the woods
Ezra Shaw / Getty Images News / Getty Images North America

In the United States, Lyme disease primarily occurs in three geographic regions: the Northeast and Mid-Atlantic states (from Maine to Virginia), the Midwest (Minnesota, Wisconsin, and Michigan), and Northern California. Early treatment is vital to prevent the disease from progressing through later stages.

Learn what to expect during each stage of Lyme disease. With a timely diagnosis and antibiotic treatment, you can get back to feeling like yourself again.

Early Localized Lyme Disease (Stage 1)

During this stage, the infection has not yet spread to other parts of the body. Diagnosing Lyme disease during stage 1 gives you the best chances of a quicker recovery.

Early localized Lyme disease commonly begins with a rash called erythema migrans. This rash, which occurs in 70% to 80% of infected people, typically develops seven days after a bite but can occur within three to 30 days.

The rash grows slowly over several days and can be more than 12 inches in diameter. The rash may be warm to the touch but is not usually painful or itchy. Some people may develop the classic “bull’s eye” rash, but the rash's appearance can vary greatly.

The following symptoms may also be present with or without a rash:

  • Chills
  • Fatigue
  • Fever
  • Headache
  • Joint or muscle pain
  • Swollen lymph nodes

People treated during this stage often recover quickly and completely. Treatment involves 10 to 14 days of oral antibiotics.

Unfortunately, 10% to 25% of cases may go unnoticed and progress to later stages of the disease.

Early Disseminated Lyme Disease (Stage 2)

If Lyme disease is left untreated, it may progress to early disseminated Lyme disease, which spreads from the bite location to other parts of the body. It may begin to affect the skin, nervous system, and heart. This stage can occur days to months following the initial infection.
Neurologic symptoms occur in approximately 10% of untreated people.

Inflammation of the nervous system can cause:

  • Facial paralysis (drooping on one or both sides of the face)
  • Fever
  • Numbness, tingling, shooting pain, or weakness in the arms or legs
  • Sensitivity to light
  • Severe headache or neck stiffness

Lyme carditis, which affects approximately 5% of people in this stage, occurs when the infection reaches the heart tissue and slows down the heart rate too much. Some people may not have any symptoms, while others may experience severe effects requiring hospitalization.

Symptoms include:

During this stage, you may develop multiple erythema migrans rashes on areas distant from the original bite. You may also experience headaches, muscle or joint pain, or extreme fatigue.

Early disseminated Lyme disease can be treated with oral or intravenous antibiotics for two or more weeks, depending on the severity of the symptoms.

Late Persistent Lyme Disease (Stage 3)

Late persistent Lyme disease usually occurs in those who did not receive early treatment. It's the most severe stage and can occur months to years following the initial infection. Damage to the joints, nerves, and brain is possible if not treated.

Muscle and joint pain is the most common complaint of those in late-stage Lyme disease, affecting 80% of untreated people. Lyme arthritis, which occurs in 50% of cases, can cause swelling and pain, usually in one knee, but can be present in both knees or other large joints.

Various neurological symptoms can occur depending on the area of the nervous system affected. Some symptoms may be similar to stage 2 but can be more extensive, severe, or longer-lasting. If the infection has traveled to the brain, you may experience:

  • Difficulty following conversations and processing information
  • Mental fogginess
  • Trouble sleeping
  • Vertigo or dizziness

Oral antibiotics are typically used for Lyme arthritis, while intravenous antibiotics treat neurologic issues. The length of therapy can be two to four weeks, depending on the symptoms.

Recognizing Lyme Disease

Early detection and treatment of Lyme disease may prevent the infection from progressing to later stages of the illness. Since symptoms may vary from person to person, it's best not to jump to conclusions until you've been properly evaluated by your healthcare professional.

An infected tick usually requires at least 36 hours to transmit the bacteria into your body. Therefore, it is imperative to check yourself for ticks after being outside. If you discover a tick attached to your skin, remove the tick using a fine-tipped tweezer.

When possible, it can be helpful to save the tick (in a sealed, plastic bag), so you can describe the tick’s appearance to your healthcare professional. Depending on the type of tick, the estimated time the tick has been attached, and the geographic location where the tick bite occurred, your healthcare professional may recommend preventative antibiotics to err on the safe side.

If preventative antibiotics are not used, you should monitor the bite location for any expanding redness. While most infected people will experience a rash, not everyone does. Additionally, the rash may be difficult to see if the bite occurred on the scalp.

Be sure to contact your doctor if you are experiencing any of the previously discussed symptoms (even if you don’t have a rash) including flu-like symptoms, muscle or joint pain, or fatigue.

Chronic Lyme Disease

Chronic Lyme disease describes pain, fatigue, or difficulty thinking that persists for six months or longer after completing antibiotic treatment. Also known as "post-treatment Lyme disease," chronic Lyme disease is controversial among medical professionals due to the vagueness and lack of established diagnostic criteria.

It is unclear what causes some people to develop chronic Lyme disease, and unfortunately, there is no proven treatment. Most people will improve slowly, but it can take many months to feel well again.

Lyme disease can be a troubling condition, affecting various parts of the body. Fortunately, most people can make a full recovery after completing a course of antibiotics.

Don't hesitate to contact your healthcare provider if any of the above symptoms sound familiar or if you suspect an infected tick may have bitten you. Lyme disease is a common issue that can be treated when properly diagnosed.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Centers for Disease Control and Prevention. Signs and symptoms of untreated Lyme disease.

  3. Global Lyme Alliance. Lyme disease symptoms.

  4. Centers for Disease Control and Prevention. Treatment for erythema migrans.

  5. American College of Rheumatology. Lyme disease.

  6. Centers for Disease Control and Prevention. Neurologic Lyme disease.

  7. Centers for Disease Control and Prevention. Lyme carditis.

  8. Hu L. Patient education: what to do after a tick bite to prevent Lyme disease (beyond the basics).

  9. Campos M. Lyme disease: resolving the "Lyme wars." Harvard Health Publishing.

  10. Centers for Disease Control and Prevention. Post-treatment Lyme disease syndrome.

By Anastasia Climan, RDN, CD-N
Anastasia, RDN, CD-N, is a writer and award-winning healthy lifestyle coach who specializes in transforming complex medical concepts into accessible health content.