Lyme Disease Timeline: From Initial Signs to Unusual Symptoms

What to Know About Lyme Disease Summary

  • Lyme disease is transmitted by the bite of the blacklegged tick. In the United States, Lyme disease occurs in the Northeast and Mid-Atlantic (from northeastern Virginia to Maine), North Central states (especially Wisconsin and Minnesota), and the West Coast (particularly northern California).
  • Lyme disease symptoms change over time (if the infection is not treated). The symptoms you experience depends on what stage the disease is in. There are 3 main stages of Lyme disease.
  • The “bull’s-eye” rash is a compelling physical sign of Lyme disease. If this rash appears on your body, get medical attention and treatment right away.
  • Want to check if Lyme disease is behind symptoms you’re experiencing? Consider taking the Everlywell at-home Lyme Disease Test. You do not need a prescription to order and take this test!

Table of contents

How to Know If You Have Lyme Disease

hat are some of the signs and symptoms of Lyme disease? That's exactly what you'll discover here. First, it's important to know what causes Lyme disease: a bacteria spread by ticks such as deer ticks. An infected tick bite can transmit the bacterium B. burgdorferi into your body within 36 to 48 hours. The incubation period for Lyme can range from three to 30 days, where symptoms such as the Lyme disease rash (or EM rash), which is a clear indicator of the infection, and flu-like symptoms, may appear.

Medical experts often divide Lyme disease into three stages, with each presenting distinct symptoms. In early localized Lyme, symptoms are immediate and may include the classic erythema migrans and early symptoms like fatigue. Without prompt Lyme disease treatment, you could progress to later stages, which involve more severe issues such as neurological symptoms from Lyme neuroborreliosis, chronic Lyme arthritis, and even Lyme carditis.

If you've been exposed to areas where tickborne diseases are common, and you're experiencing symptoms, consider using an at-home Lyme disease test kit to detect the presence of the infection early on. Early detection can aid in managing Lyme disease cases effectively and prevent long-term health complications.

The Lyme Disease Timeline: Recognizing Each Stage

Stage 1: Initial Signs of Early Localized Lyme Disease

Timeframe: First 30 days after tick bite

If you have Lyme disease, you might experience the following symptoms within the first 30 days after the infected tick bit you:

Erythema Migrans “Bull’s-eye” rash – The most clear-cut sign of a Lyme infection is a round (or oval), red rash – at least 5 centimeters across – that expands outward as time goes by. The rash begins at the site of the tick bite and often takes on a “bull’s-eye” or “target” appearance, with a reddish center and outer edge. What else should you know about this rash?

  • The rash is a very definite mark of Lyme disease. So if you spot this rash on your body, seek medical attention immediately! The sooner you receive treatment for Lyme disease, the better.
  • About 70% of people with a Lyme infection will develop this rash – which generally appears between 3 and 30 days after the tick bite (the average is 7 days) [1].
  • It’s usually not painful or itchy; however, it can feel warm when you touch it.
  • If the infection is not treated, multiple “bull’s-eye” rashes might pop up throughout your body [2].

Flu-like symptoms – A Lyme infection can trigger flu-like symptoms, including fevers, chills, headaches, swollen lymph nodes, and a sore throat. So if you’re having flu-like symptoms in the middle of the summer (and you’ve been outdoors in areas where ticks live), take note: Lyme disease could be the culprit!

What should you do if you’re experiencing these symptoms?

If you have the “bull’s-eye” rash, definitely get medical attention – and treatment – right away. Time is of the essence because Lyme bacteria can keep multiplying and spreading throughout your body – and harming your health – until you receive treatment.

If you experience other symptoms within the first 30 days after a tick bite – but not the rash – consult with your doctor, who will advise you on the next steps to take.

Stage 2: Early Disseminated Lyme Disease Symptoms

Timeframe: 3-10 weeks after tick bite

Within about 3-10 weeks after the tick bite (and the start of the Lyme infection), you might notice symptoms like:

Lyme arthritis – Within the first several weeks after a Lyme infection, you might experience muscle and/or joint pain that moves from one joint to another. These symptoms can come and go for hours or days at a time [3].

Difficulty controlling your facial muscles – This usually affects just one side of your face and can lead to facial paralysis or Bell’s palsy. Researchers think that Lyme disease causes at least 1 out of every 4 new cases of Bell’s palsy (in the parts of the country where Lyme disease occurs) [4].

Heart palpitations (a pounding heart), chest pain, light-headedness or fainting, and shortness of breath – These symptoms can occur if the Lyme bacteria infect your heart and disrupt its function [5]. Estimates suggest that Lyme bacteria invade the heart in about 4% - 10% of people with untreated Lyme disease, and that this usually occurs roughly 3 weeks after the infection begins [6]. However, Lyme disease bacteria can attack the heart more than 6 months after the infection first starts! The heart complications caused by Lyme disease, known as Lyme carditis, can be fatal, though this is very rare [7].

Flu-like symptoms – This can include fevers, chills, headaches, swollen lymph nodes, and a sore throat.

Other possible symptoms include:

  • Fatigue
  • Weakness or numbness in your arms and legs
  • Vision changes
  • A rash on your skin

What should you do if you’re experiencing these symptoms?

Don’t hesitate to talk with you doctor if you experience these symptoms in the 3-10 weeks after you suspect a tick bit you. Also, if several weeks have passed after the tick bite, consider taking the at-home Lyme Test to see if your symptoms might be the result of a Lyme infection.

(Why wait several weeks before testing? It’s because this test is based on IgG and IgM antibodies in your blood, which take several weeks to build up after an infection starts.)

Stage 3: Late Disseminated Lyme Disease Indicators

Timeframe: Months to years after Lyme infection first began

If a Lyme infection isn’t treated promptly, Lyme bacteria can keep reproducing and invading different parts of your body – causing often-dreadful symptoms long after you were first infected.

So what symptoms might you experience in the months – and even years – after a Lyme infection begins? Here are several:

Lyme arthritis – Though arthritis – joint pain and stiffness – can occur within the first few weeks of the disease, it usually develops months later (generally about 6 months later) [8]. It is a very common symptom of Lyme disease: among people with untreated Lyme, around 60% will suffer from arthritis of some kind several months after the disease starts [9]. This condition can progress to chronic Lyme arthritis, a persistent form of arthritis that results in ongoing joint inflammation and discomfort, especially affecting large joints like the knee, shoulder, ankle, elbow, hip, and wrist joints can also be affected.

Skin symptoms – Skin symptoms can arise in the months and years after the Lyme infection first began. In some cases, people experience a small, bluish-red swelling of the skin on an earlobe or nipple [10]. This, however, is quite rare.

Nervous system symptoms – Months or even years post-infection, untreated Lyme disease, caused by the Borrelia burgdorferi bacterium, may lead to memory loss, confusion, sleep disturbances, and symptoms of depression. About 10% - 15% of individuals with untreated Lyme disease develop neurological symptoms known as Lyme neuroborreliosis [11]. These symptoms include:

  • Bell's palsy
  • Nerve pain in the spine [12]
  • A feeling of numbness or tingling in the hands and/or feet
  • Mental confusion
  • Memory loss
  • Sleep disturbance and fatigue
  • Depression [13]

What should you do if you’re experiencing these symptoms?

Do some of these symptoms line up with what you’re going through? If so, it’s important to bring this to your doctor’s attention. You may also want to take a blood test for Lyme disease – something you can now do at-home with the Everlywell easy-to-use Lyme Disease Test – to see if a Lyme infection could be causing your symptoms.

Unusual Symptoms of Lyme Disease

Lyme disease can sometimes manifest symptoms that extend beyond the well-known erythema migrans rash and joint pains, particularly in its later stages. It's essential to be vigilant for these less common but significant symptoms, which can often be mistaken for other medical issues. Recognizing these atypical signs is crucial for timely diagnosis and treatment, helping to mitigate the impact of Lyme disease on your life.

As Lyme disease affects so many different organs and organ systems, it can be easy to mistake for other conditions, including:

Chronic fatigue syndrome

CFS is a complicated disorder that is characterized by extreme physical fatigue lasting for six or more months. This fatigue doesn’t go away with sleep or rest and can lead to cognition problems, dizziness, and even flu-like symptoms. There is currently no known cause of CFS, though theories suggest everything from stress to viral infections.


Fibromyalgia is a condition that causes widespread musculoskeletal pain throughout the body. This can also be accompanied by mood issues, memory problems, sleep disorders, and fatigue. The exact cause is not well known, but symptoms can begin following physical trauma, surgery, psychological stress, or other significant events.

Multiple sclerosis

Multiple sclerosis is an autoimmune disorder wherein the immune system begins to attack the protective cover (the myelin sheath) surrounding nerve fibers. This causes communication issues between the brain and the rest of the body, eventually resulting in permanent damage to the central nervous system. Symptoms include fatigue, numbness or weakness in the limbs, a loss of coordination, and vision issues.


Depression is a mental health disorder characterized by extreme feelings of sadness and a loss of interest or motivation. It can come with some serious physical symptoms, including general fatigue, cognitive problems, and unexplained physical aches and pains.

See if a Lyme infection could be causing your symptoms with EverlyWell's easy-to-use Lyme Disease Test.

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