Medically reviewed on July 13, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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When planning a summer trip to the lake or a weekend woods retreat with friends, Lyme disease is probably the last thing on your mind.
But, Lyme disease (or Lyme borreliosis) is more common than you think—approximately 30,000 cases are reported to the CDC each year, and other data suggest that this figure represents only a fraction of Lyme cases contracted annually.  Summer travelers and outdoors-lovers alike should stay vigilant against Lyme, taking precautions when possible and learning more about Lyme disease symptoms, risk factors, and stages.
In this guide, we’ll focus on the stages of Lyme disease specifically, taking a deep-dive into the symptoms, risk factors, and treatment options patients can expect to encounter in each one. Luckily, Lyme disease is easily recognizable and treatable, but education is key to prevention.
Read on to learn more about the three stages of Lyme disease.
Lyme disease is a vector-borne illness—meaning that it’s spread via arthropod bites—found in four US-based tick species. [2,3]
The disease is caused by one of two bacteria:
If you are wondering how is Lyme disease diagnosed, it is typically based on consideration of the infection timeline, laboratory testing, and physical symptoms, which include:
However, a Lyme disease skin rash is quite distinct from other rashes—like hives, ringworm, or fixed drug reactions—and you should become familiar with its specific visual qualities for ease of identification. The rash, called erythema migrans, features: 
A rash is often the first reason patients might suspect a Lyme infection, but rash lesions are distinct from tick bites. If you have a tick bite, you won’t always become infected with Lyme, but suspected tick bites should be carefully monitored to detect signs of the disease as early as possible.
Once a diagnosis is confirmed by a healthcare provider, they’ll develop a treatment plan based on: 
If left untreated, Lyme can spread throughout the body, infecting the central nervous system, joints, and heart, complicating treatment plans.
All of the information might sound intimidating. But getting educated on Lyme stages and symptoms can help you get an early diagnosis and may prevent the long-term effects of Lyme disease.
Lyme disease presents in three major phases: 
It’s important to distinguish between the third phase above and a separate condition called Post-Treatment Lyme Disease Syndrome (PTLDS).  While PTLDS research is still ongoing, the syndrome’s existence is debatable and outside the scope of this article.
Let’s dig deeper into the three stages of Lyme disease.
The first phase of the infection, early localized Lyme disease is identified via two key indicators: 
This phase typically lasts between one and thirty days, unless it’s intercepted via antibiotic treatment within that timeframe.
The first stage of Lyme can sometimes be difficult for healthcare providers to diagnose—especially if a patient doesn’t develop erythema migrans or any other skin-based symptoms.
In addition, underdeveloped erythema migrans can be mistaken for:
If you suspect a first-stage Lyme infection, discuss your medical history with your provider and be as specific as you can about your symptoms.
A risk factor is a characteristic that could increase your likelihood of getting sick or injured. 
Some general risk factors for contracting Lyme disease include: 
Because of this, it is important to know where Lyme disease is common and how many ticks can be found in the areas you travel. There are also many types of ticks that can form different infections similar to Lyme disease. For example, many people confuse Lyme disease vs. Rocky Mountain Spotted Fever.
But while you’re fighting off early localized Lyme (even with the help of antibiotics), you could be at increased risk for other health impacts. Some Lyme-related risk factors that could lead to additional medical challenges include:
Antibiotics are the most common early localized Lyme disease treatment, and they're currently the only scientifically-proven method for eradicating the infection in both human and animal models. 
Early localized Lyme disease typically only requires a short course of antibiotics, but longer courses (lasting three to four weeks) can be used to treat more complicated cases or persistent infections.
Present data suggest that additional antibiotic treatment methods (like intravenous (IV) administration or topical application) don’t provide additional infection-fighting potential or speed up the healing process.
If your Lyme infection progresses past the first stage, you’ll encounter the symptoms of early disseminated Lyme disease—the second phase.
Second-phase infections typically feature the symptoms observed in the first stage, though they could be more severe.
But, patients should remain vigilant for other potential symptoms at this stage, including: 
While they’re both considered early phases of the disease, stages one and two can have distinctly different severity levels. Patients with an early localized infection may still be able to operate as normal while they treat the disease, while an early disseminated infection can cause significant discomfort.
The second stage of the infection (unless treated with antibiotics) can last between three and ten weeks.
All Lyme infections stem from the same risk factors—particularly tick bites.
But, there are two risk factors that lead to second-and third-stage Lyme disease:
If you receive a positive diagnosis for Lyme disease, but you don’t undergo antibiotic treatment, the infection is likely to persist and develop into a further-stage illness.
But, if you take your antibiotic course for a first-phase infection as instructed, your disease could still persist if:
Treatment for early disseminated Lyme is the same—a course of antibiotics and recovery time.
But, with a more severe infection comes more intense side effects. Your medical provider might suggest some of the following tactics for side effect management:
The most severe phase of the infection, late disseminated Lyme disease can significantly impact patients in both the long- and short-term.
If you receive a positive diagnosis for late disseminated Lyme, you’ll likely display signs common in first- and second-stage infections. But, you’ll probably also experience additional symptoms impacting your joints, muscles, or nerves, including: 
Intervention is crucial for infections in this stage. Left untreated, late disseminated Lyme disease can lead to a variety of other Lyme-related medical conditions like: 
The most significant risk factor for late disseminated Lyme disease is late intervention. Specifically, late intervention could take place if:
As we briefly discussed above, late disseminated Lyme disease symptoms can be risk factors for more serious illnesses. Secondary diseases like Lyme carditis, Lyme arthritis, or meningitis can lead to long-term health impacts and extended recovery times—third-stage Lyme can last for months or even years.
Approximately 5% of stage 3 Lyme patients experience lingering aches, fatigue, and joint symptoms even after antibiotic treatment. Scientists are still studying the long-term impacts of the disease, but most patients can expect a good prognosis.
In addition to antibiotic treatment, it’s crucial that third-stage Lyme disease patients keep in close contact with their healthcare providers. In addition to antibiotics, providers might prescribe or recommend:
If you’ve reached the late dissemination stage of Lyme disease, take action as quickly as possible to eradicate the infection and reduce your risk of additional health complications.
Lyme disease can be frightening, especially in late intervention cases. But it’s important to remember that antibiotic treatment is a highly effective Lyme disease treatment at all stages—with help from your healthcare provider, you’ll recover from Lyme disease.
Identification is the first step to treating Lyme disease—and, with help from Everlywell, you can test for Lyme disease antibodies from the comfort of your home.
Our at-home Lyme disease panel tests for infection from three different types of Borrelia bacteri that can result in Lyme disease. Testing is easy:
Everlywell is putting the power of testing in your hands—check out our full slate of at-home lab tests for Lyme disease, heart health, and more.