Woman with Lyme disease experiencing early stage symptoms

Stages of Lyme Disease Explained

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.


Table of contents


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. [1] 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.

What is 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:

  • Borrelia burgdorferi
  • Borrelia mayonii

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:

  • Headache
  • Fever
  • Fatigue or malaise
  • Skin rash

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: [4]

  • Round or oval skin redness
  • A visible characteristic in the center of each lesion, including:
  • A crusty, round nodule
  • A dusky or grey disc shape
  • A bluish halo around a central red spot (visually similar to a bullseye)
  • Central clearing, or a round shape that's the same color as healthy skin
  • Large lesions sometimes spread throughout the entire body

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: [5]

  • The severity of the infection
  • The stage of the disease
  • A patient’s tolerance for antibiotic medications
  • A patient’s age and pregnancy status. Adults generally respond well to doxycycline while providers typically prescribe amoxicillin for children
  • Ceftriaxone is typically only prescribed for pregnant patients

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.

The three stages of Lyme disease

Lyme disease presents in three major phases: [5]

  • Early localized disease
  • Early disseminated disease
  • Late or chronic disseminated disease

It’s important to distinguish between the third phase above and a separate condition called Post-Treatment Lyme Disease Syndrome (PTLDS). [6] 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.

Early localized Lyme disease

The first phase of the infection, early localized Lyme disease is identified via two key indicators: [5]

  • Erythema migrans (the rash symptoms described in a previous section)
  • Flu-like symptoms including:
  • Fever
  • Headaches
  • Fatigue or malaise
  • Full-body aches

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:

  • Contact dermatitis
  • Cellulitis
  • Gout and pseudogout
  • Rheumatoid arthritis

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.

Risk factors

A risk factor is a characteristic that could increase your likelihood of getting sick or injured. [7]

Some general risk factors for contracting Lyme disease include: [5]

  • Vegetation levels in the areas you frequent
  • How often you visit tick-dense areas
  • The rodent population in your local ecosystem
  • Overall tick density in your area

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:

  • Antibiotic resistance
  • Biome disruption—antibiotics can impact the healthy flora throughout your body
  • Secondary infection
  • Allergic reactions to antibiotics

Treatment options

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. [9]

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.

Early disseminated Lyme disease

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: [5]

  • Increased pain (both acute and generalized)
  • Higher fever
  • Organ impacts in one or more of the following systems: neurological organs, eyes, musculoskeletal systems

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.

Risk factors

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:

  • Lack of antibiotic intervention
  • Insufficient antibiotic intervention

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:

  • The efficacy of the antibiotics was impacted by other medications, alcohol consumption, or allergic reaction
  • Your antibiotic dose was too low or your course too short
  • You show signs of antibiotic resistance

Treatment options

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:

  • Tylenol or other over-the-counter (OTC) medications for pain and fever management
  • Sleep aids (like Melatonin) for sleep disruption
  • Anti-nausea drugs (like Nauzene or Dramamine) for antibiotic-induced stomach aches

Late disseminated Lyme disease

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: [5]

  • Persistent, severe pain
  • Arthritis-like symptoms, including joint pain, difficulty maintaining grip strength, and/or fine and gross motor deficiencies
  • Brain fog or a state of disorientation

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: [5]

  • Lyme carditis, or heart malfunctions related to a Lyme infection [10]
  • Lyme arthritis, causing localized or general joint swelling [11]
  • Meningitis, or brain and spinal cord inflammation [13]

Risk factors

The most significant risk factor for late disseminated Lyme disease is late intervention. Specifically, late intervention could take place if:

  • Early intervention attempts are unsuccessful (which is uncommon)
  • A patient refuses antibiotic treatment
  • Patients don’t recognize the symptoms until the disease is widespread

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.

Treatment options

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:

  • Pain relief medications (either prescription or OTC)
  • Physical therapy for joint or musculoskeletal damage
  • Medical interventions for heart impacts, including stents or vasodilation medications

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.

Test for Lyme disease at home with Everlywell

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:

  • Register your kit using the unique ID number on the package
  • Collect your sample and mail it to the laboratory using the prepaid shipping label
  • Receive your secure, digital results in just days

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.

What Are the Long-Term Effects of Lyme Disease?

How is Lyme Disease Diagnosed?

Where Is Lyme Disease Common?

Lyme Disease vs. Rocky Mountain Spotted Fever


References

  1. Lyme Disease – Data and Surveillance. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
  2. Lyme Disease. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
  3. Vector-Borne Diseases. European Centre for Disease Prevention and Control. URL. Accessed July 13, 2022.
  4. Lyme Disease Rashes and Look-Alikes. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
  5. Lyme Disease. US National Library of Medicine. URL. Accessed July 13, 2022.
  6. Post-Treatment Lyme Disease Syndrome. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
  7. Understanding Health Risks. US National Institutes of Health. URL. Accessed July 13, 2022.
  8. Risk Factors of Lyme Disease: An Intersection of Environmental Ecology and Systems Science. US National Library of Medicine. URL. Accessed July 13, 2022.
  9. . Lyme Disease Antibiotic Treatment Research. National Institute of Allergy and Infectious Diseases. URL. Accessed July 13, 2022.
  10. Lyme Carditis. US Centers for Disease Control and Prevention.. URL. Accessed July 13, 2022.
  11. Lyme Arthritis. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
  12. Lyme Disease. US National Library of Medicine. URL. Accessed July 13, 2022.
  13. Meningitis. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
Everlywell makes lab testing easy and convenient with at-home collection and digital results in days. Learn More