--- title: "Lyme disease: Symptoms, Causes & Treatment | HealthAnswers" description: "Lyme disease — tick bites, erythema migrans rash, diagnosis, antibiotic treatment, and prevention when walking in wooded areas." url: https://healthanswers.co.uk/conditions/lyme-disease/ robots: noindex --- # Lyme disease: Symptoms, Causes & Treatment | HealthAnswers Health A–Z Lyme disease — tick bites, erythema migrans rash, diagnosis, antibiotic treatment, and prevention when walking in wooded areas. Written by HealthAnswers editorial team Medically reviewed by [HealthAnswers UK doctor review panel](https://healthanswers.co.uk/our-doctors/) Reviewed 3 July 2026 ## Quick answer What is Lyme disease? Lyme disease is a bacterial infection spread by infected tick bites — common in UK woodland and moorland areas. Early sign is expanding circular red rash (erythema migrans) often with flu-like illness. Treated with antibiotics — doxycycline or amoxicillin — usually full recovery if caught early. Not all tick bites cause Lyme — remove ticks promptly with tick remover. See a GP if rash or illness after tick bite — blood tests support diagnosis but rash alone can start treatment. ## Who is this page for? This page is for people in the UK who want a plain-English overview of Lyme disease, including when to seek help and what NHS care usually involves. It explains general information, not what is wrong with you personally. ## Who should skip this page? Skip this page if you need a diagnosis, a prescription, or emergency care. It cannot replace a GP, pharmacist, NHS 111 or 999. If you are in immediate danger, call 999; for urgent advice that is not life-threatening, call 111 in England, Scotland or Wales, or use your GP out-of-hours service in Northern Ireland. On this page 9 sections ## Key facts about Lyme disease - Lyme disease is caused by Borrelia bacteria transmitted by Ixodes tick bites — peak spring and summer. - Erythema migrans — bullseye or expanding red rash — appears 1 to 4 weeks post bite — diagnostic — treat without waiting for blood test. - Not every tick carries Borrelia — estimated 2 to 10% in UK tick population depending on area. - Remove ticks within 24 to 36 hours reduces transmission risk — fine-tipped tweezers or tick tool — do not squeeze body. - Chronic symptoms after treatment controversial — post-Lyme syndrome debated — prolonged antibiotics not recommended without evidence of ongoing infection. ## Lyme disease — tick-borne Borrelia infection **Lyme disease** ( **Lyme borreliosis** ) — **Borrelia burgdorferi** sensu lato **transmitted by Ixodes ricinus ticks** — **sheep/deer ticks**. **UK hotspots:** **Scottish Highlands**, **New Forest**, **South Downs**, **Yorkshire Moors** — **anywhere ticks present**. **Incidence rising** — **awareness + climate** — **still treatable early**. ## Lifecycle - Tick attaches — feeds 48–72h for efficient transmission - Borrelia spreads locally → erythema migrans - Haematogenous dissemination if untreated ## Stage 1 — Early localised **3–30 days post bite:** - Erythema migrans (EM) — expanding red rash — central clearing “bullseye” — not always bullseye - ≥5cm diameter typically - not painful/pruritic usually - flu-like — fatigue, myalgia, fever **EM alone** — **start antibiotics** — **no test wait** ## Stage 2 — Early disseminated **Weeks–months:** - multiple EM lesions - cranial nerve palsy — facial palsy (Bell’s) - lymphocytic meningitis - radiculopathy — Bannwarth syndrome - carditis — AV block — may need pacing - migratory arthralgia ## Stage 3 — Late **Months–years untreated:** - Lyme arthritis — large joint , knee - acrodermatitis chronica atrophicans — skin **Rare in UK with modern treatment** ## Diagnosis **Clinical EM** — **sufficient** **Serology:** - ELISA → immunoblot if positive/equivocal - false negatives early **Do not test asymptomatic tick bite** ## Treatment (NICE) | Stage | Regimen | | --- | --- | | Early | Doxycycline 21 days OR amoxicillin OR azithromycin | | Neuro/cardiac | IV ceftriaxone — specialist | | Arthritis | Oral or IV per severity | **Pregnancy** — **amoxicillin** — **avoid doxycycline** ## Prevention - long trousers , tucked socks walking - stick to paths - insect repellent DEET - check skin after outdoors — prompt removal - shower within 2 hours **No UK Lyme vaccine** currently licensed ## Post-treatment symptoms **Fatigue after adequate antibiotics** — **common** — **usually resolves months** **Chronic Lyme** term **controversial** — **NICE** — **no long-term antibiotics without active infection evidence** **Specialist infectious diseases** if **persistent objective signs** **Tick attached** — **remove correctly**, **watch rash 4 weeks** — **bullseye = GP same week antibiotics**. ## ! When to see a GP about Lyme disease See a GP if erythema migrans rash or flu-like illness after tick bite or time in tick habitat — antibiotics started empirically if classic rash. Same-day if facial palsy, severe headache, meningism, heart palpitations, or painful swollen joints — disseminated Lyme. Save removed tick in sealed bag if identification needed — not routinely tested. ## Common questions about Lyme disease What are the symptoms of Lyme disease? Early localised — erytheema migrans rash (expanding red ring), fatigue, fever, headache, muscle aches. Disseminated weeks later — multiple rashes, facial nerve palsy (Bell's palsy), meningitis symptoms, joint swelling (often knee), heart block. Late — Lyme arthritis, neurological symptoms months later if untreated. How do you remove a tick? Use tick removal tool or fine tweezers close to skin — pull steadily upward without twisting or squeezing body. Clean skin and hands. Do not use petroleum jelly, heat, or nail polish — increases infection risk. Monitor bite site 4 weeks. How is Lyme disease diagnosed? Erythema migrans rash — clinical diagnosis — start antibiotics immediately. Blood tests (ELISA then immunoblot) detect antibodies — often negative early — repeat if suspicion persists. PCR on joint fluid or CSF selected cases. What antibiotics treat Lyme disease? Early Lyme — doxycycline 100mg twice daily 21 days (not pregnancy/under 12), or amoxicillin, or azithromycin alternatives. Neurological or cardiac Lyme — IV ceftriaxone — specialist. Most people recover fully with prompt treatment. Can Lyme disease be chronic? Some report fatigue, pain, cognitive symptoms after treated Lyme — post-infectious syndrome may occur — not proven persistent infection in most. NICE advises against long-term antibiotics without objective evidence of active Lyme. Specialist referral if ongoing symptoms. ## Sources - [NHS — Lyme disease](https://www.nhs.uk/conditions/lyme-disease/) - [NICE — Lyme disease](https://www.nice.org.uk/guidance/ng95)