Can You Get Lyme Disease More Than Once?

Lyme disease can happen more than once
A previous infection does not provide complete immunity
Another infected tick bite can cause reinfection

Can you get Lyme disease more than once? Yes. Having Lyme disease in the past does not reliably protect a person from developing Lyme disease again after another infected tick bite.

This is called reinfection. It is important to distinguish reinfection from persistent or recurring symptoms after an earlier episode of Lyme disease. A new infection follows a new exposure, while symptoms that continue or return after treatment may have several possible explanations.

A large 2025 European study provides additional evidence that Lyme disease can occur repeatedly. Researchers identified 1,962 episodes of erythema migrans in patients who had previously been treated for Lyme disease.²

Prior Lyme disease did not provide complete protection against another clinically apparent infection.

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Why doesn’t having Lyme disease make you immune?

Infection with Borrelia burgdorferi can produce an immune response, but that response does not create reliable protection against all future Lyme infections.

Research has suggested that some immunity may be directed against particular strains of Borrelia. However, Lyme disease bacteria are genetically diverse, and another infected tick can expose a person to a different strain.

That means a person who recovered from one episode of Lyme disease can later develop another episode after a new infected tick bite.

A history of Lyme disease should therefore not be considered protection against future Lyme disease.

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What did the 2025 Lyme reinfection study find?

Strle and colleagues examined 12,384 cases of erythema migrans diagnosed at an outpatient Lyme disease clinic in Slovenia between 1990 and 2014.²

Among those cases, 1,962 episodes occurred in patients who had previously been treated for Lyme disease. Most of those patients had experienced erythema migrans during their earlier infection.

The interval between the original infection and reinfection varied widely. The median interval was approximately six years, but reinfections occurred from several months to more than two decades after the earlier episode.²

Some patients experienced Lyme disease repeatedly. Most had one reinfection, but others had two or three reinfections, and one patient experienced multiple additional episodes.

The study reinforces a simple clinical message:

Having Lyme disease once does not mean a person cannot get it again.

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Can reinfection occur after more than one type of Lyme disease?

Yes. Most patients in the 2025 study had previously experienced erythema migrans, but reinfection was also documented in patients whose earlier Lyme disease had included other manifestations.²

Previous manifestations included:

• Lyme neuroborreliosis
• Lyme arthritis
• acrodermatitis chronica atrophicans
• borrelial lymphocytoma

None of the previous clinical manifestations evaluated in the study provided complete protection against subsequently developing erythema migrans.

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Could a second Lyme infection look different?

The 2025 study found an intriguing difference between first infections and reinfections.

Multiple erythema migrans lesions were present in 5.5% of reinfection episodes compared with 7.4% of cases in patients without a previous history of Lyme disease.²

Multiple erythema migrans lesions can be a manifestation of disseminated Lyme disease. The researchers therefore suggested that previous Lyme disease might provide some partial immune protection that modifies the clinical expression of a later infection.

However, this finding should be interpreted cautiously.

It does not mean that a second Lyme infection will necessarily be milder. The study examined multiple erythema migrans as a marker of dissemination and did not establish that reinfections overall produce less severe illness.

The biological mechanisms responsible for the difference also remain uncertain.

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Reinfection is different from relapse or persistent symptoms

This distinction is particularly important.

Reinfection means acquiring a new Lyme infection following another exposure to an infected tick.

In the 2025 study, researchers defined reinfection carefully. The previous erythema migrans lesion had disappeared after antimicrobial treatment, and the later erythema migrans lesion appeared at a different location on the body.²

The study therefore provides evidence about new Lyme infections. It does not determine why some patients experience symptoms that persist or return following treatment of an earlier infection.

Those situations require a different clinical discussion.

When symptoms recur without a clearly documented new infection, possible explanations may include persistent infection, post-infectious immune or inflammatory responses, autonomic dysfunction, another illness, or other factors. The presence of recurrent symptoms alone cannot determine the mechanism.

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What does research in the United States show?

Reinfection has also been documented in the United States.

Nadelman and colleagues studied patients who developed recurrent episodes of culture-confirmed erythema migrans. Researchers compared Borrelia burgdorferi strains from consecutive episodes using molecular typing.¹

The bacterial strains associated with the recurrent episodes differed from those identified during the earlier episodes, supporting reinfection rather than relapse in the episodes studied.

Together, the North American molecular evidence and the large European clinical study demonstrate that Lyme disease can occur more than once.

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Do the European findings apply directly to the United States?

Not necessarily.

The 2025 study was conducted in Slovenia, where several species of Lyme disease bacteria circulate, including Borrelia afzelii, Borrelia garinii, Borrelia bavariensis, and Borrelia burgdorferi.²

In North America, Lyme disease is caused predominantly by Borrelia burgdorferi sensu stricto.

Because the bacterial species and immune responses may differ, the precise frequency and clinical pattern observed in Slovenia should not automatically be assumed to occur in the United States.

But the broader conclusion is consistent with North American experience: previous Lyme disease does not provide reliable immunity against another infection.

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What should patients watch for after having Lyme disease?

People who have previously had Lyme disease should continue taking precautions against tick bites.

A previous diagnosis does not mean that a new expanding rash, flu-like illness, facial weakness, joint swelling, neurologic symptoms, or other compatible findings following another tick exposure should automatically be attributed to the old illness.

A new infection should remain part of the clinical assessment when there has been another potential exposure.

This is especially important in Lyme-endemic areas, where a person may encounter infected ticks repeatedly over many years.

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What if Lyme antibodies are still positive?

Lyme antibody testing can be more difficult to interpret in someone who has already had Lyme disease because antibodies may remain detectable long after the original infection.

A positive antibody test therefore does not by itself establish that a person’s current symptoms represent a new infection.

The timing of symptoms, tick exposure, development of a new erythema migrans rash, physical findings, and other clinical information remain important when evaluating possible reinfection.

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Can coinfections complicate the picture?

Yes. Another tick bite may expose a person to pathogens other than the bacteria that cause Lyme disease.

Tick-borne infections such as babesiosis and anaplasmosis can produce symptoms that overlap with Lyme disease. In some patients, more than one tick-borne infection may need to be considered.

This is another reason recurrent symptoms should not automatically be assumed to represent either Lyme reinfection or recurrence of the previous illness.

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Frequently Asked Questions

Can you get Lyme disease twice?

Yes. Lyme disease can occur more than once. Another infected tick bite can result in a new infection even after a person has been treated for an earlier episode.

Are you immune to Lyme disease after having it?

No. Some strain-specific immune responses may develop, but previous Lyme disease does not provide reliable protection against future infections.

How many times can someone get Lyme disease?

There is no established maximum number. In the 2025 European study, some patients experienced multiple reinfections over time.²

Is Lyme disease worse the second time?

Not necessarily. The 2025 study found that multiple erythema migrans lesions were somewhat less common during reinfection, but this does not establish that second infections are generally milder or more severe.²

Can Lyme disease return years later?

A person can develop a new Lyme infection years after an earlier infection. Symptoms from a previous illness may also persist or recur for other reasons, so reinfection and recurrence should not automatically be considered the same process.

Can a blood test tell whether Lyme disease is new or old?

Not reliably. Lyme antibodies can persist after an earlier infection, so serology alone may not distinguish a new infection from antibodies remaining from a previous episode.

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Clinical Takeaway

Lyme disease can occur more than once.

A large 2025 European study documented nearly 2,000 erythema migrans reinfection episodes and found that previous Lyme disease did not provide complete protection against another infection.²

The study also found fewer multiple erythema migrans lesions during reinfection, raising the possibility that previous infection may partially modify the immune response to a later infection. However, this should not be interpreted to mean that every subsequent Lyme infection will be milder.

For patients with a history of Lyme disease, new symptoms following another tick exposure deserve a fresh clinical assessment. Reinfection, recurrence of a previous illness, other tick-borne infections, and unrelated medical conditions can present differently and should not automatically be treated as the same problem.

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Related Articles

• Can Lyme Disease Come Back Years Later?
• Can You Get Lyme Disease Twice? Reinfection Explained
• Persistent Lyme Disease Mechanisms: Why Symptoms Persist
• Post-Treatment Lyme Disease Syndrome (PTLDS): Why Symptoms Persist
• Autonomic Dysfunction in Lyme Disease: Symptoms and Treatment

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References

1. Nadelman RB, Hanincová K, Mukherjee P, et al. Differentiation of reinfection from relapse in recurrent Lyme disease. N Engl J Med. 2012;367(20):1883-1890. doi:10.1056/NEJMoa1114362.

2. Strle F, Maraspin V, Lotrič-Furlan S, Ogrinc K, Rojko T, Kastrin A, et al. Lower frequency of multiple erythema migrans skin lesions in Lyme reinfections, Europe. Emerg Infect Dis. 2025;31(4):662-668. doi:10.3201/eid3104.241329.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

This article is for educational purposes and is not intended to provide individual medical advice, diagnosis, or treatment.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention