One of the most common questions patients ask is: how do you get Lyme disease? Many are surprised to learn that Lyme is caused not just by one pathogen, but often involves multiple infections transmitted by the same tick.
A teacher came to me after two years of fatigue and joint pain. She’d never seen a tick, never had a rash, and lived in the suburbs. “I didn’t think I could get Lyme disease,” she told me. “I’m not a hiker.” But she had Lyme—and Babesia. Understanding how transmission actually works might have saved her two years.
Lyme disease is transmitted through the bite of an infected blacklegged tick, which carries the bacterium Borrelia burgdorferi. However, these same ticks can also carry other pathogens like Babesia, Bartonella, and Anaplasma—making “Lyme disease” a shorthand for a complex set of tick-borne infections.
Understanding how do you get Lyme disease—and how transmission actually works—is the first step toward protecting yourself and your family.
Who This Page Is For
This resource is for anyone wondering how Lyme disease is transmitted—whether you’ve just found a tick, are experiencing unexplained symptoms, or want to protect your family. If you’ve been told “you can’t have Lyme” because you don’t fit the stereotype, this page is especially for you.
The Tick That Spreads Lyme and Co-Infections
In the United States, Lyme disease is primarily spread by the blacklegged tick (also called the deer tick, Ixodes scapularis) in the Northeast, Midwest, and Mid-Atlantic regions, and by the western blacklegged tick (Ixodes pacificus) on the Pacific Coast.
Ticks go through three life stages: larva, nymph, and adult. Most human infections occur during the nymphal stage, when ticks are tiny, hard to spot, and most active in the warmer months.
Nymphs are roughly the size of a poppy seed—small enough to feed undetected for days.
How Ticks Become Infected
Ticks become infected when they feed on animals like white-footed mice that carry Borrelia and other pathogens. They can then transmit these infections to humans during later feedings.
This is Lyme transmission at its most basic: an infected tick bites you, feeds long enough to transmit bacteria, and the infection begins.
How Long Does a Tick Need to Be Attached?
The CDC notes that the risk of Lyme disease increases significantly when a tick has been attached for 36 to 48 hours or more. In general, the longer a tick feeds, the more likely it is to transmit Borrelia burgdorferi.
That said, this timeline is based on typical patterns—not an absolute rule. Some animal studies suggest that transmission might occur in less than 24 hours, especially if the tick was already partially fed or if removal is delayed. I’ve written more about why this timeline is misleading in The 24-36 Hour Tick Bite Myth.
Co-Infections May Transmit Faster
Additionally, co-infections such as Babesia or Anaplasma may be transmitted more quickly, sometimes within just a few hours. This is one reason why understanding Lyme transmission requires looking beyond the “36-hour rule” that many patients have heard.
It’s also worth noting that while many people think of “Lyme disease” as a single infection, I often remind patients that it frequently includes multiple tick-borne pathogens. These overlapping infections can lead to more severe symptoms and often require different treatment strategies.
Can You Get Lyme Disease Without Knowing?
Yes. Many people infected with Lyme don’t remember a tick bite.
Nymph-stage ticks can feed undetected in hidden areas like the scalp, groin, or behind the knees. Children are especially vulnerable because they can’t inspect these areas themselves.
“Most patients with Lyme disease never saw the tick that bit them.”
The Rash Doesn’t Always Appear
The classic bull’s-eye rash (erythema migrans) appears in about 70–80% of cases according to the CDC, but not always in an obvious location. Some patients never develop a rash at all.
This is one reason Lyme disease is often misdiagnosed or dismissed. A negative answer to “Did you see a tick?” should never rule out Lyme disease—especially when symptoms fit the clinical picture.
Symptoms to Watch For
If you’ve been in tick habitat or found a tick, watch for these early symptoms:
- Bull’s eye rash (erythema migrans) – appears in 70-80% of cases
- Fever and chills
- Fatigue
- Headache
- Muscle and joint aches
- Swollen lymph nodes
If untreated, later symptoms may include severe joint pain, neurological problems like facial paralysis (Bell’s palsy), heart issues, brain fog, and chronic fatigue. These symptoms can appear weeks, months, or even years after the initial infection.
How Do You Get Lyme Disease From the Environment?
Ticks thrive in specific habitats. You’re most likely to encounter them in:
- Tall grass and brush
- Leaf litter
- Wooded trails and forest edges
- Stone walls and logs
- Suburban yards with landscaping that creates tick habitat
How Ticks Find You
Ticks don’t jump or fly but “quest”—waiting on blades of grass or low vegetation with their legs extended to grab onto a passing host.
You’re more likely to be exposed when:
- Hiking, gardening, or walking through wooded areas
- Sitting on logs, stone walls, or leaf piles
- Spending time outdoors when ticks are most active (spring through fall)
Geographic Expansion
Lyme disease is also expanding geographically. Cases are now reported in states previously considered low-risk, including areas of the South, Midwest, and even parts of California.
Climate change, shifting deer populations, and suburban development have all contributed to this spread. If you live in a region where Lyme “didn’t used to exist,” that may no longer be true.
Understanding your environment helps you take targeted prevention steps. Lyme isn’t just a rural problem—suburban backyards can harbor significant tick populations.
Are Other Insects Involved?
There have been reports that other insects—such as mosquitoes, fleas, mites, or biting flies—might transmit Borrelia. To date, these claims have not been confirmed in peer-reviewed studies, but the question deserves more research than it has received.
Currently, the blacklegged tick remains the only confirmed vector of Lyme disease in the United States. However, science evolves, and our understanding of transmission may change as more studies are conducted.
Other Vectors for Co-Infections
What we do know is that some co-infections may be transmitted by other vectors. Bartonella, for example, can be spread by fleas and lice. Babesia has been transmitted through blood transfusion.
So while Borrelia appears to require a tick, other pathogens you might acquire alongside it may enter the body through different routes. More research is needed to fully understand all potential modes of transmission.
Is Lyme Disease Contagious?
No. Lyme disease is not spread through person-to-person contact.
You cannot catch it by:
- Hugging or kissing
- Sharing food or drinks
- Coughing or sneezing
- Sexual contact (no conclusive evidence exists for sexual transmission)
Some blood banks restrict donations from individuals with current or past Lyme disease due to theoretical concerns, particularly regarding Babesia, which has been documented in transfusion-related cases. But casual contact poses no risk.
Who Is Most at Risk?
You may be more likely to contract Lyme disease if you:
- Spend time outdoors in tick-endemic areas
- Have pets that go outside and may carry ticks indoors
- Live near wooded areas or grassy fields
- Don’t regularly perform tick checks
- Are active outdoors during spring, summer, or fall
Children, outdoor workers, gardeners, hikers, and anyone with pets are especially at risk. Understanding your risk helps you identify whether your lifestyle puts you in a higher-risk category.
How to Prevent Lyme and Co-Infections
Preventing chronic Lyme disease starts with reducing tick exposure and catching bites early.
CDC-Recommended Strategies
The CDC recommends several strategies, including:
- EPA-registered tick repellents containing DEET or picaridin
- Permethrin-treated clothing
- Wearing long sleeves and pants in tick-prone areas
- Performing full-body tick checks after outdoor activity
- Showering within two hours of coming indoors
- Removing attached ticks promptly using fine-tipped tweezers
- Managing vegetation around the home
A Note on Chemical Repellents
That said, the long-term risks and benefits of chemical repellents and yard sprays remain an area where reasonable people may have questions. Some families prefer to minimize chemical exposure, and more independent research on safety would be welcome. Ultimately, the burden of providing clear, evidence-based guidance on these products falls on public health agencies like the CDC.
What’s not in question: tick checks, prompt removal, and awareness of your environment are safe, effective, and within everyone’s control.
If You’ve Been Exposed to Ticks
If you’ve found a tick or spent time in tick habitat and develop symptoms, take action quickly.
1. See a Doctor Experienced with Tick-Borne Diseases
Don’t wait for test results to start treatment. Lyme disease is a clinical diagnosis, meaning your doctor should evaluate your symptoms and exposure history—not rely solely on lab tests, which can be negative in early Lyme disease.
If your primary care doctor is unfamiliar with Lyme disease or dismisses your symptoms, seek a second opinion from a physician experienced in treating tick-borne illnesses.
2. Document Your Symptoms and Exposure
Keep a record of:
- When symptoms started
- Whether you saw a tick or rash
- Where you’ve been recently (hiking, gardening, travel to tick-endemic areas)
- How symptoms are affecting your daily life
This information helps your doctor make an accurate diagnosis.
3. Know That Tests Can Be Negative Early
Testing can support a Lyme disease diagnosis, but tests are not always accurate, especially in the early stages of infection. Many patients with Lyme disease test negative initially, yet still have an active infection.
A negative test does not rule out Lyme disease. Clinical diagnosis based on symptoms and exposure is more reliable than lab tests alone.
4. Early Treatment Offers the Best Outcomes
Early antibiotics offer the best chance for full recovery. Waiting to “see if symptoms go away” can allow the infection to spread, making treatment and recovery more difficult.
If you’ve been bitten by a tick or are experiencing unexplained symptoms after outdoor exposure, don’t wait. Seek medical attention promptly.
Frequently Asked Questions
How do you get Lyme disease?
You get Lyme disease through the bite of an infected blacklegged tick. The tick must typically be attached for 36–48 hours to transmit Borrelia burgdorferi, though shorter transmission times are possible—especially for co-infections like Babesia.
Can you get Lyme disease without seeing a tick?
Yes. Most patients with Lyme disease never saw the tick that bit them. Nymphal ticks are the size of a poppy seed and often attach in hidden areas.
Can you get Lyme disease from mosquitoes or other insects?
Currently, the only confirmed vector for Lyme disease in the U.S. is the blacklegged tick. Some co-infections may be spread by other routes. More research is needed on potential alternative vectors.
Is Lyme disease contagious?
No. Lyme disease cannot be spread through casual contact, kissing, sharing food, or sexual activity. It requires a tick bite.
How long does a tick need to be attached to transmit Lyme?
The CDC estimates 36–48 hours for significant transmission risk. However, some studies suggest shorter times are possible, and co-infections like Babesia may transmit within hours.
The Bottom Line
How do you get Lyme disease? Through the bite of an infected blacklegged tick—typically after prolonged attachment, though shorter transmission times are possible for co-infections.
And while we call it “Lyme disease,” it’s often not just one infection. Many patients are coping with multiple tick-borne pathogens, which can complicate diagnosis, testing, treatment, and recovery.
Understanding how transmission works—and how to protect yourself—is the first step toward prevention and early intervention. If you’ve been bitten or are experiencing symptoms, don’t wait. Early treatment offers the best outcomes.
Dr. Cameron,
I was tested for Alzheimer’s almost 2 years ago. Recognized the symptoms and visited a neurologist 2 years ago. Proved positive with blood test, spinal tap and MRI.
He prescribed donepezil to begin with. I started taking just prior a business trip to Sweden and Estonia. By 3rd day, I was totally disoriented and incapable of working, including waking middle of night in a complete daze. Guessed it was the pills, and tossed them in toilet. Took two days to “recover”.
Went home and switched to Memantine. It worked almost immediately to greatly clear issues of “brain fog”.
However, I wondered if I had longterm Lyme’s disease. Why? Because I live in thick woods with countless ticks, and have taken that old drug to kill it. On more than once case, taking doxycycline. But after having Lyme’s 2 or 3 times, I had to go to 21 days of docycycline. Had Lyme’s maybe 6-8 times the following 20 years.
The past 5 years, I have not “had” Lymes. And I should have, because it is super common in the woods of NW Wisconsin.
Therefore, I wonder if I have Lyme’s and not Alzheimer’s. Because those friends who now Azheimer’s from family members – say my ability to talk, reason and remember history is way above normal. Took 3 IQ tests a few weeks ago and scored top 97% scores and 98% fastest finish.
I have looked for doctors around MN with no interested parties.
Thus my reach out to you – who I noticed researching Lyme’s vs Alzheimer’s.
Best regards, and thanks for the work you do.