How Do You Know If You Have Lyme Disease?
How do you know if you have Lyme disease? There is no single test or symptom that confirms the diagnosis, but there are key signs that can raise suspicion—especially when symptoms evolve over time.
Recognizing Lyme disease early is critical. The sooner it is identified, the easier it is to treat effectively and prevent complications.
What Is Lyme Disease?
Lyme disease is a bacterial infection caused by Borrelia burgdorferi, transmitted through blacklegged ticks (deer ticks). It is the most common vector-borne illness in the U.S.
✔ Early treatment is most effective
❌ Delayed diagnosis allows the infection to spread to joints, the nervous system, and the heart
Early Signs and Symptoms of Lyme Disease
Early Localized Lyme Disease (3–30 Days After a Tick Bite)
The Bull’s-eye Rash (Erythema Migrans)
- Appears 3–30 days after a tick bite
- Only about 1 in 4 rashes show the classic bull’s-eye pattern
- Many are flat, solid red patches
- Usually painless but may be itchy
- Typically over 2 inches in diameter
Flu-Like Symptoms
- Fever and chills
- Severe headaches
- Profound fatigue
- Muscle and joint aches
- Swollen lymph nodes
These symptoms are often mistaken for a viral illness, leading to missed diagnosis.
Early Disseminated Lyme Disease (Days to Weeks After Infection)
- Multiple rashes
- Migrating joint or muscle pain
- Neurologic symptoms (Bell’s palsy, nerve pain, headaches)
- Heart involvement (Lyme carditis)
Late Disseminated Lyme Disease (Months After Infection)
- Arthritis (especially knees)
- Brain fog and memory problems
- Numbness or tingling
- Heart rhythm problems
Advanced Symptoms That Raise Suspicion
- Severe fatigue and post-exertional crashes
- Sleep disruption
- Mood changes, anxiety, or depression
- Autonomic dysfunction (POTS-like symptoms)
- Sensitivity to light, sound, or touch
Clues to Co-Infections
Ticks can transmit multiple infections at once.
- Night sweats
- Shortness of breath or air hunger
- Disproportionate fatigue
These symptoms may suggest co-infections such as Babesia.
The Challenge of Diagnosis
- Blood tests may be negative early
- Tests can miss a significant percentage of cases
- Lyme disease mimics many other conditions
- Clinical judgment is essential
The Bottom Line
So, how do you know if you have Lyme disease?
- Watch for early signs like rash or flu-like illness
- Look for symptoms affecting multiple systems
- Do not ignore neurologic or joint symptoms
- Seek evaluation early if symptoms persist
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
20 yrs ago ( was bitten by a tick above my right upper lip-looked in mirror and thought it was a smudge. Scrubbed it off. 3 days later, small, completely round, bulls eye rash. Went to family doc who said it was ringworm. Gave a scrip that I did not use. Rash disappeared, but I became deathly ill. Ceftin from PCP-in bed two weeks. Finally recovered. 3 months later went to PCP d/t arthritic pain. Western Bloc – neg. aid I ha lupus or rheumatoid arthritis. I said – no it’s lyme disease. He said, no, you are in denial. I said, no, you’re in denial. By the grace of God, I found lyme literate physician in Philadelphia who treated me for 18 months. End up with some arthritis, but nothing horrible until 5 yrs ago – needed knee replacement. Now have arthritis in both thumbs, but I am now 77 yrs old.
2012-I notice large rash on 8 y/o grandson’s back – lyme disease. Mom takes him to head of infectious disease at Lehigh Valley Hospital. Given two weeks of Doxcyclin. Month later, mom, I & grandson return for followup labs & visit. Doc says, “well his titers are still high, but the meds got rid of the lyme!” Mom says his behaviors have greatly deteriorated – doc says he needs a paychiatrist (mom has degree in Spec Ed). He also said that he catches ticks every weekend for research & he knows what he is saying! Walked out on him & I sent her & grandson to my physician in Philly who treated him for 8 months. He recovered without incident, behavioral issues disappeared, and is a senior at Penn State. As I am sure you are aware, the Lehigh Valley area in PA. , has, and still is notorious for lyme disease – yet the docs are still quite ignorant & in denial. I can never thank God enough for giving me the knowledge to know that I had lyme and directing me to a physician who helped both me and my grandson.
Friend of mine who lives in LV, PA., has recently been dx’d with MS. Told Western bloc is neg. I have been unable to convince her to find a physician who treats lyme & find out if, in fact, it is lyme.
Any chance you can give me the Dr in Phila name and address. My husband has so many symptoms and our PC is no help